The American Society of Plastic Surgeons (ASPS), representing more than 11,000 physicians globally, has made a landmark recommendation that gender-affirming surgeries for minors should be delayed until patients reach 19 years of age. This guidance, issued in February 2026, positions ASPS as the first major medical association to formally caution against such procedures for individuals under 19.
According to the position statement, ASPS found "low certainty in the risk-benefit ratio for gender-related surgical interventions for minors." The organization cited several critical concerns, including the developing emotional and mental states of adolescents juxtaposed with the permanent nature of surgical interventions. ASPS emphasized that medical decision-making competence among minors remains debated, particularly when patients are experiencing distress and considering treatments with lifelong consequences.
The ASPS statement references a Department of Health and Human Services report highlighting a "rapid expansion and implementation of a clinical protocol that lacked sufficient scientific and ethical justification" regarding pediatric gender-affirming care. This assessment suggests that the field has evolved more quickly than the evidence base supporting its practices.
The ASPS recommendation follows significant legal developments in the field. Notably, just days before the announcement, a New York jury awarded $2 million in damages to 22-year-old Fox Varian in what appears to be the first malpractice suit from a detransitioner to go before a jury. Varian underwent gender-transition surgery at age 16, which she later regretted. This case may set an important precedent for medical liability in this emerging field.
The Trump administration has strongly praised ASPS for its position. Centers for Medicare and Medicaid Administrator Mehmet Oz stated, "When the medical ethics textbooks of the future are written, they'll look back on sex-rejecting procedures for minors the way we look back on lobotomies." Health and Human Services leadership commended ASPS for "bravely standing" with Secretary Robert F. Kennedy Jr. in opposing what they term "sex-rejecting procedures for minors."
The ASPS announcement appears to have stimulated similar reassessments among other medical organizations. Shortly after ASPS released its position, the American Medical Association (AMA) issued its own statement indicating "the evidence for gender-affirming surgical intervention in minors is insufficient for us to make a definitive statement." The AMA agreed with ASPS that "surgical interventions in minors should be generally deferred to adulthood."
The ASPS recommendation applies comprehensively to all gender-related procedures, including breast/chest, genital, and facial surgeries. Data indicates that between 2016 and 2020, approximately 3,700 patients 18 years old and younger underwent gender transition surgery, with breast removal procedures being the most common. Researchers note that gender-affirming surgeries for minors remain rare in the United States, with fewer than 1 in 1,000 U.S. adolescents receiving any form of gender-affirming medical intervention.
ASPS has clarified that its position statement is not a formal clinical practice guideline but rather "professional guidance" for care it describes as "rapidly evolving and controversial." Rather than supporting legal restrictions, ASPS has endorsed "individual decision-making" by its members while urging enhanced documentation, heightened caution, and thorough assessment of minor patients' ability to understand the irreversible nature of these procedures.
This development marks a significant shift in the medical community's approach to adolescent gender care and may influence both clinical practice and future policy decisions regarding the appropriate age for gender-affirming surgical interventions.
