Positions
In February 2026, the ASPS became the first major medical association in the U.S. to change its guidance on gender-affirming surgery for minors, recommending to its members that chest, genital, and facial surgeries not be performed until age 19 due to a lack of evidence. [5] [6] [7] In doing so, it heavily cited the Trump administration HHS gender dysphoria report, which was written in compliance with Executive Order 14187, that made it illegal for the federal government to advocate in favor of gender affirming care under the age of 19; and which recommended conversion therapy instead. [8] [9] [10] The ASPS also cited its British counterpart, the Cass Review. Both reports have been criticized for spreading misinformation about gender-affirming care. [11] The decision was lauded by the Trump administration including HHS leaders Robert F. Kennedy Jr., Jim O'Neill, Mehmet Oz and Mike Stuart. [12] However, ASPS stopped short of issuing new clinical practice guidelines. They also added that they were opposed to governments banning gender-affirming surgery, saying that "regulation of medical care is best achieved through professional self-regulation, rather than criminal law or punitive legislative approaches." [13] Additionally, ASPS said they would be open to revisiting and re assessing the position in the future "should the evidence base evolve to demonstrate clear benefit with acceptable risk". [14] The statement was criticized by transgender advocates and other major medical associations who said there is "no definitive age or one-size-fits-all approach for every patient" and emphasized that care should be delivered in case-by-case assessments rather than blanket opposition. [15]
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