The admonition to "first, do no harm" is an ancient cornerstone of medical ethics. With that in mind, the American Society of Plastic Surgeons broke ranks with other medical organizations on Tuesday, recommending that member physicians refrain from performing gender transition surgeries on anyone under age 19. The major milestone in Western society's nascent recovery from gender-transition madness follows a landmark courtroom victory for a young woman whose breasts were removed at age 16, and the AMA has already signaled it will follow the ASPS's lead.  

The ASPS's position statement uses pointed language that echoes the profound concerns that have long been raised by gender-transition skeptics: 

"When uncertainty concerns not just the magnitude of benefit but the existence of benefit in and of itself, and when potential harms are irreversible and identity-defining, the principles of beneficence and non-maleficence require a more precautionary approach." 

The group's adoption of a new philosophy followed a review of research about the long-term outcomes for transitioned youngsters. "There’s no data to suggest that you can predict who will benefit from surgery and who will have a negative outcome,” former ASPS president Scot Bradley Glasberg told the New York Times. “That requires taking the side of caution, which means deferring or postponing these surgeries until the age of 19.”

The overwhelming majority of gender-altering surgeries performed on minors are mastectomies. Last week, a New York jury found a psychologist and a surgeon liable for malpractice after they convinced a 16-year-old girl to lop off her breasts. It was the first medical malpractice case involving a de-transitioner to reach a verdict. That 16-year-old is now 22 and identifies as a woman. She also now identifies as a millionaire, after being awarded $2 million in damages, comprising $1.6 million for past and future pain and suffering, and $400,000 for future medical expenses.

During the proceedings, the victim, Fox Varian, said she had the sense she'd made a colossal error as soon as she saw the scars on her chest. "I immediately had a thought that this was wrong, and it couldn’t be true," she said, adding that the surgery left her with 'searing hot' nerve pain." There was also emotional damage. "Shame. I felt shame. It’s hard to face that you are disfigured for life."

In its statement, ASPS pointed to Finland, Sweden and the United Kingdom, who've all updated their guidance to recommend against endocrine and surgical interventions for minors. The plastic-surgeon group became the first major US medical organization to counsel against gender-morphing procedures for children.

A similar announcement by the American Medical Association may be imminent. Asked on Tuesday if the powerful group would update its stance, the AMA told National Review that, because “the evidence for gender-affirming surgical intervention in minors is insufficient for us to make a definitive statement . . . the AMA agrees with ASPS that surgical interventions in minors should be generally deferred to adulthood.”

More are sure to follow, in light of growing state-level regulatory restrictions and last week's landmark liability ruling -- doubtless the first of many that will hammer overly-eager doctors, psychologists and counselors for their malpractice. “Knowing now that a jury will feel comfortable holding doctors accountable for this is something that I think every doctor should take seriously," Adam Deutch, the lawyer who represented Varian in the New York case, told the New York Post. (When will we see the first case filed by a child against their parents?)

Public opinion will also play a part, and opposition to gender-transitioning children is mounting among the public. A February 2025 Pew Research poll found that 56% of Americans favor a ban on gender-transitions for minors, with only 26% opposing a ban, and 17% unsure. As more horror stories come to light via court cases, we expect many of those undecided people will come off the fence and land on the side of protecting children from irreversible harms springing from decisions driven by fleeting adolescent angst.