One of America’s largest and most influential doctor groups earlier this year advised their members to stop conducting surgical interventions on minors who experience gender dysphoria.
In a new position statement, the American Society of Plastic Surgeons noted that “there is insufficient evidence demonstrating a favorable risk-benefit ratio” for those interventions. This announcement represents a watershed moment for the American medical establishment, one that could help spare thousands of vulnerable children from undergoing risky medical interventions that may do more harm than good. Until now, U.S.-based doctor groups had largely ignored the mounting evidence raising concerns about potential permanent harm from those interventions, evidence that has already led many other countries to restrict their routine medicalization of gender-dysphoric minors.
Finland, for instance, concluded after a comprehensive review in 2020 that “in light of available evidence, gender reassignment of minors is an experimental practice.” In 2022, Sweden reached a similar conclusion and restricted puberty blockers, cross-sex hormones, and surgery for minors to research settings and “exceptional cases.”
The United Kingdom, meanwhile, stopped all interventions for minors with gender dysphoria (including the latest announcement of intention to stop the use of cross-sex hormones in addition to previously banned puberty blockers) after an independent review commissioned by its National Health Service found that they posed “an unacceptable safety risk” given existing data. In 2025, New Zealand’s health ministry restricted puberty-blocking drugs for minors after finding insufficient “high-quality evidence” of their benefits.
The United States, however, remained an outlier, largely due to intense pressure from activist groups that were interested in pushing an ideological agenda, regardless of the impact on children’s health. The World Professional Association for Transgender Health, which positions itself as an authority on transgender care, recommended that doctors utilize surgical interventions, alongside puberty blockers and cross-sex hormones, as part of a “multidisciplinary approach” to treat youth with gender dysphoria. Largely because of recommendations like these, nearly 1,000 American adolescents per year underwent gender-related surgeries between 2019 and 2023. Thousands more have had puberty blockers and cross-sex hormones.
Doctors and researchers who questioned the efficacy and safety of those interventions faced severe blowback from activists, even as more and more studies raised concerns about the substantial risks of those interventions, including infertility, cognitive and psychiatric impacts, sexual dysfunction, and surgical complications. That’s why the recent statement from the American Society of Plastic Surgeons is so important. This group is highly respected, and their decision to reassess prevailing assumptions, respond to mounting evidence, and articulate the limits of the current data will undoubtedly inspire more doctors and researchers to do the same.
The American Society of Plastic Surgeons cited a range of domestic and international evidence to support its position. In addition to the recently released report from the U.S. Department of Health and Human Services, the group referenced Dr. Hilary Cass’s comprehensive review in the United Kingdom and Finland’s landmark guidelines, which were among the first in the world to classify pediatric gender transition as an “experimental practice.”
Those international findings did not enter the American debate on their own. My organization, the Society for Evidence-Based Gender Medicine, has for years worked alongside other independent groups to bring international findings to an English-speaking audience, commissioning systematic reviews and translating international guidelines that are now informing the American debate.
The medical establishment’s gradual self-correction in this field is encouraging. It is precisely what should happen when clinicians and professional organizations follow the evidence, reassess prior assumptions, and adjust practice in light of stronger data. The field is young, rigorous evidence is scarce, and the decisions made will have lifelong repercussions for children.
America’s children deserve a medical system that is willing to learn and adapt, and to let evidence, not ideology, inform medical decisions.
William Malone is an endocrinologist.
