The American Society of Plastic Surgeons (ASPS) released new guidance on Tuesday cautioning physicians against performing gender-transition surgeries on minors, marking a significant breakthrough for critics of the procedures who have long called on major medical associations to be transparent about the harms associated with medicalizing gender dysphoric children.

The new ASPS guidance acknowledges that there is insufficient evidence to prove that irreversible gender-related surgical interventions have longterm benefits for adolescents and therefore recommends that surgeons delay gender-related breast, genital, and facial surgery until “a patient is at least 19 years old. The association has “substantial uncertainty” about the longterm benefits of puberty blockers and cross-sex hormones.

Surgeons should maintain responsibility for “determining whether a minor is developmentally able to understand the nature, irreversibility, and long-term implications of the proposed surgical intervention,” the guidance says. Critics of gender-related surgeries have long doubted an adolescent’s ability to make well-informed decisions about life-altering surgeries.

Doctors should also assess “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,” the ASPS says.

“When evidence regarding benefit is limited, natural history is uncertain, and fully informed consent a challenge, ASPS believes that plastic surgeons should adopt a posture of heightened caution, enhanced documentation, and explicit uncertainty disclosure, recognizing that their role is not simply technical but ethical,” the guidance adds. “Shared decision-making in this setting not only requires multidisciplinary input, but clear surgeon judgment regarding whether proceeding with irreversible surgery is consistent with the patient's long-term welfare.”

ASPS is the first major medical association to clearly disavow gender-transition surgeries for minors. The organization represents more than 11,000 physicians and was founded in 1931.

Other medical associations like the American Academy of Pediatrics (AAP) and American Medical Association (AMA) for example have remained firmly in support of gender-related surgical interventions for adolescents. The APA said in December after the Department of Health and Human Services (HHS) moved to restrict medical centers from performing gender-related surgeries on children, that it was “committed to ensuring that all children — including gender-diverse youth and children covered by Medicaid — receive care that is backed by science, delivered with compassion, and offered without political interference.”

Like other associations, ASPS supported transition surgeries for years; but in 2024, the group became an outlier when it admitted that there was “considerable uncertainty” about the effects of such surgeries. ASPS is the first organization to alter its guidance based on recent scientific reviews that evaluate the effects of genital mutilation on children.

"There has been a continuing evolution of the data," Scot Bradley Glasberg, the former president of ASPS, told the Washington Post. "As each of these systematic reviews came out, we felt compelled to enhance the position we had previously taken."

HHS applauded ASPS, saying in a statement that the association is “protecting children from harmful sex-rejecting procedures.”

“We commend the American Society of Plastic Surgeons for standing up to the overmedicalization lobby and defending sound science,” Health and Human Services Secretary Robert F. Kennedy, Jr. said. “By taking this stand, they are helping protect future generations of American children from irreversible harm.”

Health-care advocates have been lobbying the government and medical associations to place guardrails on gender-related procedures for minors. President Donald Trump signed an executive order early on in his presidency that directed HHS to strip federal funding from medical institutions that performed chemical or surgical mutilations on children.

HHS announced a rule late last year that would ban hospitals from performing such procedures on children as a condition of Medicare and Medicaid funding.

“High praise to the American Society of Plastic Surgeons for taking an important step toward ending the unscientific and harmful practice of sex-rejecting procedures on minors,” Chairman of Do No Harm, a medical advocacy group that opposes so-called gender-affirming surgery, Stanley Goldfarb said. “The ASPS becomes the first major medical organization to support evidence-based and ethical medicine and reject, in their words, these harmful and irreversible procedures. The ASPS's thoughtful, scientific, and well-reasoned statement today is a model for other medical organizations — namely the Endocrine Society, the American Academy of Pediatrics, and others — to follow and disavow their previous support for experimental and unscientific interventions.”

The report comes days after a landmark medical-malpractice ruling, in which a jury awarded $2 million to a woman who received a double mastectomy at the age of 16. Doctors rushed to “affirm” plaintiff Fox Varian’s gender confusion with a double-mastectomy in 2019, attorneys said during the trial.

Dozens more detransitioners — people who received life-altering gender surgeries, in many cases when they were children — have filed similar medical-malpractice lawsuits.