US medicine must choose between a collapsing consensus on pediatric trans surgery and kids’ well-being

After a decade of denial, America’s medical establishment is starting to blink.

Two of the country’s most powerful doctors’ organizations now say gender surgeries should generally wait until adulthood — a stunning reversal after years of waving them through on children.

The American Society of Plastic Surgeons and the American Medical Association have reversed course, admitting what was once unsayable in US medicine: Irreversible gender-related surgeries on minors are not supported by solid evidence.

That public acknowledgement marks a seminal turning point.

It also raises an unavoidable question: If these procedures are too risky and too uncertain to justify today, why were they ever allowed — even encouraged — in the first place?

For nearly a decade, activist doctors operated with an unlimited green light from the nation’s medical establishment.

Overwhelmingly female teenagers had healthy breasts amputated before finishing puberty.

Surgical interventions for minors left both boys and girls sterile and dependent on lifelong medical treatment.

Other children were placed on powerful hormones with permanent adverse effects.

All this occurred under the banner of “gender-affirming care,” despite glaring gaps in supporting evidence, serious concerns about the inability of children to provide informed consent, rapidly accumulating reports of harm and an alarming lack of safeguards.

Now the American medical establishment is slowly conceding what critics, parents, whistleblowers and detransitioners have warned all along: Pediatric gender medicine was an uncontrolled experiment on children.

Many of us who have reported on it for years think it is the greatest modern medical scandal since lobotomies.

Demonstrators gathered outside the Supreme Court in January to protest gender surgeries on minors. Joey Sussman/ZUMA / SplashNews.com

The plastic surgeons’ association, which represents most practitioners in the United States and Canada, issued a sweeping statement citing “insufficient evidence demonstrating a favorable risk-benefit ratio” and “growing uncertainty about the benefits of medical and surgical interventions” for minors.

The ASPS “recommends that surgeons delay gender-related breast/chest, genital, and facial surgery until a patient is at least 19 years old.”

The group cited concerns about irreversibility, poor-quality studies and the misuse of patient-autonomy arguments in adolescents whose decision-making capacity is still developing.

Shortly afterward, the American Medical Association followed suit: “The evidence for gender-affirming surgical intervention in minors is insufficient for us to make a definitive statement.”

The AMA also said it “agrees with ASPS that surgeries for minors should be generally deferred to adulthood in the absence of clear evidence.”

That is not a minor clarification. It is a full turnaround.

American medical organizations insisted for years there was a consensus supporting pediatric gender interventions.

That claim has now collapsed under scrutiny — just as it already had abroad. Finland, Sweden and the United Kingdom all conducted systematic evidence reviews and sharply curtailed medical transition for minors.

The British Cass Review found the science underpinning pediatric gender medicine to be remarkably weak and concluded that potential harms outweighed any purported benefits.

The United States ignored those warnings — until it could no longer.

Hospitals from Stanford to Kaiser Permanente quietly halted youth gender surgeries. More than two dozen states enacted minimum-age restrictions. Lawsuits piled up.

Americans made their feelings known outside Boston Children’s Hospital in 2022. AFP via Getty Images

And a week ago, a New York jury delivered a $2 million malpractice verdict to a detransitioner, Fox Varian — a signal that medical societies can no longer shield practitioners from accountability simply by issuing position statements.

While it is a watershed moment that two leading American medical groups now admit surgeries on minors lack sufficient evidence and carry unacceptable risk, it is only a beginning.

The AMA did not address the drugs that often precede surgery. Puberty blockers and cross-sex hormones are not neutral interventions.

They carry a long list of adverse effects and can permanently alter sexual development, fertility, bone density and neurological maturation.

When administered early and sequentially, they can lock children into a pathway many later regret — with no easy exit.

The same evidentiary flaws that doomed surgical recommendations apply with equal force, and often on a far greater scale, to these drugs.

This is where the silence of other major medical organizations becomes deafening.

Fox Varian won $2 million in her lawsuit against New York doctors who pushed her into a double mastectomy at 16. IMDb

The American Academy of Pediatrics, the American Psychiatric Association, the American Psychological Association and the Endocrine Society have so far refused to meaningfully revisit their endorsements of pediatric gender medicine.

These organizations have repeatedly relied on guidelines developed by activist-aligned clinicians rather than conducting independent, rigorous evidence reviews.

In doing so, they substituted ideological consensus for evidence-based medicine — to the detriment of thousands of children.

I previously reported in this paper on the American Psychiatric Association’s publication of an activist textbook that pushes clinicians to place children into the gender-medical pipeline rather than engage in substantive psychological evaluation and watchful waiting.

The APA ignored evidence that most of the children who identify as another gender grow out of that if given time.

One common defense medical associations offer is that they rely on standards of care developed by the World Professional Association for Transgender Health.

But I reported in these pages on the leaked internal files that revealed WPATH promoted hormonal and surgical interventions for minors — including stomach-wrenching experimental procedures — while privately acknowledging serious and permanent risks.

Relying on WPATH to set standards for pediatric gender care is reckless and negligent.

That is why this moment matters. It is not just what the medical establishment is backing away from but what it can no longer avoid confronting.

American medicine now faces a choice.

It can continue defending a collapsing consensus, exposing itself to mounting legal liability and public mistrust.

Or it can follow the evidence, acknowledge past errors and rebuild pediatric care around caution, humility and genuine informed consent.

It can put the pediatric patients ahead of ideology and a profit-driven business model.

For the thousands of young people already harmed — many living with irreversible physical changes, chronic medical complications and profound regret — this reckoning comes far too late.

But if these reversals mark the beginning of the end of the pediatric gender industry, they may still spare the next generation.

Children deserve better than slogans. Parents deserve honesty.

And pediatric gender medicine owes the public something it has withheld for far too long: the truth.

Gerald Posner is the author of 13 books, most recently “PHARMA: Greed, Lies and the Poisoning of America.”