American Society of Plastic Surgeons calls efficacy of child sex changes into question, breaks from 'gender affirming' approach

The American Society of Plastic Surgeons, representing 11,000 members or over 90 percent of those working in the field in the US and Canada, has raised concerns over surgical sex changes for minors, telling Manhattan Institute fellow Leor Sapir that "the existing evidence base is viewed as low quality/low certainty."

The organization told Sapir that it "has not endorsed any organization’s practice recommendations for the treatment of adolescents with gender dysphoria," and acknowledged that there is "considerable uncertainty as to the long-term efficacy for the use of chest and genital surgical interventions."

The ASPS said that it "is reviewing and prioritizing several initiatives that best support evidence-based gender surgical care to provide guidance to plastic surgeons." The organization's statement, Sapir said, marked the first major medical organization in the country to break away from the consensus that "gender-affirming care" for gender dysphoric youth.

Beverly Hills, California plastic surgeon Sheila Nazarian told Sapir that her colleagues are increasingly expressing concerns over the use of hormones and surgeries on minors, but fear blowback.

"It’s a real problem when colleagues are afraid to debate any medical treatment or procedure, and especially when minors are the patients," said Nazarian. "I have been following the international debate on youth gender medicine for some time now and know we [in the US] are far behind in recognizing the lack of evidence for long-term benefits, something that our European colleagues have done."

She said that an obstacle to productive discussions on the topic is political and ideological disagreements on the "gender-affirming" approach to treating youth.

Nazarian said that surgeons in the network that perform such surgeries on minors often defer to mental health professionals and endocrinologists to determine whether minors should receive these irreversible procedures. "That approach, she believes, is misguided, and reduces surgeons to mechanics," Sapir wrote.

“We are not highly trained technicians,” Nazarian said. “We are physicians with responsibility for the health and well-being of our patients. We can get input from other clinicians, but ultimately the responsibility for determining medical readiness lies with us. That means that we have to examine all the data and studies available to us. Furthermore, you can’t help people by ignoring the reasons they want to go under the knife. With every patient, I exercise discretion as a professional and determine whether the procedure they are seeking is in their ultimate best interest.” 

“You can’t outsource your professional judgment to other clinicians. It’s your responsibility as the last in a chain of treatment to ensure you are doing what is best for the patient now and in the long term.”