American Society of Plastic Surgeons Recommends Delaying Gender-Affirming Surgeries Until Age 19

The American Society of Plastic Surgeons (ASPS) issued new professional guidance recommending that gender-affirming chest, genital, and facial surgeries be delayed until patients reach 19 years of age. This development introduces a new approach within the field of plastic surgery and contrasts with positions held by other medical associations.

ASPS, which represents over 11,000 physicians specializing in cosmetic and reconstructive surgery, stated that its recommendation is based on a review of available evidence regarding gender-affirming procedures in minors. The association emphasized that its statement serves as professional guidance rather than a formal clinical practice guideline.

According to ASPS, the current evidence supporting gender-affirming surgeries for children and adolescents is of low certainty, and the association cited concerns about the irreversible nature of these procedures and potential long-term effects in younger populations. ASPS also referenced recent policy changes in countries such as the UK, Sweden, and Finland, where more restrictive or research-focused models for gender-affirming care in minors have been adopted.

ASPS board member Scott Hollenbeck stated that the association began reviewing the evidence during the Biden administration and concluded that more recent analyses reinforced the view that the available evidence is low quality and low certainty. The association noted that its position was informed by these updated reviews and international policy trends.

What the numbers show

• Over 23,000 individuals aged 19 and under received some form of plastic surgery in 2024
• More than 5,300 breast reductions were performed on patients in this age group in 2024
• Between 2016 and 2020, about 4,000 adolescents aged 12 to 18 underwent gender-affirming surgery

The U.S. Department of Health and Human Services (HHS) issued a press release on February 3, 2026, commending the ASPS for its position statement. HHS cited the ASPS reliance on an HHS report that characterized the evidence base for pediatric gender-affirming interventions as low quality and low certainty.

ASPS’s recommendation marks a departure from the positions of other major U.S. medical organizations, including the American Academy of Pediatrics and the American Medical Association. These organizations continue to support individualized, case-by-case approaches to gender-affirming care for adolescents.

The ASPS position statement highlighted that its guidance is intended for professional consideration and does not constitute a binding clinical practice rule. The association clarified that its recommendation is based on the current state of evidence and ongoing evaluation of research in the field.

Industry reaction

The U.S. Department of Health and Human Services stated support for the ASPS guidance, referencing the alignment with findings from an HHS report on the evidence base for pediatric gender-affirming interventions.

Other major U.S. medical organizations, such as the American Academy of Pediatrics and the American Medical Association, continue to endorse case-by-case gender-affirming care for adolescents, according to published positions.

* This article is based on publicly available information at the time of writing.