In a groundbreaking position statement, the American Society of Plastic Surgeons (ASPS) formally recommended that “surgeons delay gender-related breast/chest, genital, and facial surgery until a patient is at least 19 years old.” The ASPS’ position statement cites medical practice reversals in the UK, Sweden and Finland, growing uncertainty of benefits and credible evidence of harms, and marked changes in the patient population. The statement also favorably cites the U.S. Department of Health and Human Services’ report on best practices for treating gender dysphoria, including its contributions to better understanding the potential harms associated with medicalization and the gaps in the research literature regarding “long-term physical, psychological and psychosocial outcomes.” While the statement’s recommendations only apply to surgical interventions, the statement itself acknowledges that the evidence for endocrinological interventions is similarly limited. The statement marks one of the first breaks from the medical consensus on “affirming care,” with ASPS joining the American College of Pediatricians in opposing some interventions. For additional coverage, see SEGM’s analysis in Reality’s Last Stand, Paige Winfield Cunningham in the Washington Post, Ben Ryan in UnHerd, and Andrew Jacobs in the New York Times.
In City Journal, MI senior fellow Leor Sapir traces the evolution of the ASPS’ stance on surgeries for pediatric medical transition and highlights some of the more subtle, but no less significant, conceptual points made in the ASPS statement. Aside from conceding low-certainty for benefits, Sapir points out how the ASPS statement acknowledges the lack of research on the “natural course” of gender dysphoria, as well as the absence of assessments that can predict how a minor’s identity will evolve. Sapir also points out the significance of ASPS addressing the limitations of the “autonomy principle” to guide decision making in gender medicine, when the autonomy argument only applies if a treatment has a favorable risk-benefit ratio. Sapir also notes the significance of the American Medical Association agreeing with ASPS’ statement on surgeries in a statement provided to National Review (and later to the New York Times). “If other medical groups or individual doctors who have endorsed pediatric medical transition agree with the ASPS on surgeries, on what grounds can they continue advocating for puberty blockers and cross-sex hormones, given that these interventions also have an unfavorable risk-benefit profile and are given to minors whose sense of self is still developing?” Sapir muses.
In the Free Press,, journalist Ben Ryan broke the news of the first medical malpractice suit where a patient was awarded damages for harms suffered while undergoing gender transition procedures as a minor. Varian Fox, who underwent a double mastectomy at sixteen, was awarded $2 million in damages by a jury; $1.6 million for pain and suffering and an additional $400,000 for future medical expenses. Fox’s complaint accused her surgeon and psychologist of failing to conform with the “standard of care” by failing to screen Fox for psychological comorbidities which could have complicated her clinical presentation, and for violating informed consent by failing to adequately prepare her and her family to make an informed decision, including by using the looming threat of Fox’s suicide to pressure her mother into consenting to treatment. Ryan—the only journalist to cover the duration of Fox’s trial—has published a number of documents from the case on his personal Substack. For additional coverage, see the National Review and New York Times.
The Society for Evidence-Based Gender Medicine (SEGM) challenges the findings of a Swiss analysis, which echoes some American analyses in prematurely declaring that the era of peak trans-identification is over. The Swiss analysis is based on declining referral numbers to a Zurich gender clinic, however, SEGM points out alternative interpretations of the data, including failing to account for the emergence of several new gender clinics since 2020, treatments accessed via private providers, and a return to pre-covid levels of referrals which are still historically elevated. SEGM also explains the limitations of American analyses which similarly argue that “peak trans” is over. “Confirmation bias, weak data, and overconfident interpretations are at the heart of the medical scandal that has become synonymous with the field of youth gender medicine. We cannot fight bad science with more bad science. We must commit to rigorous, impartial analysis—and follow the evidence wherever it leads. Currently, we find no reliable evidence of a decline in transgender identification or in the demand for pediatric medical transition in the available data” SEGM concludes.
Citing opposition from the federal government, Minnesota Children’s Gender Health Program has announced that it might cease rendering endocrinological interventions for dysphoric minors later this month. “If conditions remain the same, we plan to temporarily pause prescribing puberty-suppressing medications and pubertal hormones (estrogen and testosterone) for patients under age 18 in our Gender Health program, effective Friday, Feb. 27, 2026,” the hospital announced on its website. The federal activity Minnesota Children’s alludes to includes new proposed federal rules which would prohibit Medicaid and CHIP reimbursements for “affirming care” for minor patients, and a rule which would make rendering sex-rejecting procedures disqualifying for participating in Medicare and Medicaid programs.
After San Diego’s Rady Children’s Hospital announced a pause on offering medical transition procedures to dysphoric minors, California Attorney General Rob Bonta has filed a suit alleging that Rady Children’s is now in violation of a merger agreement with Children’s Hospital of Orange County. According to Bonta’s suit, as a condition of its merger with Children’s Hospital of Orange County, Rady Children’s agreed to continue rendering so called “gender affirming care” for minors. “The recent changes to our gender-affirming care services reflect a very difficult decision. That decision was guided by our responsibilities as a nonprofit pediatric healthcare system to continue serving all children and families” the hospital said in a recent statement.
National Review pushes back against the findings of a report published by Utah’s Department of Health and Human Services which concluded that “affirming care” has considerable mental health benefits. NR, drawing on a recent fact check by the medical watchdog organization, Do No Harm, explains the methodological limitations of Utah’s report, including its failure to meet the standards of a systematic review, which explains how and why the report’s findings could diverge from the HHS’ umbrella review which took into account the findings of seventeen systematic reviews. “Besides researchers failing to scrutinize the reliability of the studies included, the report did not register the study with a systematic review platform, which would have allowed outside researchers to scrutinize the underlying research” National Review notes.
In Reality’s Last Stand, I fact checked a Newsweek article written by two former HHS employees—who served under the Biden-Harris administration—that mischaracterizes HHS’ peer-reviewed report on best practices for the treatment of pediatric gender dysphoria. I contextualize the Newsweek piece in our broader culture of misinformation and institutional distrust, and explain how the authors fail to grasp, or willfully ignore, the principles of evidence-based medicine while parroting verifiably false claims about the evidence-base in support of pediatric medical transition. The piece also attempts to explain how medical societies fell in line on “gender affirming care,” and the incentives that make organizational reform a daunting challenge.
Joseph Figliolia
Policy Analyst
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