The American Society of Plastic Surgeons (ASPS) is breaking with the consensus of the American medical establishment about best practices in so-called “gender-affirming care” for minors.
The organization’s move, which represents 92% of all board-certified plastic surgeons in the U.S., comes amid shifting international sentiment that psychotherapy might be a better course of action in treating transgender-identifying minors over hormones and surgery.
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 first reported by the Manhattan Institute (MI). The group said there is “considerable uncertainty as to the long-term efficacy for 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 its 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 patients and their families can set realistic expectations in the shared decision-making context.”
“It’s somewhat unexpected that the plastic surgeons of all people would be the ones to stand up for evidence-based medicine and to say we have to be more careful and not just give people what they want, because plastic surgeons have the opposite reputation,” MI fellow Leor Sapir told Fox News Digital.
“But when you think about it, it’s actually not that surprising, because the doctors who actually take the scalpel and cut into people, tend to have the heaviest sense of responsibility on their shoulders,” he added. “It’s understandable that they would be the ones who would want to know that what they’re doing, especially when it involves kids, is actually good, is not harming their patients.”
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The growing divide in standards of care in the U.S. and Europe comes amid emerging evidence like the U.K.’s Cass Review, commissioned by England’s National Health Service, which “may explain why there has been an apparent consensus on key areas of practice despite the evidence being poor.” The Cass Review was an independent assessment of youth gender treatments led by top British pediatrician Dr. Hilary Cass, which “found no definitive proof that gender dysphoria in children or teenagers was resolved or alleviated by what advocates call gender-affirming care,” the New York Times’ Pamela Paul reported.
Transgender rights advocates (Stephen Zenner/SOPA Images/LightRocket via Getty Images)
“In Europe, there’s been a course reversal because they have basically allowed their health authorities to do independent assessment of evidence, and they 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 eminence-based medicine, which is: ‘These treatments are good because these people say so.'”
“We always knew that this consensus was manufactured, we always knew that it was not based on good evidence,” he added. “We know that because we see the studies that they cite, and we’ve analyzed those studies, and they don’t say what they’re made out to say.”
A recent report from a Canadian think tank, which compared transgender medical policy for minors in Canada, the United States and Europe, found that the U.S. is one of a few Western countries where minors can receive gender surgery. In Belgium, Finland, Germany, Luxemburg, Sweden, the U.K., and three Canadian provinces, minors cannot undergo a double mastectomy before 18 and nearly all European countries included in the study do not perform sex reassignment surgery before 18.
But, in the U.S., the use of puberty blockers, cross-sex hormones and surgery continues to be the prescribed path for minors who express distress over their gender and their developing bodies. Guidance issued in June 2022 by the World Professional Association for Transgender Health (WPATH) recommended some surgeries be allowed from the age of 15, while some “gender-affirming” mastectomies have been performed on children as young as 12.
In addition to WPATH, groups like the American Academy of Pediatrics and the U.S. Endocrine Society have remained firm in their commitment to “gender-affirming care,” which influenced nearly all the other guidelines, according to the Cass Review. Court documents released in June indicated that WPATH suppressed systematic reviews of evidence and eliminated age minimums for surgery under pressure from the Department of Health and Human Services’ (HHS) Rachel Levine.
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