Top Surgeons SLAM Trans Child Gender Surgery

America’s largest association of plastic surgeons just shattered the medical consensus on youth gender surgeries, declaring that procedures should wait until age 19 because the science simply isn’t there.

Story Snapshot

The American Society of Plastic Surgeons, representing over 11,000 members, issued a groundbreaking position statement on February 3, 2026, recommending delay of all gender-affirming surgeries until age 19.
The organization cited low-quality evidence, insufficient risk-benefit data, and irreversible consequences as primary reasons for breaking from other major medical groups.
The statement aligns with international reviews including the UK’s Cass Review and the U.S. Department of Health and Human Services findings that deemed evidence for such interventions weak.
HHS Secretary Robert F. Kennedy Jr. praised the move as a victory for sound science, while advocacy groups hailed it as a watershed moment in evidence-based medicine.
The guidance affects breast, chest, genital, and facial procedures but stops short of endorsing criminalization or imposing legal restrictions on physicians.

The Evidence Problem Nobody Wanted to Discuss

The American Society of Plastic Surgeons controls 90 percent of the plastic surgery field across the United States and Canada. When an organization of this magnitude speaks, the industry listens. Their February 2026 statement didn’t mince words about the quality of research supporting gender surgeries for minors. The board examined systematic reviews from the UK’s Cass Review and the HHS comprehensive analysis, both concluding that evidence supporting these interventions ranked as low quality with insufficient data on long-term outcomes. Past ASPS president Scot Bradley Glasberg characterized the move as an evolution of position based on emerging evidence, not a retroactive condemnation of colleagues who performed these procedures in good faith.

The statement draws sharp ethical distinctions between gender-affirming surgeries and other pediatric plastic surgery procedures. While some childhood interventions carry acceptable uncertainty levels, ASPS concluded the irreversible nature of gender surgeries combined with inadequate research created an unacceptable risk profile. The organization emphasized concerns about lifelong medical dependency, foreclosed development options, and mental health outcomes that remain poorly understood. This represents a stark departure from the framing by groups like the American Academy of Pediatrics, which have characterized such interventions as potentially life-saving care.

Breaking Ranks With Medical Establishment

The ASPS position creates a dramatic fracture in what many portrayed as settled medical consensus. Major organizations including the American Academy of Pediatrics, American Medical Association, and World Health Organization continue supporting gender-affirming care for minors under physician guidance. The plastic surgeons’ association took a different path, concluding the evidence base couldn’t justify procedures with permanent consequences for patients still undergoing physical and psychological development. William Malone of the Society for Evidence-Based Gender Medicine called the statement a watershed moment for science-driven approaches to controversial medical interventions.

The timing of this announcement intersects with significant political shifts in Washington. The current administration, with RFK Jr. leading HHS, has pushed hard against what officials term the overmedicalization of gender dysphoria in youth. HHS proposed rules in December 2025 that would bar federal funding to hospitals providing such care. FBI and Justice Department investigations have examined practices at some facilities. Several hospitals paused these services amid funding threats and legal uncertainties. The ASPS statement provides medical cover for policy positions that, until recently, faced unified opposition from major medical societies.

Europe Already Changed Course

The United States isn’t pioneering caution on this issue. European nations began restricting youth gender surgeries after systematic reviews revealed the experimental nature of these interventions. The 2024 Cass Review in the United Kingdom categorized evidence quality as low and raised red flags about rushed treatment pathways. European Academy of Pediatrics guidelines shifted toward conservative approaches based on interim findings showing minimal long-term benefits and potential for significant harms. The ASPS statement brings American medical practice closer to alignment with international standards emerging from rigorous evidence reviews.

Critics argue the ASPS guidance interferes with physician autonomy and patient access to necessary care. Organizations defending current practices point to established treatment protocols and argue that delaying care increases risks for vulnerable youth populations. The American Medical Association acknowledged evidence insufficiency but maintained that decisions belong between patients, families, and physicians. This tension between evidence standards and access philosophy lies at the heart of the fractured medical consensus. ASPS notes that a majority of its members don’t provide these procedures, which may have enabled a more dispassionate evidence review.

What Happens Next

The ASPS statement functions as professional guidance rather than binding clinical guidelines. Members receive advice on navigating state laws and federal funding conditions, but the organization opposes criminalizing physicians who make different choices. The statement creates no retroactive culpability for surgeons who performed procedures before this guidance emerged. Short-term impacts include additional hospitals pausing services and state legislatures citing medical authority for age restrictions. Long-term effects may extend beyond surgery to increased scrutiny of puberty blockers and hormone interventions, which the statement referenced with concern despite offering no specific recommendations.

The broader question centers on how medical consensus forms and fractures. For years, major medical organizations presented a united front supporting gender-affirming care as standard practice. The ASPS broke that unity by elevating evidence quality over professional solidarity. Groups like Do No Harm and the Society for Evidence-Based Gender Medicine, which funded some reviews cited by ASPS, see this as validation of their push for rigorous research standards. Whether other medical societies follow this evidence-driven reconsideration or double down on existing positions will determine if February 2026 marked a true turning point or merely exposed existing fault lines in American medicine.