The American Society of Plastic Surgeons issued new guidance this week advising its members to delay gender-affirming surgeries for minors until patients are at least 19 years old, stating that such procedures, “in and of themselves,” currently lack sufficient evidence demonstrating a favorable balance of benefits and risks for children and adolescents.
In a position statement approved by its board of directors, the organization said that chest, genital, and facial gender-related surgeries are irreversible interventions being performed on a developmentally vulnerable population, and that available research does not yet establish clear long-term mental health benefits when these surgeries are performed on minors.
The group emphasized that its concern is specific to surgery itself. The statement notes that surgical intervention, taken in and of itself, has not been shown to reliably improve long-term outcomes for youth patients, and that this uncertainty warrants caution until stronger evidence is available. The guidance does not address hormone therapy or puberty blockers and does not recommend criminalizing gender-related medical care.
According to reporting by The Washington Post and Reuters, fewer than 1,000 minors undergo gender-related surgeries annually in the United States, with most procedures involving chest surgery. The society said that while these cases are rare, the lack of high-quality long-term data remains a central issue in evaluating surgical risk.
The plastic surgeons’ statement arrives amid shifting federal policy and renewed scrutiny of the evidence base for pediatric gender-affirming care. It follows a 2025 report from the Department of Health and Human Services that concluded evidence supporting gender-related medical interventions for minors is limited and that potential risks may outweigh benefits in some cases.
That HHS report has itself drawn criticism. Independent analysis and reporting found that a related HHS “Make America Healthy Again” assessment cited multiple studies in its transgender health section that had been retracted or widely criticized for methodological flaws. Critics argue that reliance on discredited research undermines the credibility of the report’s conclusions and raises concerns about how federal agencies are evaluating trans health care.
The American Society of Plastic Surgeons said its guidance is intended as professional advice rather than binding clinical standards and stressed that surgeons should continue to exercise individualized medical judgment. The organization also reiterated opposition to laws that criminalize physicians or patients for seeking or providing care.
Other major medical organizations, including the American Academy of Pediatrics and the American Medical Association, have continued to support case-by-case decision-making for gender-affirming care, arguing that individualized assessment by specialized clinicians remains essential.
LGBTQ advocacy groups have warned that the plastic surgeons’ recommendation could be used by lawmakers to justify broader restrictions on care for transgender youth, even though the statement is limited to surgical interventions and explicitly avoids legislative prescriptions.
As debates over youth gender-affirming care continue at both the state and federal levels, the plastic surgeons’ guidance adds a new layer to an already complex and contested policy landscape.
