In the first case of its kind to go before a jury, a 22-year-old woman named Fox Varian was awarded US$2 million in damages on Jan. 30 in a malpractice suit she brought against her plastic surgeon, Dr. Simon Chin, and her psychologist, Dr. Kenneth Einhorn. Chin removed Varian’s breasts at the age of 16, and Einhorn was treating her for gender dysphoria. After the operation, Varian developed severe and persistent regret and eventually reverted to identifying as female, her biological sex.

There are dozens of similar suits pending in the United States, brought by “detransitioners” beset by remorse over the medical and surgical changes wrought on their bodies by practitioners of the “gender affirmation” model of care, which has become deeply embedded in the medical landscape over the past 15 years. According to a Manhattan Institute analysis, at least 5,200 teen American girls underwent double mastectomies as part of gender transition procedures between 2017 and 2023.

It’s notable, then, that the American Society of Plastic Surgeons (ASPS) issued a new position statement this week, which acknowledged the scarcity of evidence that irreversible gender-related surgical interventions benefit adolescents, and recommended that surgeons delay gender-related breast, genital and facial surgery until patients are at least 19 years old. In its review of the evidence, the ASPS (which represents more than 11,000 physicians and more than 90 percent of the field in the U.S. and Canada) leaned heavily on data analyzed in a comprehensive Finnish study, the United Kingdom’s Cass Review, and the U.S. Department of Health and Human Services’ Gender Dysphoria Report.

Up to this point much of the conversation around “transitioning” young people has centred on their “autonomy”—their right to choose what sort of body they want to inhabit, regardless of the sparse body of evidence supporting transition. The ASPS explicitly laments this misuse of one of medicine’s bedrock principles: “Patient autonomy is more properly defined as the right of a patient to accept or refuse appropriate treatment; it does not create an obligation for a physician to provide interventions in the absence of a favorable risk-benefit profile, particularly in adolescent populations where decision-making capabilities are still developing.”

As the late Charles Krauthammer once put it: “Doctors are not just biotechnicians. They must make judgments… Before serving a patient’s will, doctors have to decide whether it is perverse and self-destructive.”

In another significant development, a day after the ASPS issued its statement, the American Medical Association, long an ardent proponent of the medical and surgical gender-affirming model of care, said this: “In the absence of clear evidence, the AMA agrees with ASPS that surgical interventions in minors should be generally deferred to adulthood.”

The new ASPS position limits its guidance to surgical intervention, but the organization did comment on the “substantial uncertainty” that exists around the long-term benefits and risks of puberty blockers and cross-sex hormones. This begs an obvious question—given that those interventions also have weak evidence of benefit (and actually, evidence for harm), and if such interventions are irreversible with life-altering consequences for the adolescents, then shouldn’t they also be kept from vulnerable children and adolescents?

There’s been a disconnect in recent years between North America and Europe with respect to the management of pediatric gender dysphoria, as detailed by the Aristotle Foundation in a comprehensive 2024 report (I’m a co-author), with the Europeans increasingly cautious about the administration of puberty blockers and cross-gender hormones to youth. The events of the past two weeks offer some promise, perhaps, that similar discretion is taking root on this side of the Atlantic.

In Canada, Alberta stands alone in passing legislation curbing the use of puberty blockers and cross-gender hormones in young people, and forbidding sex reassignment surgery for those under 18. The province’s government has suffered withering criticism (and legal attacks) from Canadian medical associations and trans advocacy groups. Again, hopefully the door has cracked open to reasonable dialogue and an honest weighing of the evidence.

Medical associations consistently state that governments and politicians should stay out of medical decision-making, that such things should be left up to patients, their families and their doctors. But the gender-affirming care saga—as with the Tuskegee syphilis experiments of yore—has revealed the danger of blindly trusting the medical profession to self-regulate.

Health-care professionals should of course care for children suffering from gender dysphoria with compassion and respect, but that care must not discard scientific rigour.

In the final analysis, I’m quite certain we all want the same thing—what’s best for our kids.

Dr. J. Edward Les, MD, is a senior fellow at the Aristotle Foundation for Public Policy, pediatrician in Calgary, and co-author of Teenagers, Children, and Gender Transition Policy: A Comparison of Transgender Medical Policy for Minors in Canada, the United States, and Europe. Photo: iStock.