Tensions Flare Within Plastic Surgery Group Over New Policy Opposing Youth Gender Surgeries
An American Society of Plastic Surgeons task force charged with examining the issue of such surgeries was, to their chagrin, cut out of the loop when the ASPS board issued its new policy last week.
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. Both the timing of the statement’s release and its contents came as a complete surprise, however, to an ASPS task force that the organization convened in May to examine the very issue of gender surgeries on youth.
According to a two-page open letter that was signed by seven members of this youth gender surgery task force and sent to the ASPS board on Monday, the board cut the task force out of the loop when it came to developing and releasing the new position statement on youth gender surgeries.
The public release of the letter, which sought clarification from the ASPS board regarding its development 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 private and has since sought to withdraw his signature. In his own letter he sent to the ASPS board on Thursday morning, which I obtained, he said he thought the organization should have actually set the minimum age for gender surgeries at 25 years old.
Dr. Scot Glasberg is a plastic surgeon in private practice in New York, a past ASPS president, was president of the ASPS Foundation for one year until October 2024, and was on the ASPS board until October 2025. He told me 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, as you can imagine.”
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.” The group met approximately monthly over the past nine months.
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. This followed the ASPS disclosing to Leor Sapir of the Manhattan Institute in August 2024 that the organization had not endorsed such medical practices. This assertion undermined the longstanding claims by youth gender medicine advocates such as GLAAD, HRC and the ACLU that “all major medical organizations” support such interventions.
In an emailed statement responding to my questions about the ASPS task force’s open letter, a spokesperson for the organization told me on Thursday morning: “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. Montante said he has yet to hear any communication from the ASPS that might clear up any such misunderstandings.
In an email he sent to the task force on Thursday afternoon that I obtained, Dr. Montante said it was to his “shock and disappointment” that his fellow task force member, child and adolescent psychiatrist Dr. Scott Leibowitz, posted the task force’s open letter to his LinkedIn page on Wednesday.
Criticizing the ASPS’s position statement’s choice of 19 as a minimum age, Dr. Leibowitz wrote in that LinkedIin 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. He stated:
The letter addresses the Task Force's concerns about the ▶️ process ◀️ by which the ASPS generated its all-or-nothing position statement that listed the arbitrary age of 19 (notably the same age listed in an Administration Jan 2025 Exec Order) in the name of “evidence.” It is worth noting that the signatories of this letter include Task Force members with diverging viewpoints on the subject at hand, yet who agree on the importance of protecting the integrity of a process. The letter did **not** address the content of the position statement.
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 in December were ever communicated to the board or informed the board’s own decision-making on the matter. The letter continued: “To date, the Task Force is unaware of the statement’s authors and what methodology was used to arrive at the statement’s position.”
Dr. Glasberg told me that 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 (which has been intensely criticized by trans advocates as having been authored by what they have asserted is a biased panel of experts). Plus there was the new set of systematic literature reviews on this medical field out of McMaster University in Canada. (The activist blowback against those reviews led to a paroxysm within the lab of leading evidence-based medicine expert Dr. Gordon Guyatt.)
The task force includes as co-chair Dr. Loren Schechter, chief of gender-affirmation surgery at Rush University Medical Center in Chicago. Dr. Schechter is also the president-elect of the World Professional Association for Transgender Health, or WPATH. He recently stunned the gender world by testifying on behalf of the plaintiff in the first detransitioner lawsuit to go to trial, which reached a $2 million verdict in White Plains, New York, on Jan. 30. I covered the trial The Free Press.
The task force also includes such varied perspectives as:
Dr. Asa Radix, the current WPATH president, who is an infectious disease specialist at Callen-Lorde Community Health Center in New York
Dr. Leibowitz, who formerly led the pediatric gender clinic at Nationwide Children’s Hospital in Columbus, Ohio, until political pressures shuttered it and he moved into private practice. He is on the board of directors at WPATH.
Dr. Montante, who is in private practice as a plastic surgeon in Virginia. He 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. Montante has spoken at length with me about his concerns about the ethics of providing such surgeries to adolescents. As a policy, he does not conduct these operations on minors.
According to multiple members of the gender surgery task force, the group held a prescheduled meeting the evening of February 3, seven hours after the release of the ASPS board’s policy statement on youth gender surgeries. I received conflicting reports about whether any members expressed concerns about the contents of the position statement during that call. But multiple members were clearly upset by the fact that the ASPS board developed and released the position statement absent the task force’s input or knowledge. (Dr. Leibowitz missed the meeting and declined to comment to me on whether he would have expressed complaints about the contents of the position statement had he attended.)
“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 told me 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, according to the PDF’s meta-data and confirmation from Dr. Montante. The letter was signed by Drs. Berli, Schechter, Radix, Leibowitz, Montante and two others.
“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 in some way,” Dr. Montante told me about the open letter. (The draft of the letter, which I have seen, called it an “open letter to the Board,” just as the final version did.) 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 youth gender surgeries.
As Dr. Leibowitz emphasized on LinkedIn, the letter did not, however, contain complaints or comments about the actual contents of the ASPS position statement on youth gender surgeries. When I spoke with Dr. Leibowitz, he was keen to emphasize that the letter “addresses process-related issues,” with respect to how the position statement was developed and released. “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, said Dr. Leibowitz. He emphasized that he was speaking as an individual task force member and not in his capacity as a leader at WPATH.
Dr. Sapir, who studies pediatric gender medicine at the Manhattan Institute and was a coauthor of the HHS report on the subject, told me: “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. Schechter and the other members of the task force did not reply to emails from me seeking comment.
The letter did include what at least appeared to be an 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 exerted considerable pressure on hospitals to cease providing gender-transition surgeries and treatments to people under age 19, including by threatening to cut off their access to Medicaid funding. So when the ASPS’s policy statement put age 19 as its own cut-off, this raised eyebrows, to say the least. For my reporting for UnHerd last week, I asked Dr. Glasberg about what at least on the surface appeared like political coordination:
“This entire statement revolves around a vulnerable population,” Glasberg told UnHerd. “The ages of development are key.” And given the weakness of the evidence base, he continued, “we felt it would be best to recommend to wait until the age of 19” to allow young people time to mature.
Facing what is sure to be considerable backlash from liberal groups and transgender advocates, Glasberg asserted that the ASPS’s work on this document was fully independent of the Trump administration. “We have the beauty as an organization to be out of the line of politics,” Glasberg said. “We deal with science and evidence and data, and that’s why we made the decision we did.”
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.
I asked HHS whether it was the “federal agency” to which the open letter referred and whether the Trump administration pressured the ASPS to bring its policy on youth gender surgeries in line with the agency’s. “These claims are entirely baseless,” replied HHS press secretary Emily G. Hilliard. “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.”
Dr. Montante told me he “took at face value” Dr. Glasberg’s word when he spoke with the task force last week about having attended the agency meeting and about his assertion that the ASPS board had operated independently from politics in developing its position statement. “I have no reason to not trust what he told us,” Dr. Montante said.
According to Dr. Montante, Dr. Glasberg told the task force at its Feb. 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 he was advised by the counsel on the board that he should not do that,” Dr. Montante said of Dr. Glasberg. “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 on Thursday afternoon, Dr. Montante wrote: “I am writing to express my shock and disappointment that a confidential communication to the ASPS Board was publicly posted by Dr. Leibowitz on his LinkedIn profile for public display. I am further troubled by the implication—created by the manner of the post—that the letter’s signatories share concerns about the validity of the ASPS Position Statement.” He said he was withdrawing his signature from the letter.
Dr. Montante went on to say that 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 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.”
“I believe that the ASPS Position Statement did not go far enough.”
—Dr. Steven Montante, in a letter to the ASPS board
He continued:
At the same time, I believe that the ASPS Position Statement did not go far enough. Patients in the 19–25-year age range often exhibit similar vulnerabilities as those under 19, and in some ways, they may be even more at risk in respect to long-term risks and potential regret. From my experience, young adult patients are less likely to receive care from a multidisciplinary team and may undergo a less thorough evaluation process. As a member of the ASPS taskforce that has been working on updating treatment recommendations, I would have advocated for extending the restrictions on surgical gender transition through age 25, rather than stopping at 19.
Alejandra Caraballo, a clinical instructor at Harvard Law School and transgender activist, on Feb. 4, posted to 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 do indeed 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 my request for comment on Dr. Basu’s politics. But Dr. Glasberg again insisted to me 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.”
“We’re a scientific organization. We’re not a political organization.” —former ASPS president Dr. Scot Glasberg
Dr. Glasberg was not, however, directly involved in the ASPS board’s final drafting and release of the statement.
I asked Dr. Leibowitz whether the passages in the letter pertaining to Dr. Glasberg were meant to imply that the task force members were accusing the board of playing politics. Dr. Leibowitz said: “I’m not implying anything. I’m not insinuating anything.” He said the group is simply “asking for clarification” about the board’s process of developing the position statement.
The task force members remain unaware of the authors of the board’s position statement, according to the open letter. This is in keeping with complaints that ASPS member Dr. Blair Peters, a gender-transition surgeon at OHSU, posted onto Threads last week. Dr. Peters complained about a lack of transparency in the board’s process and the fact that the boarder membership was never consulted.
Stepping up his game, Dr. Peters has circulated a sign-on letter among fellow members of the American Council of Educators in Plastic Surgery. The letter, which I obtained and which has over 200 signatures according to a Google doc, criticizes the ASPS board for a lack of transparency. The letter calls the exclusion of the ASPS gender surgery task force from the development process of the ASPS’s position statement “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 actually 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, attributing the proliferation of statements of support for such interventions across medical societies to “committee capture.”
Most notably, the American Academy of Pediatrics’s foundational 2018 policy statement on the 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 return a request for comment. His letter was signed by Dr. Scott Mosser, who along with leading pediatric gender medicine physician Dr. Johanna Olson-Kennedy was sued in Dec. 2024 by detransitioner Clementine Breen for removing her breasts when she was 14 years old. Dr. Sidhbh Gallagher, the infamous “yeet the teets”doctor in Florida, signed on as well.
As I reported for The New York Sun:
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.
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 I obtained, along with a copy of the broadcast email, which bears the subject line: “Collective Action Plan: ASPS Statement 2-16-26 9pm EST,” and was sent to over 100 doctors on Wednesday afternoon. 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.
In the meantime, the task force’s open letter to the ASPS board concludes by asking:
We kindly request the ASPS Board to provide the following:
the identity and role of the authors of the ASPS position statement;
the process, including timing and methodology, by which the statement was developed;
the extent to which the Board was informed of the Task Force’s ongoing work, and by whom, including discussions held by the Task Force that may have influenced the outcome of the position statement;
whether the Board reviewed the Task Force’s anonymized submissions or areas of emerging consensus
Dr. Glasberg told me that following an interview he gave to Lisa Selin Davis in which they discussed detransitioning, he has received “about 15 to 20” referrals from detransitioners. This, he said to me, 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.”
I am an independent journalist, specializing in science and health care coverage. I contribute to The New York Times, The Guardian, NBC Newsand The New York Sun. I have also written for the Washington Post, The Atlantic and The Nation. Follow me on Twitter: @benryanwriter and Bluesky: @benryanwriter.bsky.social. Visit my website: benryan.net
Great reporting, Benjamin. Thank you! Not surprised to learn that the task force were not consulted after all of the similar shenanigans that have gone on in other medical and psychology professional associations, but I’m somewhat relieved to learn that the task force has been discussing and possibly pushing for 25 as the age restriction to commence medical/surgical treatments. A distressed gender dysphoria teen with often several mental health issues is not capable of giving informed consent at 18, and certainly not if they’ve been on puberty blockers since 12!
But i have to say that i’m truly shocked to learn this:
“Most notably, the American Academy of Pediatrics’s foundational 2018 policy statement on the 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.”
Utterly astounding that 60,000 paediatricians responsible for and experienced in providing the care for these kids cannot debate, contribute to or vote on appropriate care guidelines.
These medical society reversals are going to be entertaining to watch.