In its February statement, the ASPS said it found “insufficient evidence” that the benefits of such surgeries for minors experiencing gender dysphoria outweigh the potential risks. Citing recent reports, including the controversial Cass Review from the U.K. and a 2025 Department of Health and Human Services (HHS) report, the society said existing research does not provide a clear basis for performing irreversible surgical procedures on adolescents whose bodies and brains are still developing.

“This position statement does not seek to deny or diminish the realities of any patient’s suffering, nor doubt the authenticity of their experiences,” the ASPS position reads, adding that ethical care should balance compassion with scientific rigor and concern for long-term well-being.

The change comes amid pressure from the Trump administration to restrict gender-affirming care for transgender individuals, particularly children and teens, including executive actions aimed at curbing access to such care under federal programs. Deputy Secretary of Health and Human Services Jim O’Neill praised the ASPS recommendation, calling it “another victory for biological truth” and saying the society had set a medical standard for other providers to follow.

However, major pediatric and medical groups have pushed back on broad restrictions. The American Academy of Paediatrics (AAP), whose president, Dr Andrew Racine, said the organization does not include a blanket recommendation for surgery for minors, emphasized that decisions about care should be made jointly by patients, families and clinicians, not by political influence.

Critics of the ASPS position argue that current clinical evidence and standards of care support individualized, case-by-case treatment rather than strict age cutoffs. Supporters of gender-affirming care note the rarity of surgical interventions in minors and caution that continued restrictions could impact patient well-being.