The American Society of Plastic Surgeons (ASPS) is breaking away from the U.S. medical establishment’s consensus about best practices in so-called “gender-affirming care” for minors.
The move by the organization, which represents 92% of all board-certified plastic surgeons in the U.S., comes amid an international shift in perception that psychotherapy may be a better approach than hormones and surgery in treating minors with transgender identities.
The ASPS told Fox News Digital that it “has not endorsed any organization’s practice recommendations for the treatment of adolescents with gender dysphoria,” as previously reported. Manhattan Institute The (MI) group stated that “there is considerable uncertainty about the long-term efficacy of the use of chest and genital surgical interventions” and that “the existing evidence base is viewed as low quality/low certainty.”
“ASPS is reviewing and prioritizing several initiatives that best support evidence-based gender surgical care to provide guidance to plastic surgeons,” the group said in a 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 and evidence-based informed consent process so that patients and their families can set realistic expectations in the context of shared decision-making.”
“It’s somewhat unexpected that all plastic surgeons would stand up for evidence-based medicine and say we need to be more careful and not just give people what they want, because plastic surgeons have a reputation for the opposite,” MI Fellow Lior Sapir told Fox News Digital.
“But when you think about it, it’s not really that surprising, because the doctors who actually take the scalpel and cut people up have the heaviest sense of responsibility on their shoulders,” he said. “It makes sense that they would be the ones who would want to know that what they’re doing, especially when it involves children, is actually good and not harming their patients.”
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The growing gap in standards of care in the US and Europe has been exposed amid emerging evidence such as the UK’s Cass Review, commissioned by England’s National Health Service., Which “may explain why an apparent consensus has emerged on key areas of practice even though the evidence is poor.” The Cass Review was an independent evaluation of youth gender treatments led by top British pediatrician Dr. Hilary Cass that found “no definitive evidence that gender dysphoria in children or adolescents was resolved or relieved by what advocates call gender-affirming care,” according to the New York Times’ Pamela Paul reports,
Transgender rights advocate (Stephen Jenner/SOPA Images/Light Rocket via Getty Images)
“In Europe, there’s been a shift because they’ve basically allowed their health officials to independently evaluate the evidence, and they’ve found that it’s just not there,” Sapir told Fox News Digital. “Here in the United States, instead of evidence-based medicine, we’ve relied on what I sometimes call superiority-based medicine, which is: ‘These treatments are good because these people say so.'”
“We always knew that this consensus was created, we always knew that it was not based on good evidence,” he said. “We know this because we look at the studies they cite, and we’ve analyzed those studies, and they don’t say what they were told to say.”
A Recent Reports from a Canadian think tank, which compared it toTransgender medical policy for minors in Canada, the United States and Europe found that the US is one of the few Western countries where minors can receive gender surgery. In Belgium, Finland, Germany, Luxembourg, Sweden, the UK and three Canadian provinces, minors cannot have a double mastectomy before age 18, and almost all European countries included in the study do not perform sex reassignment surgery before age 18.
But, in the US, the use of puberty blockers, cross-sex hormones and surgery remains the prescribed route for minors who express discomfort with their gender and their developing bodies. Guidelines released by the World Professional Association for Transgender Health (WPATH) in June 2022 recommend allowing some surgeries from the age of 15, while some “gender-affirming” mastectomies have been performed on children as young as 12.
In addition to WPATH, groups such as the American Academy of Pediatrics and the US Endocrine Society have been steadfast in their commitment to “gender-affirming care,” which has influenced nearly all other guidelines, according to the Cass Review. Court documents Issued In June signs WPATH, under pressure from Rachel Levine of the Department of Health and Human Services (HHS), suppressed a systematic review of the evidence and eliminated the minimum age limit for surgery.
According to a new analysis by the Manhattan Institute based on information from the All-Payer National Insurance Database, 5,288 to 6,294 “gender-affirming” double mastectomies were performed on minors from 2017 to 2023, including 50 to 179 girls who were 12.5 years old or younger at the time of their procedure.
Dr. Richard Bosshardt, a board-certified plastic surgeon and senior fellow at Do No Harm, said that as a member of the ASPS for more than thirty years, he is proud that it has raised serious concerns about the practice of “gender-affirming” care.
Transgender flag (Alison 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 watched with dismay and concern the reckless rush to adopt experimental gender-affirming care for minors,” he said in a statement to Fox News Digital. “Those pushing for puberty blockers, cross-sex hormones, and surgery on minors have oversimplified something that is incredibly complex and poorly understood as if it were ‘settled science.’”
do no harm, which recently a study published The study, called “Reassigned,” looked at differences in approach between North America and Europe. The group warned of a “worrying reality” in which patients in North America are eligible for “potentially irreversible or medically harmful interventions at a much younger age than those in Europe.”
“Plastic surgeons understand the unique and daunting challenges of transsexual surgery better than any other specialist,” Bosshardt said. “Even in the best hands and under ideal circumstances these are among the most complex and challenging surgeries. … Given the overwhelming evidence raising red flags against ‘gender-affirming’ care, I hope ASPS is the first of many organizations to take this stand.”
Sapir said the ASPS statement is evidence of a fracturing of manufactured consensus within the American medical establishment.
Transgender activists argue that “acute onset gender dysphoria“(ROGD), or the idea that teens experience gender confusion even if they have no history of gender-related trouble before puberty, which led to this shift in Europe, is not the case. The idea that gender dysphoria is innate, even biological, is used as justification for medically transitioning children, but many researchers, including Sapir, believe that the sharp increase in teen girls identifying as transgender indicates that ROGD does exist.
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“There has been a consensus in the United States about the quality of the evidence and the medical necessity of these procedures and so here is the first time a major medical organization has come out and is saying: ‘No, the evidence is actually highly inconclusive, we don’t know if these procedures help or harm children and given the vulnerability of the population … we need solid evidence,'” Sapir said. “ASPS also told me that it has never endorsed the recommendations of WPATH or any other medical organization, which is true. So, they are now challenging the U.S. consensus that these treatments are solid, evidence-based and therefore ethical.”
People attend a rally on International Transgender Day of Visibility. (Andrea Ronchini/NurPhoto via Getty Images)
Sapir said the ASPS’s changed stance on “gender-affirming care” raises questions about the legal responsibility of plastic surgeons, who are part of a “multidisciplinary team” but often receive patients only after they have been affirmed and medically cleared by physicians and other doctors.
“To what extent are surgeons responsible for determining the medical appropriateness or necessity of this type of surgery?” this question, he said, will become increasingly important as the debate over “gender-affirming care” continues in the US.
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Fox News Digital reached out to WPATH and the Endocrine Society for comment but did not receive an immediate response.
