health care reform

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

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.

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A Doctor’s New Euphoria

nancyvalko Compassion & Choices, health care reform, law, medical ethics

A Dec.4, 2016 Wall Street Journal article titled “Diagnosing Your Doc’s New Euphoria-Suddenly there’s hope for dismantling ObamaCare—and restoring sanity for doctors and patients” by Dr. Marc Siegel recounts the disturbing health insurance experiences of two of his patients in office visits.

He writes that:

Such encounters happen much more often now because ObamaCare has added low-quality heavily subsidized insurance that claims to be comprehensive and inflates patient expectations. This has bled into the entire health-care system, where more and more patients come to doctors expecting far more than we can possibly deliver regardless of their insurance….

Government regulations cause patients to buy expensive insurance policies. One example is ObamaCare’s requirement that everyone on the exchanges, Medicaid patients and businesses with fewer than 50 employees that provide coverage all be covered for maternity care and other benefits whether or not they need them.

He concludes:

 If much of ObamaCare is repealed, there will be room for more choice, competition and cost awareness. We can see a return of catastrophic health insurance with lower tax-deductible premiums, high deductibles and more payment up front, with government-run clinics for those who lack insurance.

I noticed my own doctor’s good mood the other day at my yearly wellness visit and I was not surprised. With the likely repeal or reform of Obamacare with its burdensome government regulation and compliance mandates, the current high burnout rate of physicians and other health care workers may decrease.

But there are other problems with Obamacare as it is structured today.

I have long been concerned about the direction of healthcare and in 2003, I was privileged to serve on a Catholic Medical Association task force on healthcare reform. Many great ideas, such as health savings accounts, measures to help the uninsured poor, and better conscience rights protections, were developed and published in a 2004 report entitled “Health Care in America: A Catholic Proposal for Renewal”. The result was some interest but little action as the Iraq War heated up.

In 2009, I wrote an article titled “A Nurse’s View of Ethics and Health Care Legislation”   about the proposed new Affordable Care Act (aka Obamacare). I read much of HR 3200, the 1000+-page proposed health care reform bill proposed before passage of the final Affordable Care Act that Rep. Nancy Pelosi famously said that Congress had “to pass the bill so you can find out what’s in it”.   Here is some of what I wrote then with emphasis added:

I am also concerned about a massive governmental overhaul of our health care at an exorbitant financial as well as moral cost.

Much of the bill’s language is murky legalese that is hard to understand. Much of the language is vague enough to allow all sorts of interpretations — and consequences….

Government officials who advocate the proposed healthcare reform legislation are furiously trying to allay the fears of the increasing number of citizens who oppose the bill — but we have only to look at the statements and philosophy of the people supporting this bill to recognize potential dangers. Here are some examples:

— Compassion and Choices (the newest name for the pro-euthanasia Hemlock Society) boasted that it “has worked tirelessly with supportive members of congress to include in proposed reform legislation a provision requiring Medicare to cover patient consultation with their doctors about end-of-life choice (section 1233 of House Bill 3200).”

— On abortion, President Barack Obama not only said “I remain committed to protecting a woman’s right to choose” on the January 22, 2009 anniversary of Roe v. Wade, but he also moved to rescind the recently strengthened federal conscience-rights protections for doctors and nurses who object to participating in abortion.

— On rationing: Dr. Ezekiel Emanuel, President Obama’s health care advisor, wrote in the January 2009 issue of the British medical journal Lancet about using a “complete lives system” to allocate “scarce medical interventions”. He wrote that “When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated.”

I hoped that I would be proven wrong about Obamacare but today’s problems with it speak for themselves.

Hopefully, our leaders will now come up with common sense and ethical changes that will meet the needs of the public and help healthcare providers provide the best care possible.