(ZENIT News / Washington, 02.07.2026).- The American Society of Plastic Surgeons (ASPS) has issued new guidance urging restraint when it comes to gender-affirming surgeries for minors. The recommendations, first reported by The Washington Post, advise the organization’s roughly 11,000 members to delay surgical interventions involving the breasts, genitals or facial structures until patients are at least 19 years old.
The decision places the ASPS in uncharted territory. It is the first major U.S. professional medical association to explicitly tighten its recommendations on pediatric gender-affirming surgery, grounding the shift in what it describes as insufficient evidence to support a favorable risk–benefit balance for children and adolescents.
At the heart of the new guidance is a concern familiar to both medical ethicists and religious moral theologians: irreversibility. Scot Bradley Glasberg, former president of the ASPS, emphasized that young patients require particular protection precisely because some of these procedures permanently alter healthy tissue. The age threshold of 19, he explained, is not arbitrary but reflects the point at which puberty has typically concluded, allowing for a more stable physical baseline before irreversible decisions are made.
The new stance emerges against a backdrop of rapid change in clinical practice over the past decade. A study published in 2023 in the Journal of the American Medical Association found that the number of gender reassignment surgeries in the United States tripled between 2016 and 2020. That increase was driven largely by adolescents and young adults. Even so, the study noted that surgical procedures remained relatively uncommon when compared with the far more widespread use of puberty blockers and cross-sex hormone treatments.
What makes the ASPS decision particularly striking is how sharply it contrasts with the organization’s earlier positions. In 2019, the society publicly criticized state-level efforts to restrict gender-affirming medical interventions. By August 2024, however, its tone had shifted markedly, acknowledging what it called “significant uncertainty” regarding long-term outcomes and announcing that more specific clinical guidance was forthcoming.
Reactions to the new recommendations have been predictably polarized. U.S. Secretary of Health Robert F. Kennedy Jr. welcomed the move as a corrective to what he described as the “over-medicalization” of vulnerable young people and a return to “sound science.” By contrast, a spokesperson for the LGBTQ+ policy group Movement Advancement Project argued that the guidance largely aligns with existing standards of care and does not represent a radical departure.
The ASPS announcement also lands in a highly charged legal and political environment. Nearly half of U.S. states — all with Republican majorities — have already enacted restrictions on gender reassignment surgeries for minors. At the federal level, the Trump administration proposed regulations in December that could exclude providers of such treatments from major government-funded health insurance programs, a move that would have sweeping practical consequences even in states without explicit bans.
Internationally, the American shift mirrors a broader trend toward caution. Countries such as Finland, Sweden and New Zealand have revised their national protocols to limit surgical interventions, which are generally not performed before the age of 18. In these systems, emphasis has increasingly been placed on psychological support and non-invasive approaches, especially for younger patients.
One factor contributing to the ASPS’s reassessment is an emerging phenomenon that remains poorly understood: detransition. Glasberg acknowledged a rise in consultations related to reversing or mitigating the effects of previous gender-related procedures. That concern has taken on legal weight as well. In a recent case in New York, a jury awarded a woman two million dollars in damages after she sued her surgeon over a mastectomy performed when she was 16 years old.
For observers attentive to the intersection of medicine, law and moral reasoning — including many within religious communities — the ASPS guidelines underscore a deeper question: how societies balance compassion for personal suffering with prudence in the face of scientific uncertainty. While the debate over gender identity remains deeply polarized, the surgeons’ new recommendations suggest that, at least in this corner of American medicine, caution is reasserting itself as a professional virtue.
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