The American Society of Plastic Surgeons (ASPS), which has more than 11,000 members and represents over 90% of board-certified plastic surgeons in the U.S. and Canada, this week issued a landmark position statement disavowing gender-related breast, chest, genital, and facial surgeries for “transgender” and “nonbinary” patients under age 19.

The position statement, released Feb. 3, marks a decisive break from the organization's prior positions and shatters the long-claimed "medical consensus" among major U.S. bodies supporting “gender-affirming” surgery for minors. 

The ASPS now becomes the first major American medical association to broadly advise against performing these irreversible procedures on adolescents. Plastic surgeons are often involved in performing these surgeries, so the ASPS guidance carries practical weight for clinical practice, insurance coverage, and legal considerations, such as malpractice liability.

Posted in a nine-page document on the issue, the group cited low-quality evidence on long-term outcomes, emerging reports of complications and potential harms, and substantial uncertainty about whether  “benefits” outweigh risks for irreversible interventions in minors.

“The overall evidence base for gender-related endocrine and surgical interventions is low certainty” the statement read, referring to recent publications reporting “very low/low certainty of evidence regarding mental health outcomes.” 

The group also cited emerging concerns about “potential long-term harms” and the “irreversible nature of surgical interventions in a developmentally vulnerable population,” concluding there is “insufficient evidence” about the mental health benefits with such surgeries for minors. 

The statement expressed parallel concerns about the evidence base for puberty blockers and cross-sex hormones — though it stops short of formal recommendations on those — while emphasizing that many children with prepubertal gender dysphoria see resolution or significant reduction of distress by adulthood without medical intervention.

A 2023 analysis of national U.S. surgical databases estimated that roughly 3,700 adolescents ages 12–18 underwent a form of “gender-affirming” surgery between 2016 and 2020. The overwhelming majority — more than 3,200 cases — were breast removal. 

The Trump administration's Department of Health and Human Services praised the ASPS’s position as a "victory for biological truth" and for protecting children from "harmful sex-rejecting procedures," amid federal efforts to restrict such care.

Groups such as the American Academy of Pediatrics, the Endocrine Society, and the American Medical Association continue to endorse access to “gender-affirming care,” including surgeries, for “transgender” youth, framing it as medically necessary despite mounting questions about long-term outcomes.