In a significant development at the intersection of medicine, ethics and public policy, the American Society of Plastic Surgeons (ASPS) — the largest professional body representing plastic surgeons in the United States — has issued a new position statement recommending that gender-affirming surgical procedures be delayed until patients reach at least 19 years of age. This marks a notable shift in guidance on a deeply discussed area of healthcare.
The ASPS decision, released earlier this week, comes after a review of existing scientific evidence on gender-affirming surgeries — procedures designed to align a person’s physical characteristics with their gender identity, including chest, genital and facial surgeries. The society concluded that current evidence is insufficient to demonstrate a clear favorable balance of long-term benefits over risks for minors undergoing these procedures.
In its statement, the society underscored that the guidance is not a strict clinical rule but a professional recommendation aimed at supporting safe and ethically responsible care. The document noted that evidence cited in influential reports — such as the controversial Cass Review from the United Kingdom and a 2025 U.S. Department of Health and Human Services review — suggests limitations in study quality and follow-up data on long-term outcomes for adolescents.
The ASPS stressed that this position does not deny the authenticity of individuals’ experiences with gender dysphoria — the psychological distress arising from incongruence between assigned sex and gender identity — but instead calls for heightened scientific rigor, developmental consideration and attention to long-term welfare when evaluating surgical care for young people.
However, this recommendation contrasts with positions held by several other major medical groups, including the American Academy of Pediatrics and the World Professional Association for Transgender Health (WPATH), which continue to advocate for individualized, case-by-case decisions rather than an absolute age cutoff. These organizations emphasize that in selected cases, gender-affirming care — including surgery — can be medically necessary and beneficial.
The ASPS statement also arrives amid broader political momentum in the U.S. to reinterpret or restrict gender-affirming care for minors. Federal health leaders have publicly supported more cautious approaches, and some hospitals have already paused gender-affirming services for youths due to legal and regulatory pressures.
Critics of the new guidance argue that it may limit access to care that can be life-changing for transgender adolescents, while proponents say it prioritizes patient safety and robust evidence in treating vulnerable populations. As the debate continues, many healthcare providers, families and advocacy groups are likely to remain deeply engaged in shaping future policy and clinical practice around gender-affirming care in the years ahead.
