American plastic surgeons: insufficient evidence for gender surgery in minors

In early February 2026, one of the largest medical professional organizations in the United States did something that few medical associations had previously done in the debate over gender medicine: openly acknowledge that the evidence is simply inadequate. The American Society of Plastic Surgeons (ASPS), the official professional association for plastic surgeons in the US, published a position statement saying that surgical procedures for gender dysphoria — breast, genital and facial surgeries — should preferably be postponed until the patient is at least nineteen years old.

What the statement says exactly

The ASPS concludes that there is "insufficient evidence" that the benefits of surgical procedures for minors with gender dysphoria outweigh the risks. The complications that can occur, for example, after breast removal surgery are listed with figures and sources on genderrisico.nl. This assessment is not limited to surgery: the association also raises concerns about the broader treatment pathway — social transition, puberty blockers and cross-sex hormones — and likewise describes the evidence base for these treatments as weak. In support of its position, the ASPS explicitly cites two recent and influential reports: the British Cass Review and the US 2025 HHS report, both of which concluded that the quality of the underlying research on gender care for young people is low.

A professional association that performs the procedures itself

The significance of this statement lies primarily in its source. Whereas earlier critical reports often came from outside — from journalists, health authorities or parent groups — this position comes from the professional association whose members actually perform the surgeries. An association that declares it wants to take a cautious approach to its own core activity can hardly be dismissed as politically motivated or uninformed about medical practice. Several US media outlets, including CNN and STAT News, reported that the ASPS is thereby joining a growing number of medical institutions questioning the haste with which minors are being treated surgically.

Confusion at the AMA

The position caused concern among other medical organizations. Within days, the American Medical Association (AMA) — the largest physicians' organization in the US — came forward to emphasize that there had been no coordinated change in direction among medical associations. That clarification mainly highlights how sensitive the subject is: even a technical, evidence-based position from a specialist association is immediately interpreted as a signal for the profession as a whole.

Why this is more than an American issue

For the Netherlands and Belgium, the ASPS statement is not legislation and does not immediately change clinical practice. But the statement joins a series of international assessments — the Cass Review in the United Kingdom, changes to Swedish and Finnish guidelines, and now also an American surgeons' association — that have independently reached the same conclusion: the evidence base for surgical and hormonal interventions in minors with gender dysphoria is weaker than long assumed. Each new assessment reaching the same conclusion makes it more difficult to dismiss caution as a marginal position. In the United States itself, Colorado is allowing voters to vote directly on a ban on gender surgery for minors, while in the Nordic countries, surgery for gender dysphoria remains almost universally reserved for adults.