Recognizing the dangers, at last

Last week, the American Society of Plastic Surgeons (ASPS) became the first major medical association to publicly oppose medical transition procedures for minors experiencing gender dysphoria.

Days later, the American Medical Association (AMA) followed with a notable shift of its own, stating that “the evidence for gender-affirming surgical intervention in minors is insufficient for us to make a definitive statement.”

After years of near-unanimous institutional support for pediatric gender medicine, these developments signal a meaningful change. The medical consensus that once framed childhood medical transition as settled science is beginning to fracture.

In its newly released guidance, ASPS concluded that there is “insufficient evidence demonstrating a favorable risk–benefit ratio for the pathway of gender-related endocrine and surgical interventions in children and adolescents.” That assessment represents a striking departure from earlier professional assurances that such interventions were safe, effective, and necessary.

The timing is notable. The same week ASPS released its guidance, a 22-year-old detransitioner won a $2 million malpractice lawsuit against the medical providers who approved her double mastectomy at age 16. A psychologist and a surgeon were both found liable. As more adults who were medically transitioned as minors come forward, additional lawsuits are likely to follow, particularly against specialists whose work made those interventions possible.

The United States remains an outlier in its permissiveness. While several European countries have scaled back pediatric medical transition in favor of psychotherapy-first approaches, the U.S. expanded access rapidly. That expansion can be seen in the growth of pediatric gender clinics nationwide: from a single clinic in 2007 to at least 79 children’s hospitals operating clinics by the end of 2024.

Financial incentives followed. One watchdog organization, Stop the Harm, has reported that Boston Children’s Hospital alone billed over $5 million for gender-related medical procedures. While proponents frame such care as compassionate, the scale and speed of its adoption raise valid questions about accountability.

Change has not come easily. In recent years, detransitioners have spoken publicly about the harm they believe was done to them, often at significant personal cost. Other critics, from clinicians to cultural figures, have faced intense backlash for questioning prevailing narratives. Yet investigative journalism, whistleblowers, and dissenting medical professionals have continued to document concerns many institutions were unwilling to confront.

Some of those concerns came from inside the clinics themselves. Former employees, including Jamie Reed, have said they entered the field believing they were helping vulnerable children, only later to witness what they describe as a system that rushed minors toward irreversible medical interventions without adequate psychological evaluation or long-term data.

Even as scrutiny increased, some programs appeared reluctant to stop. In 2024, a physician at Texas Children’s Hospital disclosed that gender-related medical interventions for minors were continuing internally despite public claims that they had been paused. His disclosures triggered a federal investigation and caused many to question transparency within pediatric institutions.

Medical professionals are now reckoning with the implications. Procedures once promoted as affirming may become sources of regret, litigation, and ethical scrutiny. That fear is not irrational. 

The rapid embrace of pediatric gender medicine meant safeguards were weakened and dissent was stigmatized, and children bore the greatest damage. 

Minors placed on medical transition pathways may permanently lose their fertility, miss key stages of physical development, and undergo irreversible changes to their bodies. Girls who receive double mastectomies in adolescence lose the ability to breastfeed. Others face increased risks of reduced bone density, impaired sexual function, and disruption of normal brain development during a critical period of maturation.

Encouraging families to view permanent bodily alteration as appropriate treatment for gender dysphoria, particularly when it coexists with anxiety, depression, or autism, conflicts with medicine’s foundational obligation to do no harm.

History offers a sobering perspective. Doctors once assured patients that cigarettes were safe. Thalidomide was prescribed to pregnant women. Lobotomies were hailed as breakthroughs. Each practice was defended by credentialed experts—until the harm became undeniable.

We will look back on pediatric gender medicine in much the same way. Many already do.