Plastic surgeons urge against surgeries for trans youths
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The professional society for plastic surgeons on Tuesday recommended its members delay transition-related breast, genital and facial surgery on youths until they turn 19, saying there wasn't enough evidence of benefits and risks.
Why it matters: The new guidance comes amid the Trump administration's widening crackdown on gender care, which has put doctors and other providers in the middle of a showdown between federal power, privacy protections and, in some cases, state laws.
- Attorney General Pam Bondi last year directed prosecutors to investigate providers of gender-affirming surgical procedures, which she characterized as "female genital mutilation."
Driving the news: The American Society of Plastic Surgeons issued a position statement saying ongoing reviews of clinical evidence "have not resolved earlier uncertainties regarding treatment benefit" and that in some instances, had "contributed to a clearer understanding of potential harms."
- The group also cited "substantial uncertainty" about the long-term benefits and risks of puberty blockers and hormone therapy without issuing guidance for those treatments.
- The lack of evidence showing "a favorable risk-benefit ratio" — and the irreversible nature of surgeries in question — argue for delaying gender-related surgery until a patient is at least 19 years old, the position statement said.
- The group cites a Department of Health and Human Services review and a 2020 U.K. report on gender-affirming care as key to its position. Both studies have been criticized by other medical experts for poor methodology and unsubstantiated claims.
Top Trump administration health officials were quick to praise the plastic surgeons' guidance.
- "By taking this stand, they are helping protect future generations of American children from irreversible harm," Health Secretary Robert F. Kennedy Jr. said in a statement.
- The American Medical Association said it agreed that surgeries should be generally deferred to adulthood, adding that currently "the evidence for gender-affirming surgical intervention in minors is insufficient for us to make a definitive statement."
- The recommendations still diverge from some other medical associations. The American Academy of Pediatrics has said transition-related surgery, while typically not performed until adulthood, can be an option in some cases for youths.
Transition-related care for kids is considered safe and appropriate by major medical organizations and surgeries for transgender children are rare.
- One study of gender-affirming surgery estimated the number of patients between the ages 12 and 18 at about 3,700 from 2016 to 2019.
- A 2024 Harvard study concluded that U.S. surgeons were appropriately following international guidelines around assessment and care of transgender youth.
- Breast and chest procedures accounted for most of the surgical interventions in younger patients, researchers found.
But the Trump administration has frequently cited the surgeries as part of its efforts to restrict transition-related care for youths, leading a number of health systems to limit care or end services.
Editor's note: The story has been updated with American Medical Association comment.
