Plastic surgery society becomes first major U.S. medical association to narrow guidance on pediatric gender care, emphasizing professional judgment and heightened ethical standards.
The American Society of Plastic Surgeons (ASPS) has issued a new position statement recommending that surgeons delay gender-related breast/chest, genital, and facial surgery until a patient is at least 19 years old, citing low-certainty evidence and unresolved questions about long-term benefits and harms.
Released February 3, 2026, the statement makes ASPS the first major U.S. medical association to narrow its guidance on pediatric gender care, a move that comes as the Trump administration has intensified scrutiny and regulatory pressure on gender-related medical interventions for minors.
ASPS based its position on recent large-scale evidence reassessments, including the UK’s Cass Review and a 2025 report from the U.S. Department of Health and Human Services, which found significant limitations in study quality, consistency, and follow-up, as well as gaps in long-term physical, psychological, and psychosocial outcomes.
“Consistent with ASPS’s August 2024 statement that the overall evidence base for gender-related endocrine and surgical interventions is low certainty, and in light of recent publications reporting very low/low certainty of evidence regarding mental health outcomes, along with emerging concerns about potential long-term harms and the irreversible nature of surgical interventions in a developmentally vulnerable population, ASPS concludes there is insufficient evidence demonstrating a favorable risk-benefit ratio for the pathway of gender-related endocrine and surgical interventions in children and adolescents,” the Society states.
ASPS emphasizes that the document is not a clinical practice guideline but professional guidance intended to help members navigate a rapidly evolving and controversial area of care. The Society notes that it has not undertaken a formal guideline-development process and has not endorsed any external organization’s guidelines for treating minors with gender dysphoria.
The statement also underscores the role of plastic surgeons within multidisciplinary care pathways and the need for heightened caution, enhanced documentation, and explicit disclosure of uncertainty when evaluating minors for irreversible procedures. Surgeons, ASPS says, should not rely on the presence of prior medical interventions, referrals, or letters of support as proxies for surgical indication or adolescent readiness.
ASPS further differentiates gender-related surgical interventions in minors from other adolescent plastic surgery procedures, noting that gender-related surgery permanently shapes sexual function, fertility, embodiment, and future medical needs and intervenes directly in processes of identity formation and psychosexual development.
While opposing criminalization of medical care and supporting professional self-regulation, ASPS says it will continue to review emerging evidence and revisit its position should higher-quality data demonstrate clear benefit with acceptable risk.
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