Fact Check: ASPS Did Not "Break Consensus" On Trans Care, Opposes Bans

An article in City Journal claimed that the American Society for Plastic Surgery became the first to "challenge consensus" on transgender care. A fuller statement shows this is not the case.

On Monday, anti-trans activist Leor Sapir of the Manhattan Institute released a newsletter titled “A Consensus No Longer,” claiming that the American Society of Plastic Surgeons (ASPS) became “the first major medical organization to challenge the consensus of medical groups over ‘gender-affirming care’ for minors.” However, a closer examination reveals that this claim is inaccurate. The ASPS has not altered its position on gender-affirming surgeries for minors for a simple reason: it has never issued any clinical practice guidelines for or against such care. This misleading report prompted the ASPS to release a statement affirming its continued support for the constitutional protections of transgender patients and its opposition to the penalization and criminalization of physicians providing this care

You can see a portion of the ASPS statement released on Thursday in in response to the article here (emphasis added):

“It’s important to note that, as an organization and specialty guided by evidence, the Society’s stance on this issue has remained consistent: More high-quality research in this rapidly evolving area of healthcare is needed.

To that end, ASPS efforts in this area include capturing clinical data on gender surgery procedures for adults and the development of practice resources to better aid members in implementing best practices in offering gender-surgery services when higher quality evidence is available. ASPS supports transgender patients’ constitutional protections and right to dignity, privacy and humane medical care.

Further, it has always been the Society’s position that members should be able to provide medical care without fear of government-sanctioned penalties and criminalization – and ASPS opposes any attempts at legal encroachment into the practice of medicine.”

Sapir and other far-right news outlets claimed that the ASPS had “broken consensus with other major medical organizations on transgender care” by stating that evidence surrounding gender-affirming surgeries for transgender youth is “low quality.” This term, used in a technical context, refers to the lack of blinded clinical trials or other intensive forms of study that may not be feasible, rather than the colloquial meaning of "poor quality." It’s important to note that this statement pertains specifically to transgender youth surgeries, not gender-affirming care as a whole. Given how incredibly rare these surgeries are, it should not be surprising that such trials have not been conducted.

I reached out to the ASPS communications team for comment on Sapir’s claim that the organization had “broken consensus.” In response to Sapir’s emails, the ASPS stated, "The ASPS understands there is considerable uncertainty as to the long-term efficacy of chest and genital interventions for the treatment of adolescents with gender dysphoria, and the existing evidence base is viewed as low quality/low certainty. The patient population requires specific considerations." When asked whether the statement was voted on or made official by ASPS representatives, the organization could not confirm that it had been.

When asked whether the organization had changed its practice guidelines to “break consensus” with other medical organizations, the press contact responded, “To date, ASPS has not issued a clinical practice guideline on gender surgery for adolescents or adults,” adding that they are “currently in the stage of assessing the available evidence regarding gender surgery in minors.”

I also inquired about the claims made to Sapir that the evidence surrounding trans youth surgeries was seen as “low certainty” and that it lacked “high quality evidence.” When asked whether the assessment would include gynecomastia surgeries for cisgender boys, breast implants for cisgender girls, and genital surgeries for intersex infants—procedures more commonly performed by ASPS members—and whether these surgeries were also considered “low quality/low certainty,” the press contact did not respond.

Shortly after the last question, the updated statement was sent to me by a separate source, indicating that the organization still supports doctors’ ability to provide care, upholds the constitutional rights of transgender patients, and opposes criminalization or penalties.

Inaccurate claims that the organization was the first American medical group to “break consensus” circulated like wildfire following the publication Sapir’s article. NewsNation, a major news publication source, ran an inaccurate headline claiming, “Plastic surgeon group renounces gender surgery for minors,” something that flatly did not occur in any communications. Fox News ran a headline claiming, “American Society of Plastic Surgeons breaks consensus of medical establishment on transgender care,” which also did not occur.

While it is uncertain who at the organization approved the initial statements to Sapir and what the parameters around evidence evaluation on transgender surgeries would be, the organization is set to hold its public meeting next month. I am told that many members are aware of the recent inaccurate claims of the ASPS position on gender affirming surgeries. The meeting may serve as an important venue to further challenge inaccurate reporting over the organization’s policies.