Will new limits on gender-related surgeries change anything?

0:00For a 15-year-old in California, gender-affirming top surgery was on the horizon until recently. After Kaiser made its decision to pause gender-affirming surgeries for minors, that was something I had to put on hold for a while because it's not easy to do it out of pocket. Fearing for his safety, he spoke to NPR's Selena Simmons Duffin under the condition we don't use his name. It's definitely something I want for myself, but it's a little bit hard to get into the system for pursuing it at the moment. Getting gender-affirming surgery may become even harder for teens like him now. The American Society of Plastic Surgeons, or ASPS, released a statement this week recommending that surgeons delay gender-related surgeries for patients under 19 years old.

0:49I feel like that under 19 is very distinct to trying to get rid of adult care for trans people as well as for minors. I just think it's kind of like a gateway to even more restrictive bans on gender-affirming care. ASPS tells NPR this is an update, not a reversal, of its previous stance on gender-affirming care for minors. They say there's insufficient evidence that the benefits of these surgeries outweigh the potential risks for youth with gender dysphoria. Still, the 15-year-old in California has a hard time believing these guidelines come in good faith at the same time the Trump administration is limiting transgender care.

1:33It's hard for it to be reliable. Like, it's hard to be able to trust medical associations when you know the government is putting pressure on them to make a certain claim or, you know, adopt a certain stance. Consider this. The Trump administration is describing the ASPS announcement as a watershed moment, but gender-affirming surgeries in minors are rare. So how much will this change? From NPR, I'm Juana Summers.

2:15It's Consider This from NPR. The American Society of Plastic Surgeons announced this week that it recommends surgeons delay gender-related surgeries until a patient is at least 19 years old. The Trump administration celebrated the move in a press release. Deputy Health and Human Services Secretary Jim O 'Neill said that the move, quote, marks another victory for biological truth in the Trump administration and that the group, quote, has set the scientific and medical standard for all provider groups to follow. NPR's Selena Simmons-Duffin is here to put this news into context. Hi there. Hi, I wanna.

2:52So, Selena, just to start, is this statement from the plastic surgeons a change from their previous position? The group tells me that it is not a reversal. It's updating a statement from 2024 that basically said they didn't yet have a position. ASPS did not provide anyone to NPR for an interview, but did respond to emailed questions. And their position statement seems very skeptical of the potential benefits of surgery for transgender youth and concluded that patients should wait until at least age 19. Just putting this into focus a bit more, how many people would this affect? ASPS told me they do not gather data on the number of these procedures done in a year.

3:30The CDC estimates about 3 % of teenagers are transgender. A small portion of them seek surgery as minors. So basically we're talking about a really small group. And mostly the surgery in question is breast or top surgery for transgender boys. Okay. And what are the reasons why transgender youth might not want to wait until they turn 19 for the surgery? I talked to a mom in California today. she asked NPR not to use her name because she fears for her family's safety. She says her child came out as transgender at age 13, and she and her husband did not want to okay surgery because it felt really scary to them.

4:07It's permanent. There are risks. So she says for years, her transgender son used clothes and bandages and binders to flatten his chest. It's very painful at some point, I mean, physically painful, trying to get their bodies to fit in a way that they can go out and just have a normal day. The parents finally agreed to top surgery, and she says the process of getting it was arduous. Her son is now 17. He had surgery two years ago, and she says that he's really blossomed. And to think that other kids might need this, even there's so few kids that do need this, to think that they have to just live in a shell and put their lives on pause is so unfair and makes me so angry and so sad.

4:54So, Selena, that is one family that's been affected by this news. What have you heard, if anything, from other medical groups? There have been conflicting reports about the American Medical Association's position. They sent me a statement that, quote, the AMA supports evidence-based treatment, including gender-affirming care, and then added that based on available evidence, quote, surgical interventions in minors should generally be deferred to adulthood. AMA tells me that is not a reversal or an endorsement of the plastic surgeon's new position. It's a clarification of the group's existing position.

5:28Similarly, the American Academy of Pediatrics sent a statement that the group, quote, does not include a blanket recommendation for surgery for minors and that the decision should be left to doctors and patients and their families, not politicians. Okay, but the Trump administration is describing the plastic surgeon's position statement as a watershed. Is that right? Yeah, and the context is that the White House has made restricting or even ending medical care for transgender youth a key goal. In December, they proposed a rule that would withhold all Medicaid funding from hospitals that provide gender-affirming care to children and teens.

6:02Even though it hasn't been finalized, just that threat has been shuttering hospital gender clinics all over the country because hospitals really can't afford to operate without that federal funding. And that means access is starting to shut down for people in the two dozen states that don't have state laws banning the care, which is the Trump administration's stated goal. I should say that not everyone agrees with the idea that this position statement is a watershed moment. Yeah, such as? Kellen Baker is a health researcher at an LGBTQ think tank called the Movement Advancement Project, he told me that the ASPS position actually aligns with the current standard of care for transgender youth.

6:41There's really nothing new here. The standard of care already does not recommend surgeries for minors as part of the routine approach to this care. Baker argues that it works to the Trump administration's advantage to describe this as a turning point, as a medical group finally seeing the light without acknowledging the political pressure that the Trump administration itself has been exerting to get this outcome. NPR's Selena Simmons-Duffin, thank you so much. You're welcome. This episode was produced by Alejandra Marquez-Honse with audio engineering by Tiffany Vera Castro. It was edited by Diane Weber, Courtney Dorning, and Patrick Jaron Watanon.

7:23Our executive producer is Sammy Yenigan. It's Consider This from NPR. I'm Juana Summers.