HHS praises ASPS recommendation to delay gender-related surgeries until 19

Federal health officials this week enthusiastically embraced a new position from the American Society of Plastic Surgeons that discourages gender-related breast, genital and facial surgery for people under 19. The society, which represents about 11,000 plastic surgeons, said the evidence supporting endocrine and surgical interventions for children and adolescents is limited and of low quality, and called for delaying such operations until patients reach at least age 19.

In a Feb. 3 HHS statement, the department framed the ASPS position as a public-health victory. “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.” Deputy Secretary Jim O’Neill added: “Today marks another victory for biological truth in the Trump administration. The American Society of Plastic Surgeons has set the scientific and medical standard for all provider groups to follow.”

ASPS articulated its concerns in language that focused on evidence and outcomes. The society said, “there is insufficient evidence demonstrating a favorable risk-benefit ratio for the pathway of gender-related endocrine and surgical interventions in children and adolescents,” and warned that “available evidence suggests that a substantial proportion of children with prepubertal onset gender dysphoria experience resolution or significant reduction of distress by the time they reach adulthood, absent medical or surgical intervention.” HHS also noted that ASPS relied in part on a department review, Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices, in reaching its assessment that the evidence base is “low quality/low certainty.”

Other HHS officials employed pointed language in praising the society. Centers for Medicare & Medicaid Administrator Mehmet Oz said future ethics textbooks would view pediatric sex-rejecting procedures as analogous to past harmful practices such as lobotomies, and HHS General Counsel Mike Stuart said hospital systems were increasingly abandoning what he called “tragic and irreversible” procedures for minors.

The American Medical Association responded with a clarification that did not embrace ASPS’s wider framing but aligned on deferring surgeries for young people. “The AMA supports evidence-based treatment, including gender affirming care,” the organization said, adding that “surgical interventions in minors should be generally deferred to adulthood.” A medical watchdog group, Do No Harm, praised ASPS for basing its recommendations on scientific analysis rather than prioritizing patient preference.

The guidance arrives against a tense legal backdrop. The Supreme Court upheld state restrictions on transgender medical care for minors in June 2025, and several states and hospital systems have moved to limit or curtail services. ASPS emphasized that its announcement is an articulation of recommendations given the current state of evidence and variable legal and regulatory environments, and the society clarified that the statement is not a reversal of prior positions nor a formal clinical practice guideline.

Clinicians and hospitals now face a shifting mix of professional guidance, legal constraints and administrative pressure. Supporters of gender-affirming care say deferral could deny some adolescents timely treatment; opponents say the ASPS stance and HHS endorsement protect children from irreversible procedures performed with inadequate evidence. ASPS and federal officials called for more rigorous, long-term research to resolve the uncertainties they cited and to guide future clinical practice.