Plastic Surgeons, AMA Shift on Transgender Surgeries for Minors

The American Society of Plastic Surgeons (ASPS) has just issued new guidance urging that gender-related surgical procedures not be performed on patients under the age of 19. The American Medical Association (AMA), long a vocal advocate for transgender health care, quickly signaled support for the ASPS position on surgeries, a shift that underscores growing scrutiny of clinical evidence and legal pressures surrounding pediatric gender care.

The ASPS, the nation’s largest professional organization of Plastic Surgeons with more than 11,000 members, formally recommended delaying chest, genital and facial procedures until a patient reaches at least 19, citing what it described as insufficient evidence about the benefits and risks for younger patients. “There is currently insufficient evidence showing a favorable risk-benefit ratio for gender-related surgeries in children and adolescents,” the Association said in the position statement issued February 3.

In a coordinated response, the AMA said it “agrees with the American Society of Plastic Surgeons that surgical interventions in minors should be generally deferred to adulthood” because the evidence base does not support definitive conclusions about long-term outcomes.

The dual statements mark a departure from much of the broader medical establishment’s long-standing support for allowing gender-affirming care — including surgery — to be determined by physicians and families on a case-by-case basis. As recently as the early 2020s, the AMA opposed legislative limits on gender-affirming care for minors, describing restrictions as harmful intrusions into medical practice.

ASPS officials have emphasized that this guidance reflects an evolving evaluation of scientific reviews showing “low certainty” about the outcomes of gender-affirming interventions in youth. The Association’s position statement frames the issue as one of professional caution in the face of limited long-term evidence.

That shift in tone has unfolded amid broader legal and policy actions targeting pediatric gender care — including a high-profile lawsuit in Florida. In December 2025, Florida Attorney General James Uthmeier filed a complaint against several major medical organizations, including the American Academy of Pediatrics (AAP), the World Professional Association for Transgender Health (WPATH) and the Endocrine Society. The State accuses these groups of failing to disclose risks and of using misleading claims in promoting gender-affirming treatments for children, alleging that families were told these interventions were “settled science” when, the complaint asserts, evidence was weak. “Parents were not told the full story,” Uthmeier said in announcing the lawsuit, calling the procedures “life-altering, sick procedures like double mastectomies and castration.”

Legal pressure has also come in State courts. Florida’s gender-affirming care ban — part of broader legislation that restricts treatments such as puberty blockers, hormone therapy, and surgeries for minors — has been at the center of litigation and appeals.

The ASPS and AMA developments arrive against the backdrop of State laws that already limit gender-affirming care for minors, most notably Alabama’s Vulnerable Child Compassion and Protection Act. First enacted in April 2022, the law makes it a felony for health care providers to prescribe puberty blockers, cross-sex hormones, or perform gender-related surgeries on anyone under 19, with limited exceptions for rare biological conditions.

Last spring, families challenging Alabama’s law dropped their federal lawsuit after a federal appeals court allowed the ban to go into effect. The litigation had temporarily blocked enforcement, but its dismissal effectively affirmed the statute and was hailed by State officials as a victory for child safety. “The law criminalizes providing puberty blockers or hormone treatments to individuals under 19,” according to a report summarizing the end of that legal challenge.

Alabama’s law reflects a broader trend in State policy. At least two dozen States have debated or enacted limits on gender-affirming care for minors, and many of those laws include age restrictions similar to Alabama’s.

The ASPS guidance, while non-binding, is already influencing how surgeons and hospitals think about pediatric gender surgery. Many major children’s hospitals historically limited such surgeries to adults because of the irreversible nature of the procedures and the relative rarity with which they were performed on those under 18. However, the number of these procedures nearly tripled between 2016 and 2019, likely reflecting the Obama administration (largely through the Affordable Care Act) and some States expanding insurance coverage by actively discouraging discrimination based on gender identity.

For the AMA, aligning with the ASPS on surgery may reflect both scientific caution and the growing legal scrutiny physicians face. Still, the AMA’s current position does not oppose other aspects of gender-affirming care, such as puberty blockers or hormone therapy, a distinction that makes its shift more targeted than wholesale.

Critics argue that recent legal campaigns and State bans have pressured medical groups into more conservative stances. Supporters of gender-affirming care caution that limiting access could harm youth who benefit from comprehensive, individualized treatment. 

The decisions by the ASPS and AMA reflect the growing body of evidence—most notably 2024’s Cass Review and 2025’s HHS report—that point not only to a dearth of evidence supporting the benefits of transgender treatments for youths, but also the significant potential for harm. Nonetheless, the competing perspectives of those involved make clear that the debate over gender-affirming care for minors will remain an important issue in health policy and medical practice throughout 2026 and beyond.

The full text of the ASPS Position Statement may be read HERE.

Florida AG Uthmeier’s announcement of the suit described above may be viewed at THIS LINK.