Two medical associations update their recommendations on gender-affirming care for trans youth

The American Medical Association, which has long supported gender-affirming care for transgender youth, has now endorsed some restrictions.

The AMA recommended Wednesday that any gender-affirming surgeries be delayed until adulthood, The New York Times reports. While genital surgery is almost never performed on minors, some teens undergo top surgery or facial modifications. Gender-affirming care for youth more commonly includes puberty blockers, hormone therapy, social transition, and counseling.

The AMA’s policy shift comes a day after the American Society of Plastic Surgeons recommended that surgeons delay breast/chest, genital, and facial surgery until a patient is at least 19 years old.

Gender-affirming care for minors has been under attack from conservative politicians for several years. Twenty-seven states ban all or some such care for minors, and the U.S. Supreme Court recently upheld Tennessee’s law restricting the treatment. A year ago, Donald Trump signed an executive order banning federal funding for any institution that provides the treatment to people under 19. He has also ordered the National Institutes of Health to study transition regret.

Numerous hospitals have stopped providing gender-affirming care to young people, fearing the loss of funding. The actions by the AMA and the ASPS may stop with the surgery recommendations, or they may lead to further restrictions on this care, making it harder for trans youth to access.

The plastic surgeons group cited two studies that are controversial among health care professionals and supporters of trans rights — the U.K.’s Cass Review and a report from the U.S. Department of Health and Human Services, the latter of which promotes conversion therapy and discredits gender-affirming care. Advocates and experts have said both the Cass Review and the HHS report are filled with misinformation, ignoring studies that indicate gender-affirming care is beneficial for young people.

The AMA said it remains supportive of gender-affirming care for trans youth, but it concurred with the ASPS “that surgical interventions in minors should be generally deferred to adulthood.” In 2023, the AMA had strengthened its support.

The ASPS emphasized that it is making a recommendation, not establishing a new clinical practice guideline, and that it opposes any criminalization of health care. Some states have criminalized the provision of this care to young people.

Related: What is gender-affirming care, who uses it, and do they regret it?

The American Academy of Pediatrics issued a statement Wednesday saying its support for gender-affirming care for youth has not changed.

“The guidance from the American Academy of Pediatrics for health care for young people with gender dysphoria does not include a blanket recommendation for surgery for minors,” Dr. Andrew Racine, the group’s president, said in a statement to the Times.

“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,” he added.

The World Professional Association for Transgender Health also issued a statement: “There is no definitive age or one-size-fits-all approach for every patient, which is why they are built on case-by-case assessments, involve experts on adolescent development, and are designed to support thoughtful and ethical shared decision-making in a multidisciplinary field.”

Last week, the first medical malpractice verdict related to gender-affirming care for youth came from a jury in Westchester County, New York. The jury found that a psychologist and a surgeon had failed to inform patient Fox Varian of all the risks and consequences of top surgery, which she now regrets undergoing. But her attorney said the case is not a referendum on this care but “was about whether medical professionals met the standards that covered their own profession.”