American plastic surgeons: delay gender surgery until age 19

On 3 February 2026, the American Society of Plastic Surgeons (ASPS), the American professional association of plastic surgeons with more than 11,000 physician members (source), published a position statement on gender surgery for children and adolescents. In it, it advises surgeons to delay surgical procedures for gender dysphoria — breast, genital and facial surgeries — until the patient is at least nineteen years old (source).

What the statement says exactly

The ASPS concludes that there is insufficient evidence for a favourable balance of benefits and risks of the pathway of hormonal and surgical interventions in children and adolescents (source). The complications that can occur, for example, after breast removal surgery are listed with figures and sources on genderrisico.nl. The association describes the evidence for that pathway as of very low to low certainty and also points to the uncertainty around social transition, puberty blockers and cross-sex hormones. In support, the ASPS cites, among others, the Cass Review of 2024 and the 2025 HHS report; according to the ASPS, these reviews have not removed the earlier uncertainty about the benefit of treatment. The ASPS itself says the document is not a clinical practice guideline: it has not carried out its own systematic assessment of the evidence.

A professional association that performs the procedures itself

The significance of this statement lies primarily in its source: it comes from the professional association of the surgeons who perform such operations. STAT News called it a break from major US medical organizations that have supported the care (source). At the same time, the ASPS opposes criminal or punitive measures against doctors who provide this care and expresses confidence in the individual judgement of its members (source).

The AMA's response

After the statement there were conflicting reports about the position of the American Medical Association (AMA). The AMA told NPR that it supports evidence-based treatment, including gender-affirming care, and that, based on available evidence, "surgical interventions in minors should be generally deferred to adulthood". According to the AMA, that is neither a reversal nor an endorsement of the ASPS position, but a clarification of its existing position (source).

Why this is more than an American issue

For the Netherlands and Belgium, the ASPS statement is not legislation and does not immediately change clinical practice. In its statement the ASPS also cites, besides the Cass Review and the HHS report, the Finnish recommendation of 2020 and the Swedish guideline of 2022 (source). In the United States itself, voters in Colorado will vote on 3 November 2026 on Proposition 135, a ban on gender surgery for minors (source). How the Nordic countries approach surgery for gender dysphoria is described in this overview.