What the ASPS position statement on pediatric gender surgery actually says — and what it means. A listener’s guide to our episode for March 21 2026; names, the history, and what’s at stake.
On February 3, 2026, the American Society of Plastic Surgeons issued a nine-page position statement recommending that surgeons delay all gender-related surgery — breast/chest, genital, and facial — until a patient is at least 19 years old. It was the first statement of its kind from a major American medical association, and the reverberations were immediate.
This is a significant moment. Not because it ends the debate, but because it marks the first formal fracture in the wall of institutional consensus that has, for the better part of a decade, treated surgical intervention in minors as settled, evidence-based, and beyond reproach. It was not settled. It was not evidence-based. And the ASPS has now said so on the record.
This episode of Informed Dissent features our interview with Dr. Scot Glasberg — a past president of the ASPS and a central figure in the multi-year deliberation that led to this statement. His name, and several others, will come up throughout the conversation. This piece is your guide to who these people are, what their relationships are to each other, and why the internal story of how this statement came to exist is as important as the statement itself.
The Organization and Its Reach
The ASPS is not a minor player. It represents more than 11,000 physician members and over 90 percent of board-certified plastic surgeons practicing in the United States and Canada. Crucially, plastic surgeons are the primary specialty performing mastectomies on minors with gender dysphoria — approximately 1,000 or more annually in recent years, by conservative estimates.
When the ASPS speaks on this issue, it is speaking as the guild whose members have been performing these procedures. That is what makes this statement different from outside criticism. These are the surgeons.
What the Statement Actually Says
The coverage has focused on the age cutoff — 19 — but the statement goes considerably further. The ASPS doesn’t just recommend delay. It raises foundational questions about the entire treatment pathway.
The statement is unambiguous: it characterizes the research supporting gender-related interventions in minors as “low quality/low certainty.” It draws on the 2024 Cass Review commissioned by NHS England, several European systematic reviews, and the HHS report Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices, published in 2025. The statement finds “insufficient evidence demonstrating a favorable risk-benefit ratio for the pathway of gender-related endocrine and surgical interventions in children and adolescents.”
Not just surgical interventions. The full pathway — endocrine and surgical — fails the evidence test.
The statement also addresses the natural history of gender dysphoria directly: among children, the vast majority show resolution without medical intervention. Among adolescents, existing evidence suggests most will desist as well. This directly challenges the clinical framing that has driven urgent intervention — the idea that the trajectory of a child’s gender identity is fixed and must be medically affirmed. The ASPS also explicitly rejects the “suicide narrative” — the claim that withholding or delaying these interventions is equivalent to causing a child’s death. The statement treats crisis-based justifications for irreversible procedures as a reason for greater caution, not less.
On informed consent, the statement is clear: plastic surgeons cannot treat a prior referral letter, a mental health clearance, or a prior medical intervention as a proxy for surgical indication. Each surgeon bears independent professional responsibility to assess the risk-benefit profile — and to communicate uncertainty honestly.
Before the Statement: The Cass Review Panel That Never Happened
To understand why this statement exists, you have to go back to the fall of 2024.
Dr. Scot Glasberg, then president of the Plastic Surgery Foundation — the ASPS’s research wing — had organized a panel at the ASPS annual meeting titled “Translating Evidence into Best Practices: A Gender Medicine and Surgery Paradigm.” Dr. Hilary Cass, author of the landmark 2024 independent review of gender identity services for children commissioned by NHS England, had been invited to present.
Before the meeting, a group of ASPS members — including gender surgery practitioners and leaders of gender-affirming surgery programs, among them Dr. Blair Peters — sent a letter to the ASPS board. Their demand: arrange virtual attendance for members who would be at the WPATH conference in Lisbon, Portugal, held simultaneously.
The ASPS board met the demands. And then pulled the panel anyway. Every other gender-related session at the annual meeting proceeded as scheduled. The Cass panel was the only one removed. Glasberg sent the notice describing it as “postponed.”
The Gender Surgery Task Force was established in May 2025, in part as a response to this episode. Its stated mandate was not to issue guidance, but to seek “areas of emerging consensus” among clinicians with differing perspectives.
What no one outside the ASPS initially knew: several members of that task force held simultaneous leadership positions at WPATH — the organization whose standards of care the Cass Review had found to “lack developmental rigour.”
The Gender Surgery Task Force’s response to the ASPS statement would become a flashpoint of controversy.
The Internal Fracture
When the ASPS board released its position statement on February 3, 2026, it did not go through the task force. The board acted independently. The task force — including its WPATH-affiliated members — found out when everyone else did.
Seven task force members sent an open letter to the ASPS board demanding transparency about the statement’s authorship and development. The letter was spearheaded by Dr. Jens Berli and subsequently posted publicly on LinkedIn by Dr. Scott Leibowitz — a move that created additional friction within the task force, with at least one member seeking to withdraw his signature.
The open letter did not dispute the evidentiary findings. It focused on process. But the identities of its signatories — which include WPATH’s current president, president-elect, and a board member — tell their own story about who had a stake in the task force’s approach and why the board chose to circumvent it.
The Malpractice Context
The same week the ASPS statement was released, a former patient named Fox Varian was awarded $2 million in a malpractice judgment in New York state after undergoing a double mastectomy as a minor and subsequently detransitioning. It was the first detransitioner lawsuit in the United States to reach a jury verdict.
The attorney who represented her, Adam Deutsch, said publicly that the ASPS statement validated his theory of the case: that a surgeon cannot simply defer to a mental health referral when assessing whether an irreversible procedure is appropriate for an adolescent. At least 27 other detransitioner lawsuits are currently pending.
The liability calculus for surgeons in this space has changed.
What Other Medical Organizations Said
The response from other major medical bodies was revealing in its awkwardness. The AMA told reporters it agreed that surgical interventions for minors should be generally deferred to adulthood — but framed this as a clarification of its existing position, not a response to ASPS. The American Academy of Pediatrics said it “does not include a blanket recommendation for surgery for minors” — language that carefully elides what its own guidelines say about supporting surgical interventions for minors on a case-by-case, individualized basis.
These organizations have staked significant credibility on a position the evidence no longer supports. The ASPS has now made that visible.
Who’s Who: A Listener’s Guide
Several names come up throughout this episode. Here is a brief guide to who they are and how they connect to this story.
Dr. Scot Glasberg
Past President, ASPS | President, Plastic Surgery Foundation | Co-chair, ASPS Gender Surgery Task Force
Private practice, Manhattan | Informed Dissent guest, this episode
Glasberg convened the Hilary Cass panel at the 2024 ASPS annual meeting that was pulled under pressure from WPATH-aligned members. He was central to the multi-year evidence deliberation inside ASPS that preceded the February 2026 position statement, though he was not involved in the board’s final drafting. He has spoken publicly about the evidentiary basis for the age-19 threshold and the statement’s independence from political pressure.
Dr. Hilary Cass
Author, the Cass Review (2024)
NHS England — Independent Review of Gender Identity Services for Children and Young People
Dr. Cass led the most comprehensive independent review of pediatric gender medicine to date, commissioned by NHS England. Her 2024 final report found the evidence base for hormonal and surgical interventions in minors to be “remarkably weak” and found that existing clinical guidelines — including WPATH’s — lacked developmental rigour. She was invited to present at the 2024 ASPS annual meeting and was disinvited when the panel was pulled. The ASPS position statement cites her review approvingly by name.
Dr. Loren Schechter
President-Elect, WPATH | Member, ASPS Gender Surgery Task Force | Open Letter Signatory
Medical Director, Gender Affirmation Surgery Program, Rush University Medical Center, Chicago
One of the highest-volume gender surgery practitioners in the U.S. — approximately 100–150 procedures annually. An ASPS member, signatory of the task force open letter, and WPATH’s incoming president. Part of the group that pressured the ASPS board regarding the Cass Review panel in 2024. After the February 2026 statement, he told reporters “the answer is somewhere in the middle.” In the Fox Varian malpractice trial he testified that surgery is not a mechanism to prevent suicide — a position that contradicts sworn statements he gave in a 2022 Florida case involving a minor.
Dr. Scott Leibowitz
Board Member, WPATH | Member, ASPS Gender Surgery Task Force | Open Letter Signatory
Child and Adolescent Psychiatrist
A child and adolescent psychiatrist and WPATH board member who served on the ASPS Gender Surgery Task Force. He was among the seven signatories of the open letter to the ASPS board — and was the member who posted the letter publicly on LinkedIn, an action that created friction within the task force itself. On LinkedIn, he argued that the ASPS statement “ignored the reality that a young person’s maturity to make a decision can differ across ages” and that low-certainty evidence is a reason for guardrails, not restriction. His dual role — WPATH board member and ASPS task force member — is central to understanding the conflict of interest embedded in the task force’s composition.
Dr. Asa Radix
President, WPATH | Open Letter Signatory
World Professional Association for Transgender Health
Current WPATH president and a signatory of the open letter sent by the ASPS task force to the ASPS board. WPATH is the organization whose Standards of Care have served as the primary clinical guidance framework for gender-affirming care globally — and whose guidelines the Cass Review, the HHS report, and now the ASPS have all declined to endorse as trustworthy for implementation.
Dr. Jens Berli
Head, Division of Plastic & Reconstructive Surgery, OHSU | Open Letter Author | ASPS Task Force Member
Oregon Health & Science University, Portland
Swiss-trained, Johns Hopkins-residency plastic surgeon who joined OHSU’s Transgender Health Program in 2016. He specializes in phalloplasty and gender-affirming facial surgery. Metadata from the task force open letter — and confirmation from a fellow task force member — identify Berli as the letter’s primary author. He and Blair Peters are colleagues at OHSU and frequent research collaborators. He is a WPATH member and follows WPATH surgical guidelines.
Dr. Blair Peters
Vice Chair, ASPS Gender Surgery Committee | ASPS Member
Oregon Health & Science University (OHSU)
Peters, who describes himself as a “Queer surgeon,” is one of the ASPS members who sent the letter demanding virtual attendance accommodations before the 2024 annual meeting — the action that preceded the removal of the Cass Review panel. He is Vice Chair of the ASPS gender surgery committee, with Dr. Melissa Poh as Chair. He has been publicly critical of the ASPS position statement, posting on Threads in the days following its release. He is a frequent research collaborator with Dr. Berli at OHSU.
Dr. Melissa Poh
Chair, ASPS Gender Surgery Committee | ASPS Member
Kaiser Permanente West Los Angeles Medical Center, Los Angeles
Board-certified plastic surgeon and head of the transgender surgery program at Kaiser Permanente LA, performing the full spectrum of gender-affirming procedures. She is Chair of the ASPS gender surgery committee — with Blair Peters as her Vice Chair — making them the two most senior ASPS members in formal governance oversight of gender surgery. She has published extensively about gender-affirming surgical techniques. She may be on the ASPS Gender Surgery Task Force, but that is unconfirmed in published reporting.
Dr. Rachel Bluebond-Langner
Plastic Surgeon, Gender-Affirming Surgery | ASPS Member
Laura and Isaac Perlmutter Professor of Reconstructive Plastic Surgery, NYU Langone, New York
One of the country’s leading gender-affirming plastic surgeons, based at NYU Langone where she and her team perform over 800 gender-affirming procedures annually. Bluebond-Langner is a Johns Hopkins-trained reconstructive surgeon and pioneer of robotic peritoneal flap vaginoplasty. She has a longstanding research collaboration with Dr. Berli — including a joint commentary on the mastectomy systematic review that the ASPS position statement cites as foundational evidence. A WPATH member who follows WPATH guidelines. Her connection to the task force or open letter has not been confirmed in published reporting. NYU Langone has been at the center of its own controversy: on February 17, 2026 — two weeks after the ASPS position statement — the hospital shut down its Transgender Youth Health Program entirely, citing the Trump administration’s threats to withdraw Medicare and Medicaid funding from hospitals providing gender-affirming care to minors. The closure triggered protests outside the hospital, demands from 73 New York legislators that the decision be reversed, and a directive from the New York Attorney General ordering the program reinstated within 10 days. It is not yet known how the closure affects Bluebond-Langner’s adult surgical practice.
References & Further Reading
ASPS Position Statement (February 3, 2026): Gender Surgery for Children and Adolescents
HHS Evidence Review: Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices
SEGM Analysis: The American Society of Plastic Surgeons Rejects Adolescent Gender Surgery
Broadview News (Lisa Selin Davis): Medical Groups Are Censoring the Cass Review — The 2024 reporting on the Cass panel cancellation.
Broadview News (Lisa Selin Davis): Understanding the ASPS Position Statement with Dr. Scot Glasberg
Ben Ryan / Substack: Tensions Flare Within Plastic Surgery Group Over New Policy — The definitive account of the task force open letter and internal fracture.
Gender Clinic News (Bernard Lane): Consensus Shatters — Notes Schechter’s contradictory testimony across two legal cases.
City Journal (Leor Sapir): It’s Official: No Consensus Among Medical Groups on ‘Gender-Affirming Care’ for Minors
STAT News: American Society of Plastic Surgeons Endorses Delaying Gender-Affirming Surgeries Until 19
NBC News: Plastic Surgeons Group Calls for Delaying Gender-Affirming Surgery Until Age 19
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