The American Society of Plastic Surgeons (ASPS) announced that it now recommends members refrain from performing gender transition surgeries on patients under the age of 19. The move represents a significant departure from previous positions and comes amid increasing political and legal scrutiny of pediatric gender-affirming care.

Rep. Anna Paulina (R-FL) immediately praised the guidance, stating: “Mutilating children is never done in ‘love.’ It is financially motivated coercion and needs to end.” Her comments echo a growing conservative critique of medical interventions for minors struggling with gender dysphoria.

Mutilating children is never done in “love.” It is financially motivated coercion and needs to end. https://t.co/kaLgsdgeLB

— Rep. Anna Paulina Luna (@RepLuna) February 4, 2026

The ASPS emphasized that the decision was driven by a lack of high-quality research on long-term outcomes for young patients undergoing procedures like mastectomies. The organization cited emerging evidence of potential complications and treatment harms as a reason to delay irreversible surgeries.

Between 2016 and 2020, roughly 3,700 patients aged 18 and under received gender transition surgeries, primarily breast removal, according to a study published in the Journal of the American Medical Association (JAMA). The association’s statement urges surgeons to carefully assess whether adolescents can meaningfully understand the risks, alternative approaches, and the possibility that their identity and distress may evolve over time.

“This requires taking the side of caution, which means deferring or postponing these surgeries until the age of 19,” said Dr. Scot Glasberg, a past president of the ASPS who helped shape the new guidance. The recommendation contrasts sharply with positions taken by other major medical associations, which continue to support a range of treatments for adolescents, including puberty blockers, hormone therapy, and in rarer cases, surgery.

The shift comes amid mounting political attention. The Trump administration praised the ASPS decision, calling it a “victory for biological truth,” while state-level restrictions on gender-affirming care for minors have increased following a series of Supreme Court rulings and new legislation in over 20 states. Countries including Finland, Norway, and the United Kingdom have also moved to limit or prohibit such care for minors.

Experts point to a growing number of lawsuits from “detransitioners”—individuals who later regret undergoing surgical procedures—as influencing the cautious stance. Kinnon Ross MacKinnon, a social scientist studying transgender medicine, said the guidance reflects both political pressure and liability concerns, noting, “This is a potentially protective decision for the field, but also comes at a time when governments are increasingly stepping in to regulate care for minors.”

The ASPS statement stressed that plastic surgeons have an ethical responsibility in addition to a technical one. Providers are advised to adopt “heightened caution, enhanced documentation and explicit uncertainty disclosure” when considering interventions for adolescents.