Plastic surgeons organization recommends delaying gender-affirming surgery until 19; Trump admin applauds position

The American Society of Plastic Surgeons (ASPS) on Tuesday published a position statement recommending that surgeons delay “gender-related breast/chest, genital, and facial surgery” until a patient is 19 years old, drawing praise from the Trump administration for “protecting children from harmful sex-rejecting procedures.” The ASPS, which represents more than 11,000 physicians globally, released its position that there is low certainty in the risk-benefit ratio for gender-related endocrine and surgical interventions for children and adolescents. While its position statement commented on hormonal gender-affirming care, the ASPS’s recommendation focused solely on surgical intervention, which advised that gender-affirming surgeries be delayed until 19. “Available evidence suggests that a substantial proportion of children with prepubertal onset gender dysphoria experience resolution or significant reduction of distress by the time they reach adulthood, absent medical or surgical intervention,” the ASPS’s statement read. “Evidence regarding adolescent onset presentation, which has become increasingly common since the mid-2010s, is more limited but similarly does not allow for confident prediction of long-term trajectories.” The organization cited a 2025 article from the Department of Health and Human Services (HHS) which concluded that when it came to pediatric gender-affirming care, there had been a “rapid expansion and implementation of a clinical protocol that lacked sufficient scientific and ethical justification.” The article was not intended as a clinical practice guideline. Several LGBTQ+ organizations condemned the contents of the HHS article, with health groups saying in a joint statement last year, “This document is not a neutral review of evidence; it is a politically motivated agenda that misrepresents established medical consensus and risks serious harm to vulnerable young people and their families.” The ASPS pushed back on the notion that “patient values and preferences” should lead in the treatment of children and adolescents. “Respect for emerging adolescent autonomy is also cited as a rationale for the provision of care in the face of low certainty evidence. However, patient autonomy is more properly defined as the right of a patient to accept or refuse appropriate treatment; it does not create an obligation for a physician to provide interventions in the absence of a favorable risk–benefit profile,” its statement read. At the same time, the ASPS stated its opposition to criminalizing physicians who provide gender-affirming care. While it is a nonpartisan organization, the ASPS has a political lobbying arm in the political action committee PlastyPAC. According to Open Secrets, roughly 56 percent of federal PlastyPAC contributions went to Republicans from 2023 to 2024, though no contributions were made to presidential candidates. HHS praised the ASPS’s position in a statement Tuesday. “We commend the American Society of Plastic Surgeons for standing up to the overmedicalization lobby and defending sound science,” HHS Secretary Robert F. Kennedy, Jr. said in a statement. “By taking this stand, they are helping protect future generations of American children from irreversible harm.” Centers for Medicare and Medicaid Administrator Mehmet Oz added, “When the medical ethics textbooks of the future are written, they’ll look back on sex-rejecting procedures for minors the way we look back on lobotomies. I applaud the American Society of Plastic Surgeons for placing itself on the right side of history by opposing these dangerous, unscientific experiments.”