CV NEWS FEED// The American Society of Plastic Surgeons (ASPS) has stated that they do not endorse World Professional Association for Transgender Health (WPATH)’s guidelines on transgender surgeries for minors.
In a City Journal article, Leor Sapir, a fellow at the Manhattan Institute, wrote that ASPS told him in July that it “has not endorsed any organization’s practice recommendations for the treatment of adolescents with gender dysphoria.” ASPS has 11,000 members throughout the United States and Canada, and represents over 90% of the plastic surgery field.
ASPS also told him that there is, “considerable uncertainty as to the long-term efficacy for the use of chest and genital surgical interventions,” adding that “the existing evidence base is viewed as low quality/low certainty.”
Sapir explained that the term “low-evidence” has a specific meaning in evidence based medicine, “that the true effect of an intervention is likely to be markedly different from the results reported in studies,” including the possibility that the long-term harms outweigh the benefits.
The possible harms of transgender surgeries include “infertility, sexual dysfunction, and the agony of regret,” Sapir continued, prompting many European countries to classify the surgeries as experimental and instead to prioritize psychotherapeutic treatment. Doctors in Belgium, Finland, Germany, Luxemburg, Sweden, the U.K., and some Canadian provinces are not allowed to perform double mastectomies on minors.
In contrast, the United States adopted WPATH’s Standards of Care, which do not include any minimums due to political pressure from U.S. Assistant Secretary for Health Rachel Levine (a biological male), as CatholicVote previously reported.
Sapir reported that Californian plastic surgeon Sheila Nazarian told him that despite her colleagues’ growing concern over surgeries and hormonal treatment for gender dysphoria, many surgeons are afraid to voice their concerns due to social and professional consequences.
Nazarian told him, “It’s a real problem when colleagues are afraid to debate any medical treatment or procedure, and especially when minors are the patients,” and added, “I have been following the international debate on youth gender medicine for some time now and know we [in the U.S.] are far behind in recognizing the lack of evidence for long-term benefits, something that our European colleagues have done.” She mentioned that political division over gender-affirming care also silences surgeons.
Nazarian continued that most plastic surgeons defer to mental health specialists and endocrinologists when deciding if a minor should receive a double mastectomy, but she thinks that this is not good practice.
Sapir specified that many mental health professionals have adopted template letters that give permission for minors to receive transgender surgeries, and these letters are based on “highly dubious research.” Most adolescents experience rapid-onset gender dysphoria (ROGD), which is why Europe started restricting access to gender-reassignment surgeries. The template letters, however, “effectively instructs the referring therapist to attest that the ROGD presentation is really just a teen who has always known he or she was transgender but only disclosed that information to his or her parents during adolescence.”
Nazarian said, “We can get input from other clinicians, but ultimately the responsibility for determining medical readiness lies with us.” She added, “Furthermore, you can’t help people by ignoring the reasons they want to go under the knife. With every patient, I exercise discretion as a professional and determine whether the procedure they are seeking is in their ultimate best interest.”
Nazarian concluded, “You can’t outsource your professional judgment to other clinicians. It’s your responsibility as the last in a chain of treatment to ensure you are doing what is best for the patient now and in the long term.”
