President of leading plastic surgeons org says evidence doesn’t currently support gender surgeries for minors

The American Society of Plastic Surgeons (ASPS) stands by its statement that there is currently not enough evidence to support so-called gender-affirming care (GAC) for minors, according to an interview with the president of the organization.

Fox News Digital spoke with ASPS President Dr. Steven Williams about its current stance regarding GAC, which includes the use of puberty blockers, cross-sex hormones and surgery which is being prescribed to minors who express distress over their gender.

The United States 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 do not perform sex reassignment surgery before 18, according to a recent report from a Canadian think tank.

"We feel that additional work and evidence needs to be provided to support gender-affirming care in adolescents," Williams told Fox News Digital. "The reason why, is it is a particularly vulnerable population that's subject to a lot of different influences and may not have the decision-making capacity that an adult has, so, because of that, it's incredibly important that we make sure that there is strong evidence. Right now, we don't think there is."

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ASPS, which represents 92% of all board-certified plastic surgeons in the United States, and more than 11,000 plastic surgeons worldwide, encourages high standards of training, ethics, physician practice and research in plastic surgery through education, advocacy, practice support and enhanced public awareness of the value of plastic surgery, according to its website.

ASPS previously told Fox News Digital in a statement that it "has not endorsed any organization’s practice recommendations for the treatment of adolescents with gender dysphoria." 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's statement continued. "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."

Williams clarified that this has always been ASPS' stance on gender-affirming care, explaining the issue is complicated because it is multidisciplinary, involving doctors who "may all have different feelings, procedures, policies or maybe even have access to different research."

"American Society of Plastic Surgeons focuses on plastic surgery, patient safety and plastic surgery advancement, so I have no idea where the endocrinologists should come down," he said. "We are not in lockstep with any organization. It's our job to independently consider the appropriate things for our members, for our patients and for the advancement of plastic surgery in a safe and ethical manner."

However, Williams described it as a "fallacy to say that every aesthetic operation that plastic surgeons do is backed by incredible evidence." 

"A lot of the surgeries we do don't have substantial evidence, which I know sounds kind of crazy," he added. "But, when you think about tummy tucks or liposuction, there's not a lot of evidence to support whether that's the best operation in the world."

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But, Williams argued the difference is the informed consent of adults verus minors, which requires the evidence for the necessity or benefit of surgical procedures to be stronger.

"I think very few people would say some of the gender dysphoria should be excluded from getting psychiatric care or counseling or some sort clinical support," Williams said. "We're recognizing at some level medicine needs to be involved because that's supportive and helpful. But, as you go to more and more potentially permanent changes, the level of evidence that needs to be involved to support those decisions has to go up."

He argued that adults, including people who have tummy tucks or liposuction, have regrets, but those operations don't require as high a level of data. 

"Sometimes people [adults] can make a decision that they may later regret, but they have all the capacity and all the resources at their fingertips to make that decision and the reason is that adolescents may not have those same tools and so the evidence has to be stronger," he added.

Surgery is typically a later step in the gender-transition process, most often occurring after puberty blockers and hormones, which raises the question among critics: To what extent are surgeons responsible for determining the medical propriety or necessity of GAC surgery?

Williams said surgery "is almost always the last part of any consideration, not just for adolescents, but for for anyone" and "anything that a plastic surgeon does, we do because we think it's a good idea, and we do it with the consideration of the patient."

"No one tells us you have to operate, right?" Williams said. "It's our decision to judge the clinical evidence, interact with the patient and then potentially consult specialists. But that's true of everything. I don't think I've ever done a surgery where I said, 'Well, they told me to do it, so I guess I have no choice,' that doesn't exist."

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