American Medicine Pumps the Brakes on Youth Gender Surgery

On February 3rd, a single sentence from the American Society of Plastic Surgeons sent shockwaves through American medicine: "Surgeons delay gender-related breast/chest, genital, and facial surgery until a patient is at least 19 years old." The next day, the American Medical Association—representing 1.3 million doctors—endorsed that view.

This wasn't just another medical guideline. It was a fundamental crack in what activists had long claimed was an unshakeable medical consensus supporting youth gender transition.

The Crumbling "Doctors Agree" Narrative

For years, the argument was simple and powerful. The American Civil Liberties Union proclaimed: "Doctors Agree: Gender-Affirming Care Is Life-Saving Care." GLAAD declared that "every major medical association" supported transgender youth healthcare. Fired up by Republican attacks and naturally deferential to institutional authority, Democrats echoed this line religiously.

At a 2023 congressional hearing, Representative Mary Gay Scanlon declared that gender-affirming care was "safe and effective" and "supported by every major medical association." "It's not up for debate," she insisted.

But the ASPS statement shattered that narrative. More significantly, it explicitly endorsed the conclusions of Britain's Cass Report and the evidence review commissioned by the Department of Health and Human Services—documents that LGBTQ groups had dismissed as fuel for right-wing attacks.

When "Yeet the Teet" Meets Reality

The Miami surgeon Sidhbh Gallagher became TikTok-famous for her catchphrase "yeet the teet," referring to mastectomies, and calling herself "Dr. Teetus Deletus." The detransitioner Chloe Cole, who received a double mastectomy at 15, became a powerful symbol of medical overreach.

But it was Fox Varian's recent lawsuit that truly exposed the system's failures. Varian had her breasts removed at 16, just 11 months after first identifying as male. She had autism, an eating disorder, and anxiety. By surgery time, she'd already changed her name twice.

Varian testified that she regretted the surgery instantly and detransitioned three years later. The court awarded her $2 million in damages, hearing that she was left with scarring, loss of sensation, and inability to breastfeed. Her case is one of more than two dozen similar lawsuits currently underway.

The Suicide Prevention Myth Unravels

Doctors often convinced parents by invoking suicide risk—the stark choice between "a dead son and a living daughter." This emotional blackmail was central to overriding parental concerns.

But at the Supreme Court, the ACLU'sChase Strangio made a crucial concession: there was no evidence that transition prevents suicide because "completed suicide, thankfully and admittedly, is rare." Instead, he argued it reduced suicidal thoughts—a significant retreat from the life-or-death rhetoric that had dominated the debate.

A Quiet Revolution in Medical Thinking

The tide has turned decisively. Twenty-seven states have placed restrictions on the medical pathway for minors. Gender clinics in blue cities like Los Angeles have shut down under Trump's funding threats. The success of high-profile detransitioner lawsuits has made remaining affirmative clinicians nervous.

Even Democratic rhetoric has shifted. In 2024, 11 Democratic senators and 153 House members urged the Supreme Court not to uphold Tennessee's ban—but their argument focused on "individual freedom" rather than treatment effectiveness. It's a telling retreat from the confident medical claims of the 2010s.

The European Model Resurfaces

The ASPS statement notes that "available evidence suggests that a substantial proportion of children with prepubertal onset gender dysphoria experience resolution or significant reduction of distress by the time they reach adulthood, absent medical or surgical intervention." This acknowledgment that gender dysphoria often resolves naturally challenges the core assumption of the affirmative model.

Advocates now stress the need for "careful assessments"—ironically, the essential feature of the Dutch protocol that American providers largely rejected in the 2010s. The field is quietly returning to the cautious, evidence-based approach it abandoned in its rush to affirm.

The excesses of the affirmative era fueled the current backlash. The real tragedy isn't just in the individual cases of regret—it's in how polarization made thoughtful, evidence-based medicine nearly impossible. The question now is whether American healthcare can find its way back to the careful, individualized approach that complex cases demand.