Do No Harm Calls on Medical Associations to Follow the ASPS and Reject ‘Gender-Affirming Care’ for Minors

Earlier this week, City Journal published a statement from the American Society of Plastic Surgeons questioning the evidence for so-called “gender-affirming care” for minors. The ASPS told Manhattan Institute fellow Leor Sapir that there is “considerable uncertainty as to the long-term efficacy for the use of chest and genital surgical interventions” for minors and that “the existing evidence base is viewed as low quality/low certainty.” 

Moreover, the ASPS stated it is currently reviewing its initiatives to promote evidence-based gender surgical care, and noted it has not endorsed any medical organization’s standards of care regarding child gender transitions.

Do No Harm applauds the ASPS for choosing to follow the evidence, and urges other medical associations to do the same.

The efficacy of gender medical interventions for minors is not well supported by existing evidence, and these treatments carry unknown dangers and uncertain long-term effects. This is true of puberty blockers, cross-sex hormones, and other interventions – not just gender surgical procedures.

Several European countries already recognize the experimental nature of “gender-affirming care” for minors and have limited children’s access to these interventions. It’s time for the U.S. to follow suit.

However, this can only happen when leading medical institutions acknowledge the obvious reality: that so-called “gender-affirming care” is grounded not in well-established science, but ideological zeal. 

It is incumbent upon all physicians to speak up for evidence-based care and reject dangerous treatments. It is not too late for the American Medical Association, the American Academy of Pediatrics, the Endocrine Society, and many others to return to the truth.

Hear from Do No Harm’s fellows on the ASPS statement.

Do No Harm Senior Fellow Dr. Richard Bosshardt: 

“As a proud member of the American Society of Plastic Surgeons for over thirty years, a father of three, and grandfather of six, I have viewed the uncritical rush to embrace experimental gender-affirming care for minors with dismay and alarm. 

I have wondered and even asked on the ASPS discussion forums why my society, which should be in the forefront of discussions regarding transgender surgery, has not weighed in on this issue. 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,’ when it is not even close.

I am proud that my society has finally stepped up and raised serious concerns about this practice. Plastic surgeons appreciate better than any other specialist the unique and daunting challenges of transsexual surgery. Even in the best of hands and ideal circumstances, these are among the most complex and challenging surgeries, with a high rate of complications, some of which can be permanently crippling and with no good data on long term results in minors.

Such operations in minors who have not gone through normal puberty amount to nothing less than childhood experimentation. Given the overwhelming evidence that should raise red flags about gender-affirming care, I hope that the courageous stance of the ASPS will be the first of many such organizations to do the same.”

Do No Harm Senior Fellow Dr. Travis Morrell:

“The American Society of Plastic Surgeons (ASPS) deserves credit for being the first major U.S. medical society to simply acknowledge the obvious truth: we don’t have a solid evidence-base for the chest and genital surgery pushed widely by other American medical societies. 

Yet mastectomy is widely performed on 15, 16, and 17-year-olds, and sometimes even 12-year-olds, despite the lack of evidence of long-term help or safety.

The ASPS acknowledgement is the first crack in a dam – a crumbling dam of activism struggling to hold back a sea of evidence. Following evidence-based decisions of multiple European medical organizations, most practicing American physicians are hoping that their leadership will soon quit deferring to activists and instead make statements defending their patients with accurate assessments of the evidence.”

Do No Harm Senior Fellow Dr. Miriam Grossman:

“The evidence for surgically modifying the body to treat gender dysphoria, an emotional disorder, has always been remarkably weak, in minors as well as adults. In the absence of robust evidence of long-term benefit, how is it that surgeons have permanently disfigured EVEN ONE PATIENT, let alone thousands? Will the ASPS issue a warning to its members that youth who reject the reality of their sexed bodies need psychotherapy, not operations? While the ASPS’s new position, as expressed in their email to Mr. Sapir, is a major breakthrough, many questions remain.”

Do No Harm Senior Fellow Dr. Aida Cerundolo:

“Medical ‘gender-affirming’ care for children is the canary in the coal mine. The embrace of ideology and subjective reality over evidence and truth threaten the integrity of all of medicine, risking patient harm. As an increasing number of patients emerge from life-altering gender-affirming treatments realizing that gender was not the cause of their emotional distress, the harm will become impossible to ignore. It seems the ASPS recognizes this weighty decision and has chosen in favor of patient well-being by prioritizing evidence above all else.”

Do No Harm Patient Advocate Chloe Cole: 

“It’s bittersweet to see the gender industry now acknowledging the harm of cross-sex modification surgeries for minors. If they had recognized this sooner, it’s possible my detransitioned friends and I wouldn’t have lost our breasts and other organs. We cannot allow them to walk away as though they just realized the truth. This was always wrong – irreversibly harming children for profit is unconscionable, and it’s time the entire industry is held accountable for these grave injustices. Still, I’m relieved to see medical professionals finally moving in the right direction.”