Gender-affirming surgery should wait until 19 say US plastic surgeons, citing UK policy

Getty/shapecharge

By Erin Dean

Surgeons should delay gender-related breast, chest, genital and facial surgery until a patient is at least 19 years old, the American Society of Plastic Surgeons has recommended in a position statement.

The guidance said the clinical management of children and adolescents with gender dysphoria or gender incongruence has undergone rapid change, driven by insights from new research and the independent review in the UK into gender identity services in England.

The Cass review, commissioned by NHS England and published in April 2024, found the evidence base for youth gender interventions, particularly puberty blockers, was "weak".

It called for a holistic, care-focused approach with more research and regional hubs. 

The American Society of Plastic Surgeons (ASPS) says that over the past two decades treatment has increasingly included psychological assessment, social transition, puberty blockers, hormones and surgical procedures.

But while numbers of children seeking care has risen, both the Cass review and a major review from the US Department of Health and Human Sciences in 2025 highlighted that the “natural course” of the condition remains poorly understood.