For some time, the medical establishment in America has supported so-called transition surgeries for minors to become a member of the opposite sex. The “science” supposedly had spoken and no one dared contest it.
However, the American Society for Plastic Surgeons (ASPS) has recently tossed a rather heavy stone into the placid waters of the medical consensus concerning transgender surgery and medication.
Following the scientific observations outlined by Dr. Hilary Cass in the “Cass Review,” the ASPS has broken ranks on this highly contentious topic by affirming its opposition to the transgender medical interventions.
In a move of quiet irony, the ASPS dares to say what many have whispered, but few have had the courage to publish: The medical benefits of such surgeries and medications in youth are, at present, supported by evidence that is limited and of remarkably low quality.
Currently, the landscape of transgender treatment is a battleground of legal, political and medical disputes across Europe and the United States. Unfortunately, there is insufficient input from the clergy on the moral implications. The main focus of the debate is on restricting sex reassignment surgeries and puberty blockers for minors—and increasingly, for adults.
In June 2025, the U.S. Supreme Court upheld a Tennessee law banning puberty blockers and hormone therapies for minors. The ruling effectively encouraged 25 other states to follow suit. Meanwhile, the second Trump administration has proposed rules to block Medicare and Medicaid funds from hospitals providing these interventions to youth.
Approaching 2026, a patchwork of states has enacted bans, and federal efforts are advancing to limit nationwide funding.
The Transatlantic Divide
What led to this shifting perspective is a meticulous 2020 report by Dr. Hilary Cass, a British consultant pediatrician. The “Cass Review” gently but firmly dismantled the prevailing approach of the Gender Identity Development Services (GIDS).
Her report pointed out a glaring lack of clear guidelines on when to provide psychological support instead of medical treatment. It also observed that endocrinologists were often absent from multidisciplinary meetings and that a rush to medicalize frequently led to “diagnostic overshadowing” (a cognitive bias in which healthcare providers wrongly attribute new physical or mental symptoms to a patient’s pre-existing condition). Thus, serious underlying mental health issues were tragically ignored.
The irony is palpable: European countries like Britain, Finland and Sweden and also New Zealand, have looked at the sparse evidence and decided to hit the brakes, restricting medical treatments for young people. In the United States, however, the debate has become deeply entangled in political theater, where questioning the effectiveness of a treatment is instantly branded as a partisan attack.
A Meeting of Minds—and Motives
In America, this ideological clash peaked during a meeting organized by cardiothoracic surgeon Dr. Mehmet Oz, head of the Centers for Medicare and Medicaid Services. Calling together leaders of the country’s major medical societies, he stated that “The evidence here doesn’t seem to be very good, and there isn’t a lot of it.” He asked a question that weighs heavily on the entire field: Why support irreversible physical interventions for young patients when long-term scientific research on mental health remains notably inconclusive?
On one side sat medical giants such as the American Medical Association (AMA) and the American Psychiatric Association (APA), defending guidelines that consider these procedures lifesaving. On the other side, doctors and academics pointed out the glaring gaps, insufficient controls, and short follow-up periods in the foundational research.
Given that the trend for sex reassignment medication and surgeries has been to offer them at the earliest ages, the real surprise at the meeting came from the American Society of Plastic Surgeons (ASPS). Representing plastic surgeons—the very practitioners of these physical transformations—the society announced a shift in stance. Acknowledging the low quality of current studies, they recommended that any gender-related surgeries, especially mastectomies in minors, at least be delayed until the patient is at least nineteen.
Biology, Politics and the Search for Truth
This pivot echoes the earlier, foundational critiques by Dr. Paul R. McHugh, former psychiatrist-in-chief at Johns Hopkins Hospital. Dr. McHugh has long argued that sex reassignment is a biological impossibility and that treating psychological distress with surgical intervention and medication fundamentally violates the God-given human nature.
People who undergo sex-reassignment surgery do not change from men to women or vice versa. Instead, they become feminized men or masculinized women. Claiming that this is a civil rights issue and encouraging surgical intervention is, in reality, to support and promote a mental disorder. Such actions in minors are tantamount to child abuse, considering that nearly 80 percent of those children will abandon their confused infatuation and naturally grow into adults if left alone.
The ASPS’s decision was immediately condemned from a political perspective, with critics questioning the board president’s conservative political donations. However, Dr. Scot Glasberg, the former ASPS president, explained that this policy change had been planned since 2024, when he was president, and was driven entirely by the lack of strong clinical evidence—not politics.
Blind adherence to consensus rarely leads to lasting good. When a medical community can freely question assumptions and challenge existing orthodoxies without fear of political reprisals, it fosters an environment of genuine intellectual superiority and proper care.
The decision by the ASPS to step away from the crowd and demand better science may just be the catalyst needed to restore a grounded, evidence-based perspective to prevent the mutilation of countless young people.
Photo Credit: © Raivo – stock.adobe.com
First published on TFP.org.