Physician Group Opposes Youth Gender Transition Surgery— Plastic surgeons support waiting until patients are at least 19 years old

February 28, 2026 nancyvalko AMA, culture, health care reform, law, media, medical ethics, transgender, transgender care

In a stunning February 3, 2026 Medpage article “Physician Group Opposes Youth Gender Transition Surgery” by Kristina Fiore, Director of Enterprise & Investigative Reporting, MedPage Today reports:

“For the first time, a major U.S. physician group has recommended against gender transition surgeries for youths.

On Tuesday, the American Society of Plastic Surgeons (ASPS) sent a position statement to its 11,000 members recommending against gender-related breast/chest, genital, and facial surgery until a patient is at least 19 years old.”

and

ASPS said its understanding has evolved in light of “additional comprehensive evidence reviews” on gender dysphoria, including an HHS report that was issued last May. Both the HHS report and the U.K.’s Cass Review concluded that the “natural course of pediatric gender dysphoria remains poorly understood,” according to the position statement.

“The HHS report underscores that this uncertainty has significant ethical implications: when the likelihood of spontaneous resolution is unknown and when irreversible interventions carry known and plausible risks, adhering to the principles of beneficence and non-maleficence … requires a precautionary approach,” the statement said.

ASPS emphasized that its advice comes in the form of a policy statement, not a clinical practice guideline, given the “current state of the evidence and variability in legal and regulatory environments.”

It also advised its members to “remain aware of state laws concerning transgender and gender-diverse individuals that may impact their practices,” as many states have banned gender-affirming care in youths.

The ASPS statement comes just a few days after a jury in New York awarded $2 million to a patient who had accused her psychologist and plastic surgeon of failing to obtain adequate consent before performing a double mastectomy on her when she was a teenager. It’s the first malpractice verdict against providers of youth gender care.” (Emphasis added)

She also writes that:

“The position statement breaks with other major medical associations in the U.S., most notably the American Academy of Pediatrics (AAP) and the Endocrine Society, which support gender-affirming care. It’s also a departure from ASPS’s past stance in 2019, which was that gender surgery can help patients improve their mental health, according to the Washington Post.

The American Medical Association said in a statement that it supports evidence-based treatment, including gender-affirming care. The association agreed with ASPS in part, but stopped short of saying surgeries should be deferred to adulthood in all cases.

“Currently, the evidence for gender-affirming surgical intervention in minors is insufficient for us to make a definitive statement,” the group said in a statement. “In the absence of clear evidence, the AMA agrees with ASPS that surgical interventions in minors should be generally deferred to adulthood.”

However,

“The World Professional Association for Transgender Health (WPATH), which develops standards of care for transgender patients globally, reiterated its support for access to surgical care for minors under “cautious guidelines and criteria.”

The group’s guidelines oppose a “definitive age or ‘one-size-fits-all’ approach for every patient.” Decisions should be case-by-case, based on the evaluations of multiple types of health experts and experts in adolescent development.

“WPATH stands firm in its commitment to advancing evidence-informed clinical guidelines to help improve the lives and well-being of transgender people around the world,” the group said in a statement.

and:

“AAP president Andrew Racine, MD, PhD, said his organization “does not include a blanket recommendation for surgery for minors” with gender dysphoria. “The AAP continues to hold to the principle that patients, their families, and their physicians — not politicians — should be the ones to make decisions together about what care is best for them.”

Fewer than 1,000 children under age 19 receive gender surgery in the U.S. each year, and the vast majority of those cases are mastectomies, according to a 2023 cohort study.

CONCLUSION

As the Medpage article states:

Nonetheless, the Trump administration has been cracking down on gender-affirming care in the U.S., through the HHS report, as well as through proposed CMS rules that would prohibit hospitals from performing gender surgeries for people under 18 as a condition of participation in Medicare and Medicaid programs.

HHS issued a press release supporting the ASPS position statement, with Secretary Robert F. Kennedy Jr. congratulating the group for “standing up to the overmedicalization lobby and defending sound science.”

CMS Administrator Mehmet Oz, MD, also applauded the move: “When the medical ethics textbooks of the future are written, they’ll look back on sex-rejecting procedures for minors the way we look back on lobotomies. I applaud the American Society of Plastic Surgeons for placing itself on the right side of history by opposing these dangerous, unscientific experiments.”

This will continue to be a hot topic.

What do YOU think?

Two States Are Facing Challenges in Death Decisions Regarding Death Determination Errors and Assisted Suicide

February 3, 2026February 4, 2026 nancyvalko advance directives, assisted suicide, brain death, civil rights, conscience rights, end-of-life, law, Living wills, medical, medical ethics, mental health, organ donation, suicide

Delaware and Kentucky are facing challenenges to lasws r4gatding end of life deicisions.

In Kentucky, Thaddeus Pope in his January 29th blog Death Determination Errors Addressed in New Legislation states:

“The goal in death determination is 100% accuracy: zero false positives. So, it is regrettable that we need legislation to address roles and responsibilities when a patient who was determined and declared dead is not dead. But we now have such legislation.

Kentucky H.B. 510 provides that “during any organ donation recovery, preservation, or procurement activity … a pause in procedure shall be initiated if any individual … reports on any of the following: (1) Observed or suspected change in neurological status; (2) Observed or suspected indication of life; or (3) Uncertainty regarding the accuracy or completeness of neurological status or death declaration assessments.” (Emphasis added)

The goal in death determination is 100% accuracy: zero false positives. So, it is regrettable that we need legislation to address roles and responsibilities when a patient who was determined and declared dead is not dead. But we now have such legislation.

And in Delaware, a lawsuit has been filed by several disability organizations and others, after the bill was signed by the governor and took effect January 1, 202. the plaintiffs state that:

Delaware’s End of Life Options Act, 16 Del. C. § 2501C, et seq. (“EOLOA” or the
“Act”), is scheduled to go into effect on January 1, 2026 (or as soon as final regulations are in
place), and will allow providers, including Advanced Practice Registered Nurses (“APRN”), to
prescribe drugs—not to alleviate pain or suffering—but to cause the death of the patient and
intentionally facilitate suicide.
Plaintiffs, people with life-threatening disabilities and organizations that represent
and advocate for people with life-threatening disabilities, belong to a class of protected individuals
who are at imminent risk of harm if the Act is allowed to go into effect. To protect themselves
from this fast-approaching threat, Plaintiffs bring this action to stop Defendants, government
officials, from putting in place this deadly and discriminatory system. The Act—if allowed to go
into effect—will steer people with life-threatening disabilities away from necessary lifesaving and
mental health care, medical care, and disability supports, and toward death by suicide under the
guise of “mercy” and “dignity” in dying.
Throughout the country, a state-endorsed narrative is rapidly spreading that threatens people with disabilities: namely, that people with life-threatening disabilities should be directed to suicide help and not suicide prevention. This world view is being touted as a common-sense objective: people who have life-threatening disabilities should be able to readily obtain physician-assisted suicide. At its core, this is discrimination plain and simple. With cuts in healthcare spending at the federal level, persons with life-threatening disabilities are now more vulnerable than ever.
EOLOA’s passage is clear and present danger to people with life-threatening
disabilities in Delaware. Persons who are identified as “terminal”—i.e., people with life-threatening disabilities- are able to obtain assisted suicide. The new law does not require any evaluation, screening, or treatment by a mental health professional for serious mental illness, depression, or treatable suicidality, all of which could are necessary for informed consent and a
truly autonomous choice, before the lethal prescription is written. The provider need not have
expertise with the patient’s specific illness or condition and need not be trained on mental health
symptoms or side effects associated with the patient’s illness or treatment. While the provider is
supposed to discuss “feasible” alternatives to suicide, including available treatment options and
the foreseeable risks and benefits of each, the provider is not required to do anything to help the
patient obtain access to these frequently difficult to obtain services, nor are insurers required to
cover them.

Assisted suicide under EOLOA violates federal disability rights laws and the U.S.
Constitution’s Equal Protection clause, which protects people with disabilities from discrimination,
exclusion, and life-threatening state action. Under federal law, a public entity may not withhold
services or make services available on unequal terms based on disability. EOLOA, however, does
just that. EOLOA is offered to people with life-threatening disabilities. Not only is this facially
discriminatory, it also places persons with disabilities in a much more vulnerable position.

The lawsuit makes several other important points. I suggest anyone concerned with this issue read them all, especially those of us fighting assisted suicide laws.

Forgiveness is a Decision, Not a Feeling

January 8, 2026 nancyvalko faith, faith and forgiveness, law, mental health, pro-life

I was shocked when I turned on the tv September 10, 2025 and saw the assassination of Charlie Kirk, the founder of Turning Point USA, on September 10, 2025 debate while speaking at Utah Valley University on the first stop this fall of his “The American Comeback Tour,” which invited students on college campuses to debate hot-button issues.

I admired the 31-year-old’s efforts to engage college students and others in open and respectful debate about some of the most divisive issues roiling politics today.

As Emily Standley Allard wrote for MSN:

“(h)e built a political platform that resonated deeply with young conservatives while provoking equally strong opposition from progressives.

Kirk presented himself as a combatant in America’s culture wars, speaking directly to students, churchgoers, and millions of podcast listeners about what he considered existential battles over freedom, faith, and America’s future. “

Since then, his wife, Erica Kirk, has become the head of Turning Point USA while raising their two young children.

Erica Kirk’s Response to Her Husband’s Murder

As The Hill reported:

“I’ve had so many people ask, ‘Do you feel anger toward this man? Like, do you want to seek the death penalty?” Kirk said. “I’ll be honest. I told our lawyer, I want the government to decide this. I do not want that man’s blood on my ledger.”

Kirk reiterated that message during her eulogy on Sunday. The 36-year-old received a lengthy standing ovation when she was called to the stage, and was emotional throughout her remarks.”

“Erika Kirk, the widow of Charlie Kirk, said Sunday that she forgives the man accused of killing her husband.

“On the cross, our savior said, ‘Father, forgive them. For they do not know what they do.’ That man. That young man. I forgive him,” Erika Kirk said at her husband’s memorial, with her voice softening and tears streaming down her face.

“The answer to hate is not hate,” she said. “The answer we know from the Gospel is love, and always love.”

CONCLUSION

Erica Kirk’s forgiveness of her husband’s killer shocked many people, but I understand the power of forgiveness.

In 1983, we lost a daughter with Down syndrome and a severe heart defect, and my husband had a breakdown and was hospitalized several times.

I thought he was getting better, but in 1987, my three children and I returned home from church, and he was gone. I discovered that he had taken all our money and fled to Illinois.

Our 10-year-old son was devastated and said, “I will never forgive him!”

I told him that he will and he must. He was shocked and asked me if I could forgive him.

“I already have”, I told him.

I explained that forgiveness is a decision, not a feeling, and that refusing to forgive his father would hurt him more. Faith and forgiveness would heal all of us.

It was a difficult time for all three children with a divorce, selling our house, moving to another home, and the children going to new schools- not to mention my having to go back to working as a nurse because Missouri did not cross state lines to enforce child support.

However, I did allow the children to visit with their father with a guardian supervising.

I was so happy when my son eventually told me that he was starting to feel forgiveness in his heart! He was healing!

Although my ex-husband never got better mentally and eventually died, we visited him in his last days, and that was a blessing for all of us!

Thank you, Erica Kirk, for your example of faith and forgiveness!

nancyvalko

A Nurse's Perspective on Life, Healthcare and Ethics

Year: 2026