The Trump administration has officially commended a recent declaration by the American Society of Plastic Surgeons (ASPS), which suggests delaying gender-affirming surgical interventions until individuals are at least 19 years old. This endorsement aligns with the administration's ongoing initiatives to curb access to gender-affirming care for young people across the nation. Through executive orders, critical policy reports, and various legal pressures, the White House has actively sought to influence the landscape of medical care for transgender minors, creating an environment where medical organizations are re-evaluating their guidelines and practices.
This week, the Trump administration lauded a statement from the American Society of Plastic Surgeons (ASPS), which advises that gender-related surgeries be deferred until a patient is at least 19 years old. Jim O'Neill, Deputy Health and Human Services Secretary, celebrated this as a "victory for biological truth," asserting that the ASPS had established a "scientific and medical standard" for all healthcare providers. This commendation underscores the administration's consistent stance on restricting gender-affirming care for minors.
The ASPS clarified in an email to NPR that their updated position is not a deviation from previous guidelines, nor is it a new clinical practice standard. Instead, it represents a refinement of their recommendations, considering current scientific evidence and the varied legal and regulatory environments. This clarification comes amidst an evolving landscape shaped by numerous state-level prohibitions on gender-affirming care and the White House's explicit objective to end such procedures for minors nationwide.
In a significant move during his second term, President Trump issued an executive order declaring a policy against federal funding, sponsorship, promotion, or assistance for the "transition" of children, vowing rigorous enforcement of laws prohibiting or limiting these procedures. Subsequently, the Department of Health and Human Services (HHS) released a report questioning the research supporting access to gender-affirming care and cautioned state Medicaid directors. The Department of Justice also issued subpoenas to children's hospitals and threatened providers with prosecution, intensifying the pressure on medical institutions.
These actions culminated in a proposed rule by federal health officials to withhold Medicare and Medicaid funding from hospitals offering gender-affirming care to children and teenagers. This, combined with a wave of investigations by the HHS Inspector General, has led to the closure of many hospital gender clinics across the country. The prevailing climate of potential malpractice lawsuits, state-imposed bans, and hospital program terminations has significantly reduced options for transgender adolescents seeking surgery, aligning with the White House's declared objectives.
The impact of these policies is deeply felt by individuals like a 15-year-old transgender boy in California, whose plans for top surgery were put on hold after Kaiser Permanente stopped offering such procedures to youth. He expressed his disappointment with the ASPS's position, noting the administration's consistent efforts to restrict various forms of gender-affirming support, including warning letters to manufacturers of chest binders. He critically observed that the implicit message from these actions appears to be a push towards detransitioning.
Statistics indicate that gender-affirming surgery for teenagers is relatively uncommon, with most procedures being top surgeries. A study examining surgical databases revealed an average of 800 top surgeries performed annually on patients aged 18 or younger between 2016 and 2020. However, the exact impact of state-level bans, which surged after 2022, on these numbers remains unclear. The ASPS's recommendation to delay surgery until age 19 largely aligns with existing standards of care for transgender youth, which typically advise waiting until adulthood for gender-affirming surgical interventions.
The ASPS emphasized that cosmetic procedures, such as breast augmentation for cisgender teenagers (which they recommend waiting until age 18 for), involve different ethical considerations than gender-affirming surgeries. They highlighted that gender-affirming interventions are irreversible, have uncertain long-term benefits, and carry potential lifelong harms for minors whose identities are still developing. This distinction underscores the cautious approach taken by the medical community regarding surgical decisions for minors.
A California mother recounted her family's journey, beginning when her child came out as transgender at 13. Initially hesitant about permanent surgery, she eventually witnessed her son's distress from using binders and agreed to pursue top surgery at age 15. She detailed the extensive therapeutic and medical consultations required, and the challenges faced, including a canceled appointment. Her son, now 17, has flourished since his surgery two years ago. She expressed profound regret that they couldn't act sooner and anger at the systemic barriers preventing other transgender youth from accessing necessary care, forcing them to endure significant hardship.
In the wake of the ASPS statement and the Trump administration's promotion, there has been some confusion regarding the stance of other medical groups. The American Medical Association (AMA) clarified its position, stating that it supports evidence-based treatment, including gender-affirming care, but generally recommends deferring surgical interventions until adulthood. The AMA emphasized that this is not a shift but a clarification of its existing guidelines. Similarly, the American Academy of Pediatrics asserted that it does not issue blanket recommendations for surgery for minors, advocating that such decisions should remain between doctors, patients, and their families, free from political interference.
Kellan Baker of the Movement Advancement Project, an LGBTQ think tank, noted that the ASPS position on delaying surgery until age 19 is not novel, observing it aligns with long-standing standards of care for transgender youth. Baker suggested that the Trump administration strategically frames this as a significant shift within the medical community towards more stringent restrictions, while downplaying its own substantial political influence in pushing for such outcomes. This highlights the ongoing tension between medical autonomy and political agendas in the realm of transgender healthcare.