Plastic Surgeons Recommend Delaying Gender-Affirming Surgeries Until Age 19

The American Society of Plastic Surgeons (ASPS), the largest professional organization representing plastic surgeons in the United States, has issued a position statement recommending that gender-affirming surgeries be delayed until patients reach 19 years of age. The statement marks a notable shift in tone from previous guidance and places the group at odds with several other leading medical associations that continue to support case-by-case access to such procedures for minors under cautious clinical criteria.

In its statement, the ASPS said it found “insufficient evidence” that the benefits of chest, genital, and facial gender-affirming surgeries for minors experiencing gender dysphoria clearly outweigh the risks. The organization referenced two widely debated reviews: the Cass Review conducted in England and a 2025 report from the U.S. Department of Health and Human Services.

The surgeons’ group emphasized that the document is not a clinical guideline and did not involve a full independent evidence review typically used in the development of formal care standards. Instead, it is described as an ethical and professional position reflecting concern about scientific certainty, long-term welfare, and legal considerations.

“This position statement doesn’t seek to deny or minimize the reality of any patient’s distress, and it does not question the authenticity of any patient’s experience,” the ASPS wrote. “Instead, ASPS affirms that truly humane, ethical, and just care, particularly for children and adolescents, must balance compassion with scientific rigor, developmental considerations and concern for long-term welfare.”

Diverging views among major medical organizations

The ASPS position differs from the approach taken by other prominent medical groups, which note that existing guidance already places strict caution around surgical interventions for minors and does not recommend blanket access.

Dr. Andrew Racine, president of the American Academy of Pediatrics (AAP), said the organization does not recommend surgery as a standard course of care for minors with gender dysphoria and maintains that decisions should be made by families and physicians rather than policymakers.

“The AAP continues to hold to the principle that patients, their families, and their physicians — not politicians — should be the ones to make decisions together about what care is best for them,” Racine said.

The World Professional Association for Transgender Health (WPATH), which develops global standards of care for transgender patients, reiterated that its guidance supports access to surgical care for minors only under “cautious guidelines and criteria.” WPATH opposes setting a single age threshold for all patients, stating that assessments should be individualized and involve multidisciplinary expertise in adolescent development.

“WPATH stands firm in its commitment to advancing evidence-informed clinical guidelines to help improve the lives and well-being of transgender people around the world,” the organization said.

Gender-affirming care among minors remains uncommon

Research cited by multiple health groups indicates that gender-affirming surgeries are rare among U.S. minors. Fewer than 1 in 1,000 adolescents receive gender-affirming medications such as puberty blockers or hormone therapy, and an even smaller number undergo surgical procedures.

Care for transgender youth under widely used standards in the United States typically begins with supportive therapy and comprehensive evaluation by medical professionals and family members. Medical treatments may be considered in some cases, but many adolescents with gender dysphoria do not proceed to medication or surgery.

The ASPS noted that the variability in legal and regulatory environments across the United States also influenced the decision to issue a position statement. The group said the limited evidence base, combined with shifting legal conditions, creates heightened ethical, clinical, and legal risks for surgeons performing such procedures on minors.

Political and legal backdrop

The statement comes during an ongoing national debate over transgender health care for minors. The Trump administration has taken steps aimed at restricting access to gender-affirming care for young people, arguing that such treatments may pose risks. In response, several states have filed legal challenges.

Deputy Health and Human Services Secretary Jim O’Neill welcomed the ASPS position, calling it a step toward what he described as a scientific standard.

Hospitals across the country have reported suspending or reviewing gender-affirming services for minors amid concerns over potential federal enforcement actions. Children’s Minnesota recently announced it would pause prescribing puberty-suppressing medications and hormones to patients under 18, citing federal pressure.

“This is not the decision we wanted to make,” the health system said. “This is the decision we had to make to protect our hospital and our providers. We stand firmly behind the fact that gender-affirming care is evidence-based, safe and lifesaving.”

Internal process behind the statement

Dr. Scot Glasberg, a past president of the ASPS who helped develop the statement, said the group’s deliberations began in 2024 and were not influenced by political pressure.

“This was an iterative process that took time, with no outside pressure,” Glasberg said. “We understand there will be different opinions about it and we respect those opinions.”

The ASPS reiterated that its statement is intended to reflect caution rather than dictate clinical practice. By clarifying its position, the organization said it seeks to guide surgeons facing complex ethical and legal decisions in a rapidly changing medical and policy landscape.