(NewsNation) — The American Society of Plastic Surgeons has become the first major medical association to recommend against permanent gender surgeries for minors, a move that follows the first successful medical malpractice lawsuit by a detransitioner.
The recommendation comes as Fox Varian, 22, was awarded $2 million after suing New York doctors who she says pushed her into a double mastectomy at age 16 when she identified as male. Varian later detransitioned.
Detransitioning refers to the process when someone who previously identified as transgender and underwent social or medical transition steps later decides to stop or reverse those changes and return to living as their birth sex.
The lawsuit victory has raised questions about potential liability for medical providers who perform gender-related procedures on minors.
The American Society of Plastic Surgeons’ position statement cited insufficient evidence of favorable risk-benefit ratios for gender surgeries in minors and expressed concerns about long-term harm from irreversible interventions.
The organization’s position applies to breast/chest, genital and facial gender-related surgeries for individuals younger than 19.
“ASPS concludes there is insufficient evidence demonstrating a favorable risk-benefit ratio for the pathway of gender-related endocrine and surgical interventions in children and adolescents,” the statement said.
The position follows recent comprehensive evidence reviews, including a 2025 report from the U.S. Department of Health and Human Services titled “Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices” and the 2024 Cass Review commissioned by NHS England.
Chloe Cole, an activist who underwent similar procedures as a teenager and later detransitioned, said the verdict represents “a massive leap for the detransitioner movement.”
“She deserves every single bit of justice that she gets, if not more,” Cole told NewsNation’s “Katie Pavlich Tonight” on Tuesday, noting that Varian experienced depression, autism symptoms and family estrangement alongside gender-related distress.
Cole, who has filed her own lawsuit against Kaiser Permanente with the Center for American Liberty, said doctors failed to explore underlying factors contributing to gender confusion before recommending irreversible treatments.
Matt Sharp, senior counsel at Alliance Defending Freedom, said the verdict sends a message that children harmed by such procedures “are entitled to justice, and those that did the harm are going to be held accountable.”
A study by the medical group Do No Harm found that at least 5,700 American children underwent gender-related surgeries from 2019 to 2023.
Sharp noted that 27 states have now passed laws banning such procedures for minors, and federal legislation is being considered. The Trump administration has also opposed pediatric gender treatments.
“This is a watershed moment to finally hold the wrongdoers accountable,” Sharp said, adding that work remains to remove gender ideology from medical practice and schools.
Cole said studies show these surgeries don’t improve mental health outcomes and can increase suicidal thoughts and self-harm. She said she has witnessed a significant cultural shift on the issue over the past four years.
“No matter how much any of us are compensated, it is never going to bring back time,” Cole said. “We are never going to be able to relive our childhoods or get our innocence or healthy body parts back.”
The ASPS position statement emphasized that plastic surgeons retain “independent professional responsibility” in surgical decision-making and cannot rely solely on referrals or letters of support as proxies for surgical indication.
ASPS opposed criminalization of medical care and supported professional self-regulation over punitive legislative approaches, while advising members to remain aware of varying state laws.
The organization committed to ongoing review of emerging evidence and said it would reassess its recommendations if higher-quality data demonstrate clear benefits with acceptable risks.
