Tensions Flare Within Plastic Surgery Group Over Bombshell New Policy Opposing Youth Gender Surgeries

The American Society of Plastic Surgeons shook the transgender care field last week when it issued a nine-page policy statement recommending its members not conduct gender-transition surgeries on patients under age 19. The statement — the first by a major medical association explicitly opposing the treatments for minors — came as a complete surprise, in its timing and contents, to an ASPS task force that the organization convened in May to examine the very issue of gender surgeries on youth.The field of transgender medicine for minors, which most centrally entails providing puberty blockers and cross-sex hormones and, more uncommonly, major plastic surgeries – has been under siege in recent years.Red-state legislatures have passed laws banning these interventions for minors in just over half the states, and the Trump Administration has threatened to pull federal funding from hospitals that provide them, leading to so-called anticipatory obedience from a slew of major hospitals in blue states.Last year, the Supreme Court upheld the right of states to ban the treatments. All the while, however, major medical associations, including the powerful American Academy of Pediatrics – have sweepingly backed giving the treatments to minors. The new ASPS statement, therefore, is profoundly consequential.The American Society of Plastic Surgeons is the first physicians’ group to come out against medical gender treatment for minors. ASPSHistorically, gender surgeries among minors have overwhelmingly been mastectomies. The nation saw about 1,000 such operations annually during the several years preceding state bans going into effect. Much more rarely, minors have undergone so-called vaginoplasties, in which the skin of the penis is inverted to create a neo-vagina, as well as hysterectomies and facial feminization surgeries. The ASPS’s position statement recommends “deferring” such surgeries until young adulthood. The organization’s board cut its own youth gender surgery task force out of the loop when it came to developing and releasing the statement, according to a two-page open letter that was signed by seven members of the task force and sent to the ASPS board on Monday. The subsequent public release of the letter, which sought clarification from the ASPS board regarding the genesis of the position statement, has led to further friction within the task force. Dr. Steven Montante, a Virginia plastic surgeon, signed the letter thinking it would remain out of the public eye and has since sought to withdraw his signature. In his own letter to the ASPS board that he sent on Thursday, which the Sun obtained, he said he thought the organization should have actually set the minimum age for gender surgeries at 25 years old.A transgender rights supporter takes part in a rally outside of the U.S. Supreme Court. Kevin Dietsch/Getty ImagesDr. Scot Glasberg is a plastic surgeon in private practice in New York, a past ASPS president, and was on the organization’s board until October 2025. He said the ASPS Gender Surgery Task Force, which he co-chairs, was established nine months ago with a vague yet challenging remit: to see if experts coming to this issue from different perspectives and disciplines could, he said, “try to have discussions to see if there are areas where we could come to consensus.” “These conversations are very difficult,” said Dr. Glasberg. “There are many different opinions around this issue. And so it’s very difficult to come to consensus.”The task force’s open letter to the board noted that the group includes, in addition plastic surgeons, “experts in adolescent psychiatry, medicine and research methodology.”According to Dr. Glasberg, unbeknownst to the task force, the ASPS board undertook its own separate, “iterative” process, beginning in the fall of 2024, of developing a position statement on youth gender surgeries. Dr. Steven Montante, a Virginia plastic surgeon. Montante Plastic Surgery and AestheticsIn an email he sent to the task force on Thursday afternoon that the Sun obtained, Dr. Montante said it was to his “shock and disappointment” that his fellow task force member, Columbus, Ohio, child and adolescent psychiatrist Dr. Scott Leibowitz, posted the task force’s open letter to his LinkedIn page on Wednesday. Dr. Leibowitz is on the board at the World Professional Association for Transgender Health, or WPATH – a quasi-medical-activist group that champions gender-transition medical interventions for minors – and coauthored the controversial adolescent chapter of its transgender-care guidelines, known as the Standards of Care.Criticizing the ASPS’s position statement’s choice of 19 as a minimum age, Dr. Leibowitz wrote in his LinkedIn post: “The statement clearly ignored the reality that a young person’s **maturity** to make a decision can differ across ages, and that guardrails/criteria are important **because** of the low certainty evidence, **not in spite of it.**”Dr. Leibowitz’s evident opposition to the contents of the ASPS position statement notwithstanding, he further emphasized in his post that the task force’s open letter to the board was solely concerned with process-related issues by which it developed the guidance setting, he said, “the arbitrary age of 19” as the age minimum. Only the ASPS board, Dr. Glasberg said, ever had the authority to establish and release a position statement about youth gender surgeries. The task force members each submitted anonymous positions on the matter in December, including, according to the open letter, “areas of agreement, uncertainty, and disagreement.” Per the letter, these positions were meant to guide the task force toward releasing its own “evidence-informed statement.” Also, the task force “was actively working towards a summary intended to inform Board-level deliberation regarding any Society position or policy statement.”But the letter further stated that it remains unclear to the task force whether their perspectives that they submitted two months ago were ever communicated to the board or informed the board’s own decision-making. “To date, the Task Force is unaware of the statement’s authors and what methodology was used to arrive at the statement’s position,” the letter continued.Dr. Scot Glasberg. YouTubeIn an email, an ASPS spokesperson told the Sun: “It is important to note that the letter is based on a series of misunderstandings, which ASPS is in the process of clarifying for its members.” Dr. Glasberg said the board’s process of developing and releasing its statement remained confidential. He said he did provide verbal reports of the task force’s progress to the board, but did not inform the task force about what he knew about the board’s own parallel operations on this matter. Since the board began work on the gender-surgery position statement, Dr. Glasberg pointed out, a number of key reports and papers that informed and refined the board’s understanding of youth gender medicine were released. This included the massive Health and Human Services, or HHS, report on the issue. Plus there was the new set of systematic literature reviews on this medical field out of McMaster University in Canada. The task force includes as co-chair Dr. Loren Schechter, chief of gender-affirmation surgery at Rush University Medical Center in Chicago and president-elect of WPATH. He recently stunned the gender world by testifying, in White Plains, New York, last month, on behalf of a plaintiff who is what is known as a detransitioner–meaning she underwent a gender-transition medical intervention only to revert to identifying and presenting as her birth sex. She sued her psychologist and plastic surgeon over the mastectomy she received at age 16 and came to bitterly regret. The jury found in her favor and awarded her $2 million, a judgment that sent shockwaves through the medical and mental-health establishments. Dr. Montante is a coauthor, with the McMaster researchers, of the only systematic literature review—the gold standard of scientific evidence—to assess the quality of the evidence regarding gender-transition mastectomies for adolescents and young adults. The evidence base proved weak and unreliable, as with gender-transition treatments for minors. Dr. Loren Schechter, a plastic surgeon. YouTubeAccording to multiple members of the ASPS gender surgery task force, the group held a prescheduled meeting the evening of February 3, hours after the release of the board’s policy statement on youth gender surgeries. Some members were clearly upset by the fact that the ASPS board went over the task force’s head. “Loren was not surprisingly very vocal about the fact that the statement was released without the task force knowing about it in advance,” Dr. Montante said of Dr. Schechter’s discourse on the call. “Clearly he was very emotional about it.”The task force’s subsequent open letter to the board was spearheaded by Dr. Jens Berli, the head of plastic and reconstructive surgery at Oregon Health & Science University, or OHSU, according to Dr. Montante.“I got kind of hoodwinked into signing this thing. I didn’t realize that it was going to be used as a cudgel against the board,” Dr. Montante said about the letter. He said he felt the public nature of the letter put him in an awkward position to at least seemingly stand on the opposite side of his public stance of expressing concern about the ethics of conducting gender surgeries on youths.In an interview, Dr. Leibowitz said, “The members of this task force had no knowledge of some long-standing process” on the part of the board to develop the position statement. He emphasized that he was speaking as an individual task force member and not in his capacity as a WPATH leader. Leor Sapir of the Manhattan Institute. Manhattan InstituteLeor Sapir, who studies pediatric gender medicine as a senior fellow the Manhattan Institute and coauthored the recent HHS report on youth gender medicine, said: “Leibowitz made no public protests about ‘process’ when it was revealed that WPATH committed serious violations in the creation of its recent Standards of Care, including suppression of evidence reviews, failures to manage conflicts of interest, and elimination of age minimums for political reasons. Apparently, ‘process’ only matters when you don’t get the result you want.”Dr. Berli, Dr. Schechter, and other members of the task force did not respond to requests for comment.Dr. Blair Peters, a gender-transition surgeon at OHSU who is a highly public and ardent supporter of youth gender transition interventions on social media under the moniker “queersurgeon,” has circulated a sign-on letter among fellow members of the American Council of Educators in Plastic Surgery. The letter, which the Sun has obtained and has over 200 signatures according to a Google doc, strikes a similar tone to the youth gender surgery task force’s letter. Instead of objecting to the contents of the position statement, Dr. Peters’ letter criticizes the ASPS board for a lack of transparency in releasing it. The letter calls the task force’s exclusion from the development process “deeply troubling.”“This position statement was published, presented, and discussed in the media as though it represents the consensus of ASPS membership,” the letter complains.It is quite typical, however, for medical societies to task the development of position statements to small, insular committees. People opposed to gender-transition interventions for minors are usually the ones complaining about this phenomenon, attributing the proliferation of statements of support for such interventions across medical societies to “committee capture.”Dr. Jason Rafferty, a leading specialist in pediatric gender transitions. Brown UniversityMost notably, the American Academy of Pediatrics’s foundational 2018 policy statement on the so-called gender-affirming care method was written by a single AAP member, Dr. Jason Rafferty, when he was still a resident, and then edited by a small committee. Dissidents have pressured AAP leadership to put the controversial and highly contested statement to a vote by the organization’s more than 60,000 members, to no avail.Dr. Peters did not respond to emails requesting comment.Notable plastic surgeons who have signed Dr. Peters’ letter include Dr. Scott Mosser, a California surgeon, who along with leading pediatric gender medicine physician Dr. Johanna Olson-Kennedy was sued by a detransitioner for removing her breasts when she was 14 years old. Dr. Sidhbh Gallagher, a Florida surgeon who is notorious for social media videos in which she exuberantly champions mastectomies with the euphemism “yeet the teets,” signed on as well.Another signatory is Dr. Alison Snyder-Warwick, the chief of plastic surgery at the University of Michigan. In 2022, she was a plastic surgeon at Washington University at St. Louis. According to an email exchange the Sun obtained from Jamie Reed, a former case manager in — and whistleblower from — the university’s since-shuttered pediatric gender clinic, Dr. Snyder-Warwick responded with apparent reluctance to emailed inquiries about a young patient who had detransitioned and was seeking reconstruction following the mastectomy the university hospital performed.“I don’t think any of our group would be interested in a reversal surgery in the short term,” Dr. Snyder-Warwick wrote, “but also don’t want to withhold surgery if the team feels it’s a valuable treatment.”Dr. Snyder-Warwick did not immediately return a request for comment.Dr. Alison Snyder-Warwick. Washington UniversityThe ASPS task force’s open letter contained an apparent insinuation that politics might have played a role in the ASPS board’s release of the policy statement. The letter referred to “communication sent to the Task Force by Michael Costelloe, Executive Vice President of ASPS, on February 2, 2026 stating: ‘Over the past several weeks, ASPS, along with a small number of other national medical societies, has been participating in an urgent, time-limited process initiated by a federal agency seeking clarification of medical society positions on this topic.’”The Trump Administration has threatened to cut off hospitals’ access to Medicaid funding if they continue providing gender-transition interventions to patients under age 19. So when the ASPS’s policy statement put the same age as its own cut-off, this raised accusations of coordination, or at least capitulation. According to the task force’s open letter to the ASPS board: “Following the release of the ASPS position statement, Task Force members became aware that Dr. Glasberg and two ASPS administrators (who attend Task Force meetings) participated in discussions with a federal agency. The Task Force members were told that Dr. Glasberg did not represent ASPS at this meeting, but rather attended the meeting as an invited guest on behalf of the agency. In other words, no ASPS surgeon represented the organization.”“These claims are entirely baseless,” HHS press secretary Emily G. Hilliard said in response to a question regarding whether the Trump administration pressured the ASPS to produce a policy on youth gender surgeries in line with its own. “HHS commends the American Society of Plastic Surgeons for standing up to the overmedicalization lobby and defending sound science that helps protect future generations of American children from damaging, irreversible harm.”According to Dr. Montante, Dr. Glasberg told the task force at its February 3 meeting that Dr. Glasberg and Mr. Costelloe had wanted to share the ASPS board’s position statement with the task force in advance of its release. But Dr. Glasberg “was advised by the counsel on the board that he should not do that,” Dr. Montante said. “I understand why his hands were tied.” Dr. Montante further said that Dr. Glasberg relayed that the ASPS counsel was concerned about conflicts of interest on the task force. In his own email to the task force, sent Thursday afternoon, Dr. Montante said he signed the letter because hoped “to better understand how the Task Force might re-engage constructively in a process that strengthens safeguards for young adults ages 19-25.”Dr. Montante separately wrote to the board on Thursday morning: “While I support the availability of gender-affirming surgeries for mature adults with stable identities and well-managed mental illness, both my clinical and research experience have led me to conclude that the vulnerable patient population of adolescents and young adults should be safeguarded from irreversible procedures such as gender-affirming surgery.”Dr. Sheila Nazarian. Nazarian Plastic SurgeryDr. Sheila Nazarian, a Beverly Hills plastic surgeon and frequent public critic of pediatric gender medicine, noted that researchers in Europe are in the process of analyzing long-term outcomes in young adults who undergo gender-transition interventions to determine if there is a benefit. “If the data shows there isn’t,” she said, “then all societies should put out another position statement on that.”Alejandra Caraballo, a clinical instructor at Harvard Law School and prominent transgender activist, on February 4, posted to the social-media site Bluesky records indicating that the ASPS president, Dr. Bob Basu, is, in her words, “a huge Trump supporter,” given his many political donations to the president and to related super PACs.Federal records indicate that Dr. Basu has contributed thousands of dollars to Republicans, including nearly 300 separate donations dating back to 2009.The ASPS did not reply to a request for comment on Dr. Basu’s politics. But Dr. Glasberg insisted that the board’s process of developing its position statement, which he said he was directly involved in until his term on the board ended in October 2025, operated independently from the Trump administration.“The start of the process was during the Biden administration,” he said. “We’re a scientific organization. We’re not a political organization. We don’t get driven by politics.”Dr. Glasberg was not, however, directly involved in the ASPS board’s final drafting and release of the statement. ASPS members who have a history of performing gender surgeries on adolescents are slated to meet on Monday evening to discuss strategy and next steps in the wake of the release of the board’s policy on such interventions. This is according to the agenda for their meeting, which the Sun obtained and which was sent to over 100 doctors on Wednesday. One agenda item — “Focus on anticipated impact on surgeon autonomy, scientific integrity, and member representation” — apparently suggests that these physicians are now grappling with how to process the particulars of the new ASPS policy on youth gender surgeries.Dr. Glasberg said he has recently begun treating a sizable population of patients seeking reconstruction after undergoing gender surgeries they regretted. This, he said, has opened his eyes to their plight. “The community that’s being forgotten here are the detransitioners,” Dr. Glasberg said. “And I’ve been very vocal about the fact that we cannot forget them. It’s a very difficult care that they need.”

Tensions Flare Within Plastic Surgery Group Over Bombshell New Policy Opposing Youth Gender Surgeries

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