Commentary: Big Tent Ideas

KURT MICELI: The Silence Has Been Broken. Will The Rest Of Organized Medicine Listen?

A hospital room. (Screen Capture/PBS North Carolina Channel)

The American Society of Plastic Surgeons (ASPS) did something rare in organized medicine: it changed course.

In its new position statement on gender surgery for minors, ASPS acknowledged that its understanding has shifted given recent, comprehensive evidence reviews. That willingness to revisit assumptions, confront uncertainty, and prioritize patient welfare is what medical professionalism requires. The American Medical Association (AMA), Endocrine Society, American Academy of Pediatrics (AAP), and American Psychiatric Association (APA) should follow suit, recognizing that concerns extend beyond surgery to the entire spectrum of pediatric medical transition.

Unfortunately, for years, these organizations have endorsed transition-related interventions for minors despite weak evidence and mounting international concern. ASPS’s statement is the first from a major U.S. medical society to openly acknowledge that the evidence does not justify these interventions in youth, explicitly calling out “gender‑related endocrine and surgical interventions.”

ASPS begins with a point too often ignored: “the natural course of pediatric gender dysphoria remains poorly understood.” The Department of Health and Human Services (HHS) report, which welcomed peer review, underscores that clinicians cannot reliably predict which children will persist in their distress and which will desist. This uncertainty is not a minor footnote. When a condition’s trajectory is unknown and interventions carry irreversible consequences, medical ethics demands caution, not acceleration. This applies to both surgeries and medications, including puberty blockers and cross-sex hormones, whose long-term physiological effects and side effects cannot be fully undone.

ASPS’s statement also sharpens the proper role of autonomy in clinical ethics. Patient autonomy does not compel physicians to offer interventions when the risk-benefit profile is unfavorable or uncertain, especially for minors whose decision‑making capacity is still maturing. Again, this is true for surgeries and medications. If medicine is to remain a moral profession, it must abandon the “have it your way” model of care that has failed children with gender confusion, fast‑tracking them to hormones and surgeries despite systematic reviews showing very low evidence of benefit and significant risk of harm.

Moreover, ASPS makes clear that a physician’s ethical duty cannot be diluted through the “shared responsibility” of a multidisciplinary team that might pass the patient like a hot potato through the course of care. Instead, ASPS calls on its members to exercise “independent professional responsibility.”

So too must every physician. Team-based care cannot be allowed to fragment accountability to the point of making no one accountable. If anything, pediatricians and psychiatrists bear heightened responsibility to ensure that vulnerable children with gender confusion are not swept into a reflexive algorithm that replaces judgment with momentum and exploratory therapy with experimental medications.

Medicine must do better. This is not ideological. Sound professional judgment must weigh both ethics and evidence. Fortunately, for plastic surgeons and the entire house of medicine, ASPS has taken an important first step.

It is also a courageous one.

Up to this point, U.S. medical societies have failed to regulate themselves. Instead, they have issued statements and guidelines that outpaced evidence, dismissed legitimate scientific debate, and marginalized clinicians who raised concerns. The result has been a vacuum of professional oversight—one that necessitated lawmakers to fill.

ASPS has now broken the silence. It has acknowledged uncertainty, weighed the evidence, and applied ethical judgment—placing children’s welfare above political pressure. The rest of American medicine should follow.

The Endocrine Society, AAP, and APA should not view ASPS’s statement as a challenge but as an invitation to re‑examine their own positions with similar humility and integrity. Health authorities in Sweden, Finland, and the U.K. have already revised their policies in response to evidence reviews.

And their concerns extend beyond surgeries. The effects of puberty blockers and cross‑sex hormones include reduced bone density, infertility, along with metabolic, cardiovascular, and neurocognitive risks. It’s no surprise that our counterparts overseas have emphasized psychotherapy and psychosocial support as the appropriate first-line response.

The stakes could not be higher. Now is the time for the AMA and the rest of organized medicine to demonstrate genuine leadership. ASPS has opened the door to meaningful professional self‑regulation in the care of children with gender dysphoria. Yet, in a statement, the AMA offered only vague support for ASPS’s position. It couldn’t make a “definitive statement” on surgical interventions, let alone address the harms of gender‑related endocrine interventions.

Now is not the time to waffle. The AMA should seize this moment by convening a national, multi‑society effort to open scientific dialogue, address ethical considerations, ensure rigorous guideline review, and make certain that recommendations—especially those involving powerful medications—match the true state of pediatric gender medicine. Surgeons have taken the first step; the rest of medicine must do the same.

This moment demands clarity, bravery, and leadership. Patients and families deserve so much better from the medical community. The path forward is clear—but only if organized medicine chooses to take it. By doing so, medical societies can honor their duty to children and begin restoring public trust in medicine.

Kurt Miceli, MD, is the Chief Medical Officer at Do No Harm.

The views and opinions expressed in this commentary are those of the author and do not reflect the official position of the Daily Caller News Foundation.

(Featured Image Media Credit: Screen Capture/PBS North Carolina Channel)