Plastic surgeons dissent from pro-trans trend with minors

Editor’s note: This story contains descriptions of human reproductive anatomy.

Plastic surgeon Dr. Jess Ting and gynecologic surgeon Dr. Marci Bowers performed a transgender procedure that took twice as long as it typically does. Their patient, a 17-year-old male who had identified as female since age 5, wanted a vagina.

Normally, fully developed male sexual organs provide enough skin for a plastic surgeon to create a “neo-vagina.” But because the boy had been using puberty suppression medication since age 11, his sexual organs were small. As journalist Abigail Shrier put it, the 17-year-old’s sexual organs were “the size and sexual maturity of an 11-year-old’s.”

Nevertheless, the practitioners performed the procedure. The next day, the patient felt pain and was rushed back to the hospital. “As I was getting her on the bed,” Ting said, “I heard something go pop.” That sound was the patient’s newly created vagina tearing apart.

The TLC reality show I Am Jazz documented the surgical journey, and the patient, Jazz Jennings, eventually recovered and continues to identify as a woman today. But last month, a network of plastic surgeons began to challenge the science behind gender change procedures for patients who are under age 18, as Jennings was at the time of the 2018 surgery.

On Aug. 12, Manhattan Institute fellow Leor Sapir wrote in City Journal that the American Society of Plastic Surgeons, a group with 11,000 members, “has not endorsed any organization’s practice recommendations for the treatment of adolescents with gender dysphoria.” Earlier this week, the group’s president, Dr. Steven Williams, reinforced the group’s reluctance, telling a NewsNation reporter, “Right now, there isn’t great data supporting gender-affirming care in adolescents.”

To be clear, the group has not rejected gender surgeries on adolescents, and its statement only applies to plastic surgery procedures, not other transgender treatments like cross-sex hormone treatments. In a statement to WORLD, the society expressed “considerable uncertainty” regarding the long-term effectiveness of chest and genital surgeries on minors with gender dysphoria.

This announcement is a stark contrast to the numerous professional medical associations that have endorsed—and in some cases championed—medical attempts to change the sex characteristics of minors. The American Medical Association, the American Academy of Pediatrics, and the Endocrine Society have all supported what is commonly called “gender-affirming care.” The American Psychological Association issued a policy in February, calling for “unobstructed access” to the interventions for children and adolescents and said denying them would pose “a direct threat to the mental health and emotional well-being of transgender, gender diverse, and nonbinary youth.”

But the hesitation and skepticism expressed by the plastic surgeons suggest the tide may be turning.

Dr. Matthew Chetta is a plastic surgeon in South Carolina and a member of the American Society of Plastic Surgeons. He did not expect the group to take this stance. “This statement was a shock to us, because we had the assumption that ASPS was very much for gender affirmation of all sorts,” he said.

Chetta, who does not support gender treatments in youth, said his specialty—breast reconstruction for women—bears some similarities to gender surgeries like vaginoplasty or facial feminization. None are life-saving or improve a body’s function. “It has a 100 percent aesthetic, cosmetic outcome and has zero functional outcome,” he said.

But he says there is one key difference. Breast reconstruction procedures have now been proven to give women psychosocial benefits post-cancer, by what Chetta said is “a procedure and technique that was so well studied and proven beyond a shadow of a doubt.” So much so that a federal law passed in 1998 now requires insurance providers to cover women who choose to get breast reconstruction after a mastectomy.

The benefits of plastic surgery on youth with gender dysphoria, on the other hand, has neither been well studied nor proven beyond a shadow of a doubt, says Chetta. And currently, the country is divided on the procedures, with 26 states protecting minors from receiving cross-sex medication, surgery, or both.

In a statement, the plastic surgeon group said it is “reviewing and prioritizing several initiatives that best support evidence-based gender surgical care to provide guidance to plastic surgeons.” Although the group is set to convene a national conference of plastic surgeons at the end of this month, Chetta said that transgender treatments don’t appear to be on the conference agenda.

Sapir, with the Manhattan Institute, and Chetta both said the American Society of Plastic Surgeons will likely not recommend plastic surgery for adolescents with gender dysphoria. But since plastic surgery is often touted as the last stop on a person’s gender transition journey, it will be difficult to justify denying it to someone who’s already spent years altering their bodies using puberty blockers and cross-sex hormones.

Sapir said that if plastic surgeons say plastic surgery isn’t good for gender dysphoric adolescents, they are subtly disagreeing with the idea of gender medicine entirely.

“All of these treatments are tethered together in some sense, right?” Sapir told me. “If you think about the conceptual basis of gender medicine, either these kids are transgender or they’re not. Either their gender related-distress is best addressed with body modifications or it's not. It’s hard to see why hormones, yes, but surgeries, no.”