The American Society of Plastic Surgeons (ASPS) is breaking with the consensus of the American medical establishment on best practices for so-called “gender-affirming” care for minors.
The decision by the organization, which represents 92 percent of all board-certified plastic surgeons in the United States, comes amid a shift in international sentiment that psychotherapy may be a better option for treating minors who identify as transgender than hormones and surgery.
The ASPS told Fox News Digital that it “has not endorsed any organization’s practice guidelines for the treatment of adolescents with gender dysphoria,” as first reported by the Manhattan Institute (MI). The group said there is “considerable uncertainty about the long-term effectiveness of using thoracic and genital surgical procedures” and that “the existing evidence base is considered low-quality/low-certainty.”
“ASPS is reviewing and prioritizing several initiatives that best support evidence-based gender-sensitive surgical care to provide guidance to plastic surgeons,” the group said in its statement to Fox News Digital. “As members of the multidisciplinary care team, plastic surgeons have a responsibility to provide comprehensive patient education and maintain a robust, evidence-based informed consent process so that patients and their families can set realistic expectations in the context of shared decision-making.”
“It’s kind of unexpected that plastic surgeons are the ones who are championing evidence-based medicine and saying we need to be more careful and not just give people what they want, because plastic surgeons have the opposite reputation,” MI member Leor Sapir told Fox News Digital.
“But when you think about it, it’s not so surprising, because the doctors who pick up the scalpel and make incisions on patients tend to have the greatest sense of responsibility on their shoulders,” he added. “It’s understandable that they’re the ones who want to know that what they’re doing, especially when it comes to children, is actually beneficial and not harming their patients.”
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The growing gap between standards of care in the United States and Europe comes as evidence emerges, such as the Cass study in the United Kingdom, commissioned by England’s National Health Service, which “may explain why there is apparent consensus on key areas of practice despite the weakness of the evidence.” The Cass study is an independent review of gender treatments for young people, led by renowned British pediatrician Dr. Hilary Cass, who “found no definitive evidence that gender dysphoria in children or adolescents was resolved or alleviated by what advocates call gender-affirming care,” reported Pamela Paul of the New York Times.
Transgender Rights Defenders (Stephen Zenner/SOPA Images/LightRocket via Getty Images)
“In Europe, there was a shift in focus because health authorities actually allowed their authorities to do an independent assessment of the evidence, and they found that it just wasn’t there,” Sapir told Fox News Digital. “Here in the United States, instead of evidence-based medicine, we’ve relied on what I sometimes call eminence-based medicine, which says, ‘These treatments are good because these people say so.’”
“We always knew that this consensus was manufactured, we always knew that it was not based on solid evidence,” he added. “We know that because we see the studies that they cite, we’ve analyzed them and they don’t say what they claim to say.”
A recent report by a Canadian think tank, which compared transgender medical policies for minors in Canada, the United States and Europe, found that the United States is one of the few Western countries where minors can have sex reassignment surgery. In Belgium, Finland, Germany, Luxembourg, Sweden, the United Kingdom and three Canadian provinces, minors cannot have a double mastectomy before age 18, and almost all of the European countries included in the study do not perform sex reassignment surgery before age 18.
But in the United States, puberty blockers, intersex hormones, and surgery remain the prescribed path for minors who express distress about their gender and developing bodies. Guidelines released in June 2022 by the World Professional Association for Transgender Health (WPATH) recommended that some surgeries be allowed starting at age 15, while some “gender-affirming” mastectomies have been performed on children as young as 12.
In addition to WPATH, groups like the American Academy of Pediatrics and the American Endocrine Society have remained steadfast in their commitment to “gender-affirming care,” which has influenced nearly every other guideline, according to the Cass Review. Court documents released in June said WPATH eliminated systematic reviews of the evidence and removed minimum ages for surgery under pressure from Rachel Levine of the Department of Health and Human Services (HHS).
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Between 2017 and 2023, between 5,288 and 6,294 “gender reassignment” double mastectomies were performed on minors, including 50 to 179 girls who were 12.5 years old or younger at the time of their procedure, according to a new Manhattan Institute analysis based on information from a national all-payer insurance database.
Dr. Richard Bosshardt, a board-certified plastic surgeon and core member of Do No Harm, said that as an ASPS member for more than thirty years, he was proud that the association had stepped forward and raised serious concerns about the practice of “gender-affirming” care.
Transgender flag (ALLISON DINNER/AFP via Getty Images)
“As a proud member of the American Society of Plastic Surgeons for over thirty years, a father of three, and a grandfather of six, I have been appalled and alarmed by the uncritical rush to embrace experimental gender-affirming care for minors,” he said in a statement provided to Fox News Digital. “Those pushing for puberty blockers, intersex hormones, and surgery on minors have grossly oversimplified something incredibly complex and poorly understood, as if it were ‘settled science.’”
Do no harm, who recently A study called “Reassigned” was published that examined the differences in approaches between North America and Europe. The group warned of a “worrying reality” in which North American patients are eligible for “potentially irreversible or medically dangerous procedures at a much younger age than those in Europe.”
“Plastic surgeons understand better than any other specialist the unique and daunting challenges of transgender surgery,” Bosshardt said. “Even in the best hands and under ideal circumstances, these procedures are among the most complex and difficult.”[…]Given the overwhelming evidence that warns against “gender-affirming” care, I hope that ASPS will be only the first of many organizations to take a stand in this direction.”
Sapir said the ASPS statement is evidence of the collapse of a manufactured consensus within the American medical establishment.
Transgender activists argue that “rapid onset gender dysphoria” (RAGD), or the idea that adolescents who never experienced gender disorders before puberty suffer from gender confusion, which has led to the reversal in Europe, does not exist. The idea that gender dysphoria is innate, or even biological, is used to justify medically transitioning children, but many researchers, including Sapir, believe that the sharp rise in the number of teenage girls identifying as transgender indicates that RAGD does exist.
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“In the United States, the consensus is that these procedures are evidence-based and medically necessary. For the first time, a major medical organization is saying, ‘No, the evidence is very uncertain, we don’t know whether these procedures are beneficial or harmful to children, and given the vulnerability of the population, we need to have compelling evidence,’” Sapir said. “ASPS also told me that they have never endorsed the recommendations of WPATH or any other medical organization, which is true. So now they are challenging the American consensus that these treatments are reliable, evidence-based, and therefore ethical.”
People take part in a rally to mark International Transgender Day of Visibility. (Andrea Ronchini/NurPhoto via Getty Images)
Sapir said the ASPS’s changed position on “gender-affirming care” raises questions about the legal liability of plastic surgeons, who are part of a “multidisciplinary team” but often see patients after they have been confirmed and medicalized by therapists and other physicians.
He said the question of “To what extent are surgeons responsible for determining the medical appropriateness or necessity of these types of surgeries?” will gain importance as the debate over “gender-affirming care” in the United States rages.
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Fox News Digital reached out to WPATH and the Endocrine Society for comment but did not immediately receive a response.
