Major Wins in Pediatric Gender Medicalization Battle

We are seeing a return of scientific, evidence-based treatment of gender distressed children -- and physicians being held accountable

This week, the American Society of Plastic Surgeons (ASPS), which represents more than 11,000 physician members, released a Position Statement on Gender Surgery for Children and Adolescents.

Consistent with ASPS’s August 2024 statement that the overall evidence base for gender-related endocrine and surgical interventions is low certainty, and in light of recent publications reporting very low/low certainty of evidence regarding mental health outcomes, along with emerging concerns about potential long-term harms and the irreversible nature of surgical interventions in a developmentally vulnerable population, ASPS concludes there is insufficient evidence demonstrating a favorable risk-benefit ratio for the pathway of gender-related endocrine and surgical interventions in children and adolescents. ASPS recommends that surgeons delay gender-related breast/chest, genital, and facial surgery until a patient is at least 19 years old.

This remarkable conclusion came after ASPS continued to analyze comprehensive evidence reviews, including, among others, the Cass Review commissioned by NHS England in 2024 and the 2025 report from the U.S. Department of Health and Human Services (HHS) titled Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices. Both extensive systemic reviews (and, in the case of the HHS report, an umbrella review) not only concluded that the treatment benefit from gender medicalization was uncertain, but “in some areas they have contributed to a clearer understanding of potential harms, while also highlighting limitations of the available evidence, including gaps in documenting long-term physical, psychological, and psychosocial outcomes” (ASPS Position Statement, page 1).

What makes this change in position by the ASPS so important is that it marks the first major medical association to break from the others in the blanket approval of the so-called “safe and effective” gender medicalization treatment for gender-distressed children in the U.S. The Endocrine Society and the American Psychiatric Association continue to endorse puberty blockers, cross sex hormones, and surgery to treat gender distressed children.

According to Leor Sapir’s article in City Journal, the ASPS’s new position:

• acknowledges the lack of research on the natural course of gender dysphoria in pediatric populations, the absence of reliable assessments for predicting the course of a minor’s identity development, and the dangers of performing irreversible interventions with life-altering consequences;

• warns against the misuse of the patient autonomy principle, which is “more properly defined as the right of a patient to accept or refuse appropriate treatment; it does not create an obligation for a physician to provide interventions in the absence of a favorable risk–benefit profile, particularly in adolescent populations where decision-making capabilities are still developing.” This is a key point, as appeals to autonomy have served as a central justification, in the absence of clinical evidence, for letting minors or their parents consent to endocrine or surgical interventions;

• does not seek to deny or minimize the reality of any patient’s distress, and it does not question the authenticity of any patient’s experience. Instead, ASPS affirms that truly humane, ethical, and just care, particularly for children and adolescents, must balance compassion with scientific rigor, developmental considerations, and concern for long-term welfare.

This is a major step towards the return of ethics-based, scientifically driven medicine, and we applaud the integrity and courage shown by ASPS to change course.

“Medical societies shape far more than professional opinion — they set the guardrails for how medicine is practiced, taught, and reimbursed,” Dr. Kurt Miceli, chief medical officer at Do No Harm, told The Daily Wire. “That’s why the ASPS statement on pediatric medical transition lands with such weight,” Miceli added. “When a leading surgical society acknowledges that the risks of endocrine and surgical interventions outweigh their benefits, it makes clear that the so-called ‘standard of care’ pushed by gender activists is far from established. In fact, the evidence points to the harms of so-called ‘gender-affirming care.’”

The day after this pivot from the ASPS, the American Medical Association (AMA), previously entrenched in its support of pediatric gender medicalization, also took the position that these procedures should “generally” be delayed until adulthood.

The timing of these monumental position shifts from two major medical associations is noteworthy, given that a young detransitioner, Fox Varian, was just awarded $2 million in damages in a medical malpractice lawsuit in New York after her physicians were found liable for harm for her bilateral mastectomy at age sixteen.

This is the first successful malpractice lawsuit brought by a detransitioner. It will likely open the floodgates to many similar cases in the pipeline. The writing is on the wall for physicians and insurance companies that continue to provide these treatments.

The tide is turning in other ways as well. President Trump issued Executive Order 14187 in January 2025, which “prohibits Federal departments from funding, sponsoring, assisting, or facilitating the chemical and surgical mutilation of minors and directs them to stop these immoral, unjust, and disproven practices more broadly to the greatest extent possible.” The result of this executive order has been the full discontinuation of pediatric gender services in at least nine hospitals, and indications of narrowed or restricted care in more than twenty other hospitals.

Here in Montana, a bill that we championed —HB 682 — was passed and took effect on October 1, 2025. It extends the statute of limitations for medical malpractice claims related to gender-transition treatments that were received as a minor, allowing plaintiffs to bring such civil claims later than Montana’s standard two-year malpractice window — until the age of 27. It also includes insurance coverage provisions for detransition-related care.

As of 2026, there are no clinics or hospitals in Montana currently advertising gender treatment for minors.

This is a major win in our overarching goal to bring integrity back to health care and protection of Montana’s youth.