2 major medical groups back limits on gender transition procedures for minors

WASHINGTON (OSV News) -- Two major medical groups have backed limitations on certain types of medical or surgical gender reassignment procedures for minors who identify as transgender.

Statements from the American Society of Plastic Surgeons and the American Medical Association marked the first time major medical groups backed such limitations, while most have opposed efforts to restrict gender transition surgeries or provide hormonal treatments for minors experiencing gender dysphoria, often citing doctor-patient privacy.

In its policy statement, the American Society of Plastic Surgeons cited "a growing uncertainty about the benefits of medical and surgical interventions," saying it therefore "recommends that surgeons delay gender-related breast/chest, genital, and facial surgery until a patient is at least 19 years old."

"Plastic surgeons should maintain a working understanding of the current limits of evidence regarding social transition, puberty suppression, and cross-sex hormones; how prior medical/hormonal interventions may themselves influence physical and cognitive development, psychosocial functioning, and surgical care and risk; and the degree to which patient goals, expectations, and decision-making capacity have been evaluated in light of developmental stage and uncertainty of long-term outcomes," the guidance said.

The American Medical Association, which is the nation's largest organization representing doctors and has previously backed such procedures, said Feb. 4 that they should generally be deferred until patients reach adulthood.

"In the absence of clear evidence, the AMA agrees with ASPS that surgical interventions in minors should be generally deferred to adulthood,” it stated.

The Catholic Medical Association praised the ASPS recommendation in a Feb. 5 statement.

"The Catholic Medical Association has consistently maintained opposition to gender transition interventions, especially in minors," Dr. David J. Hilger, the group's president, said in the statement. "The use of such sex-rejecting procedures fails to recognize the scientific fact that biological sex is established, determinate, and unchangeable. No medication or surgery can alter that fact."

Dr. Tim Millea, the chair of CMA's Health Care Policy Committee, added, "We look forward to many other medical organizations providing similar warnings about these interventions."

Chieko Noguchi, spokesperson for the U.S. Conference of Catholic Bishops, told OSV News Feb. 6 that "the Catholic Church is called to compassionately accompany people in their respective circumstances, which includes those struggling with his or her God-given sexual identity as male or female."

"The bishops of the U.S. have been clear that medical procedures or interventions related to 'gender transition' are not morally acceptable, and this is reflected in the revisions they recently approved for the Ethical and Religious Directives for Catholic Health Care Services (ERDs) that give authoritative guidance to those who provide Catholic health care," she said. "However, whether a provider is Catholic or not, we pray that we may all find the compassion and wisdom to better help our brothers and sisters accept who God created them to be."

The U.S. bishops in November approved an updated version of "Ethical and Religious Directives for Catholic Health Care Services," their guiding document on Catholic health care, with substantial revisions that include explicit prohibitions against such surgeries.

The updated ERDs incorporated guidance on health care policy and practices released in March 2023 by the USCCB's Committee on Doctrine. It stated the church's opposition to interventions that "involve the use of surgical or chemical techniques that aim to exchange the sex characteristics of a patient's body for those of the opposite sex or for simulations thereof."

"Any technological intervention that does not accord with the fundamental order of the human person as a unity of body and soul, including the sexual difference inscribed in the body, ultimately does not help but, rather, harms the human person," the document states.

The ASPS recommendations appear to closely mirror regulatory actions announced by the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services in December in response to President Donald Trump's executive order that sought to prohibit these procedures for individuals under 19 years old.

The ASPS did not immediately respond to a request for comment from OSV News about why age 19 was chosen.

HHS Secretary Robert F. Kennedy, Jr. said in a Feb. 3 statement, "We commend the American Society of Plastic Surgeons for standing up to the overmedicalization lobby and defending sound science."

"By taking this stand, they are helping protect future generations of American children from irreversible harm," he said.

The World Professional Association for Transgender Health, which claims to be "the leading global professional organization for clinicians, researchers, and experts in the field of transgender healthcare," said in a statement that it supports "cautious guardrails and criteria" for "adolescents to access surgical care," but argued against a "'one-size-fits-all' approach."

The group, however, has been criticized as not being solely a professional body, due to the inclusion of activists, and that its views do not represent a professional consensus.

Twenty-six states and Puerto Rico already ban or restrict such procedures, according to data from the Movement Advancement Project, an LGBTQ+ policy group.

A 2022 study by the UCLA Williams Institute found there are approximately 1.6 million people in the U.S. who identify as transgender, including about 300,000 youth (those ages 13 to 17) who identify as transgender.

A recent JAMA Pediatrics study found 926 U.S. adolescents with commercial insurance and a gender-related diagnosis received puberty blockers from 2018 through 2022, and none of them were under age 12. The study did not include minors covered by Medicaid.