The American Society of Plastic Surgeons has apparently split from other major medical organizations that are endorsing surgical interventions for transgender youth, raising questions about whether the tide in America is turning toward a more cautious approach regarding adolescent gender transitions. 

The ASPS, which represents more than 11,000 surgeons globally and is the world’s largest plastic surgery organization, may have tipped its hand when a representative for the group told a Manhattan Institute senior fellow, Leor Sapir, that it has “not endorsed any organization’s practice recommendations for the treatment of adolescents with gender dysphoria.” The association added that there is “considerable uncertainty as to the long-term efficacy for the use of chest and genital surgical interventions,” and noted that “the existing evidence base is viewed as low quality/low certainty.” 

This acknowledgment marks a rift within the medical establishment, which has often been portrayed as a unified front in support of treating transgender youth with drugs and medical procedures that cause changes that can be difficult to reverse. It also comes several months after a highly influential U.K. report, the Cass Review, found that so-called youth gender-affirming treatments, such as hormone therapy and puberty blockers, are based on “remarkably weak evidence.”

In America, more than 20 states have banned gender transition procedures for minors, many of them recently, and the Biden administration has been fighting the bans in court. The Supreme Court — which previously has been largely quiet on transgender topics — has said that next term it will weigh in on the constitutionality of a state ban on gender-transition procedures for minors in what could be a landmark decision.

Gender-related medical procedures and drug treatments for minors – which proponents call “gender affirming care” — have increasingly come under fire, as a federal court last month unsealed documents showing that a group at the center of promoting youth gender transitions, the World Professional Association for Transgender Health, had succumbed to political pressure when creating its guidelines. The documents disclosed that the Department of Health and Human Services’ Rachel Levine, a high-ranking Biden-Administration official who is a transgender woman, pressured WPATH to drop age requirements for pediatric transgender treatments when creating its guidelines, as the Sun reported at the time, because she and her staff worried calling attention to the issue could lead to further state-mandated restrictions. 

Plastic surgeons play an important role in so-called gender treatments for minors, performing key procedures on the face, Adam’s apples, and genitals. The ASPS, in response to questions from the Manhattan Institute about the WPATH disclosures, said it “is reviewing and prioritizing several initiatives that best support evidence-based gender surgical care to provide guidance to plastic surgeons,” and added that surgeons have “a responsibility to provide comprehensive patient education and maintain a robust and evidence-based informed consent process.”

The ASPS did not immediately respond to requests for comment from the Sun.

A representative of WPATH tells the Sun that “gender-affirming care for youth is supported by numerous medical authorities in the United States,” including the American Medical Association, the National Institutes of Health, and the American Academy of Pediatrics, among others. “Trans youth should have access to life-saving health care based on the best medical science available, and the broad consensus of medical authorities in the United States should ensure the urgency of that common sense position,” the representative says.

Yet, others hope that by breaking away from the medical establishment, the ASPS will encourage other healthcare organizations to change their tune. 

“Those pushing for puberty blockers, cross-sex hormones, and surgery on minors have grossly oversimplified something which is incredibly complex and poorly understood as though this is ‘settled science’ when it is not even close,” a plastic surgeon who is a member of the ASPS and a senior fellow at Do No Harm, Richard Bosshardt, tells the Sun. “I am proud that my society has finally stepped up and raised serious concerns about this practice.”

Noting that plastic surgeons “appreciate better than any other specialist the unique and daunting challenges of transexual surgery,” he says even under the best circumstances, the surgeries are “among the most complex and challenging operations with a high rate of complications, some of which can be permanently crippling, and with no good data on long term results in minors.”

“Given the extremely weak evidence supporting them, such operations in minors amount to nothing less than incomprehensible child experimentation,” Dr. Bosshardt says, adding that he hopes the ASPS’s “courageous stance” will “make it the first of many such organizations to publicly question this practice.”

Plastic surgery came to the forefront of the transgender healthcare debate earlier this summer, as the Sun reported, amid a push for surgeries — such as enhancing or reducing Adam’s apples, genital surgeries, and lengthening or reducing the chin and forehead — to be regarded as medically necessary procedures covered by insurance.