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A major American medical organization representing more than 11,000 physicians says there exists “insufficient evidence demonstrating a favorable risk-benefit ratio for the pathway of gender-related endocrine and surgical interventions in children and adolescents.”
In a position statement published Tuesday, the American Society of Plastic Surgeons (ASPS) said its view of medical interventions for the treatment of gender dysphoria in minors has “evolved” to its new recommendation that plastic surgeons “delay gender-related breast/chest, genital, and facial surgery until a patient is at least 19 years old.”
Citing evidence found in both the U.K.-based Cass report and the U.S. Department of Health and Human Services (HHS) report Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices, ASPS – a leading authority on cosmetic and reconstructive plastic surgery – asserts the treatment of gender dysphoria in minors requires a “precautionary approach.”
“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,” ASPS explains in its position statement. “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 … Importantly, clinicians, even those with extensive experience, currently lack reliable methods to distinguish those whose distress will persist from those whose distress will remit.”
“The HHS report underscores that this uncertainty has significant ethical implications: when the likelihood of spontaneous resolution is unknown and when irreversible interventions carry known and plausible risks, adhering to the principles of beneficence and non-maleficence (i.e., promoting health and well-being while avoiding harm),” ASPS adds.
HHS Secretary Robert F. Kennedy, Jr. applauded ASPS on the release of its statement on biological sex-rejecting medical procedures for minors.
“We commend the American Society of Plastic Surgeons for standing up to the overmedicalization lobby and defending sound science,” Kennedy said. “By taking this stand, they are helping protect future generations of American children from irreversible harm.”
Deputy HHS Secretary Jim O’Neill added that ASPS “has set the scientific and medical standard for all provider groups to follow.”
Similarly, Centers for Medicare & Medicaid (CMS) Administrator Mehmet Oz, M.D. said ASPS has now placed itself “on the right side of history by opposing these dangerous, unscientific experiments.”
HHS addressed in a press statement the issue of “patient autonomy,” so frequently used to justify so-called “gender-affirming” treatment protocols and even school district policies that require allowing a child to act out a “new” gender at school while keeping it a secret from parents.
In its own report, the department said, HHS “concluded that ‘respect for patient autonomy does not negate clinicians’ professional and ethical obligation to protect and promote their patients’ health.’”
“The ASPS position statement similarly finds that adolescent autonomy does not obligate a medical professional to provide sex-rejecting procedures not supported by evidence,” HHS added.
The ASPS position statement comes several days after the final verdict in a landmark case in New York State Supreme Court, Westchester County. A jury awarded $2 million to a young woman who filed a malpractice lawsuit against a psychologist and plastic surgeon, alleging they promoted the removal of her healthy breasts when she was 16 years old.
The case – now the first successful lawsuit brought by a detransitioner – revolved around the question of whether the psychologist and plastic surgeon acted competently and professionally.
The verdict is expected to change the landscape of a field of pediatric medicine that grew rapidly while tied to an ideology that rejects the science of biological sex.
ASPS’ new position statement speaks to the commonplace practice of plastic surgeons relying upon referrals or letters of support from psychologists or psychiatrists addressing a minor’s readiness for surgery.
“Psychological and psychiatric assessments play an essential role in multidisciplinary care, but surgeons retain an independent professional responsibility to understand how uncertainty in diagnosis, natural history, and the effects of prior treatment may bear directly on surgical risk-benefit assessment,” ASPS asserts, adding that the ability of minors to be able to consent to such treatment is questionable, “particularly when patients are experiencing distress and considering treatments with lifelong consequences.”
“Surgeons share responsibility for determining whether a minor is developmentally able to understand the nature, irreversibility, and long-term implications of the proposed surgical intervention,” the position statement continues. “This includes assessing whether the adolescent patient can meaningfully engage with information about uncertainty, alternative approaches, and the possibility that distress or perceived identity may evolve over time.”
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