American Society of Plastic Surgeons breaks consensus of medical establishment on transgender care

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.

"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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Between 5,288 and 6,294 "gender-affirming" double mastectomies for minors took place from 2017 to 2023, which includes 50 to 179 girls who were 12.5 or younger at the time of their procedure, according to a new analysis by the Manhattan Institute based on information from an all-payer national insurance database.

Dr. Richard Bosshardt, a board certified plastic surgeon and senior fellow at Do No Harm, said that as a member of ASPS for over thirty years, he is proud that it has stepped up and raised serious concerns about the practice of "gender-affirming" care. 

"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 viewed the uncritical rush to embrace experimental gender-affirming care for minors with dismay and alarm," he said in a statement provided to Fox News Digital. "Those pushing for puberty blockers, cross-sex hormones, and surgery on minors have grossly oversimplified something which is incredibly complex and poorly understood as though this is ‘settled science.’"

Do No Harm, which recently published a study called "Reassigned," looked at the difference in approaches between North America and Europe. The group warned of a "concerning 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 better than any other specialist the unique and daunting challenges of transexual surgery," Bosshardt said. "Even in the best of 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 the ASPS is just the first of many organizations to take this stand."

Sapir said the statement by ASPS is evidence of a crumbling manufactured consensus among the American medical establishment. 

Transgender activists argue that "rapid onset gender dysphoria" (ROGD), or the idea that adolescents with no history before puberty of gender distress experience gender confusion, which prompted the course reversal in Europe, does not exist. The idea that gender dysphoria is innate, even biological, is used as justification for the medical transition of children, but many researchers, including Sapir, believe the sharp rise in adolescent girls identifying as transgender indicates ROGD does exist. 

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"The consensus in the United States has been a consensus about the quality of evidence and the medical necessity of these procedures and so here you have, for the first time, a major medical organization coming out and saying: ‘Nope, the evidence is actually highly uncertain, we have no idea if these procedures help or harm kids and given the vulnerability of the population … we need to have compelling evidence," Sapir said. "ASPS also told me that it has never endorsed recommendations by WPATH or any other medical organization, which is true. So, they're now challenging the US consensus that these treatments are sound, evidence-based and therefore ethical."

Sapir said ASPS' altered stance on "gender-affirming care" raises questions about legal liability of plastic surgeons, who are part of a "multidisciplinary team," but often receive patients after they've been affirmed and medicalized by therapists and other doctors. 

He said the question of: "To what extent are surgeons responsible for determining the medical propriety or necessity of these types of surgeries?" will grow in importance as the debate over "gender-affirming care" in the U.S. rages on. 

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Fox News Digital reached out to WPATH and the Endocrine Society for comment, but did not immediately hear back.