Top US surgeon breaks ranks and speaks out against teen gender surgery- 'I won't even entertain it'

One of America's top plastic surgeons has refused to perform gender surgeries on children at his practice because he worries about the long-term effects.

California-based plastic surgeon Dr Steven Williams, who serves as president of the American Society of Plastic Surgeons (ASPS), cited a lack of long-term research into the effects of transitioning as a teenager.

He also pointed out how the situation in America had become 'political', while the UK and European countries had banned the procedure for children due to a lack of evidence on efficacy and harms.

Gender-affirming care is a relatively new field of research and doctors are still investigating the effects of puberty blockers and hormone treatments on young people’s brains and development into adulthood.

At the same time, transitioning has been shown to reduce suicidal ideation, drive down rates of depression among gender-questioning young people, and improve their overall well-being. 

Dr Steven Williams, a California-based plastic surgeon, does not perform transition surgeries on young people and has never considered doing so, citing questionable long-term evidence

Dr Williams told NewsNation: ‘I don’t perform gender-affirming care in adolescents, and the reason why is because I don’t think the data supports it.

‘So at my practice, we don’t even entertain that.’

Transition surgery, which can include removing the breasts (also called 'top surgery') and changes to genitalia, under 18 is extremely rare and decided on a case-by-case basis by teams of primary care doctors, psychologists, endocrinologists, and surgeons. 

Trans children typically begin their transition with puberty blockers. These medications delay the onset of puberty to provide the child and their family with more time to decide whether to pursue hormone therapies.

Hormone therapies, meanwhile, typically begin in a child’s teenage years to help them develop secondary sex characteristics. A girl transitioning to become a boy, for instance, may take hormones to deepen their voice and grow body hair.

After undergoing hormone therapy, a trans person may choose to undergo surgery to medically transition, though not everyone does this. 

In the past, the typical pathway involved a psychological assessment, followed by hormones, culminating in surgery. But not all transgender people seek all interventions, and some may seek none. 

‘Personally, for adolescents, I don’t think I’m capable of unwinding all of that,’ Dr Williams said.

‘I know that I’m not comfortable with the level of evidence there is yet — and it’s a particularly vulnerable population — which is why I think it’s important to proceed with caution.’

The above graph shows the number of gender-affirming top surgeries carried out in the US by year

Professional medical organizations, including the American Academy of Pediatrics, the American Medical Association, and the American Psychological Association, maintain that gender-affirming care - surgery included - is necessary for the emotional and physical well-being of trans youth. 

On the other hand, critics of allowing children access to gender-affirming care including hormones and surgery, have described reassignment surgeries as experimental, given the dearth of long-term research into its benefits as well as a lack of consensus among doctors for best surgical techniques. 

Jay Richards, a fellow at the conservative Heritage Foundation, previously told DailyMail.com that is it 'tempting' to compare clinics performing these 'ghoulish procedures' to Dr Frankesntein's lab. 

'But that would be uncharitable to Dr Frankenstein,' Dr Richards said. 

Critics of gender-affirming care for children have also noted instances of children and parents feeling as though they were being forced through the transition process without adequate psychological support. 

In response to a Dutch study suggesting that children with gender dysphoria may grow out of it by the time they reach age 25, Patrick Brown, a fellow at the conservative Ethics and Public Policy Center said it provides 'even more reason to be skeptical towards aggressive steps to facilitate gender transition in childhood and adolescence.

He added that, for the vast majority of people, 'prudence and caution, rather than a rush towards permanent surgeries or hormone therapies, will be the best approach for teenagers struggling to make sense of the world and their place in it.

'As such, policies that prohibit gender transition for minors make a great deal of sense.'

The most common type of gender-affirming surgery involves removing the breasts to make the chest more masculine, followed by genital reconstruction and then by facial procedures. 

But research has shown that surgeries among children and teens, who typically begin the transition process by changing their pronouns and clothes and meeting with a psychologist, are rare. 

Researchers at the Harvard T.H. Chan School of Public Health looked at millions of adults and minors across different age groups to determine how frequently transition surgeries occurred in the US in 2019.

The findings showed that in 2019, around two per 100,000 minors aged 15 to 17 underwent a gender transition surgery. For minors aged 13 to 14 years, the rate dropped to 0.1 per 100,000, and no gender-affirming surgeries were performed on minors aged 12 years or younger. 

Dr Elizabeth Boskey, a social worker and researcher at Harvard who co-led the research, said: 'We found that gender-affirming surgeries are rarely performed for transgender minors, suggesting that U.S. surgeons are appropriately following international guidelines around assessment and care.'  

Allowing young people to access these transition services has become a contentious culture war issue spawning bans on gender-affirming care in nearly two dozen states.

While surveys of trans youth who have begun the transition process tend to show improved mood and anxiety levels, experts are increasingly concerned that doctors are doling out medicines without a wealth of information about their long-term effects to back them up.

Gender researchers in the UK, where doctors are no longer allowed to prescribe puberty blockers, have argued in a landmark review commissioned by the National Health Service that previous studies on the topic are of ‘poor quality’ and there is ‘very limited evidence on the longer-term outcomes’ associated with medical transition.

According to the government-sponsored report: ‘This is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint. The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress.’

Earlier this year, Oxford University endocrinologist Ashley Grossman weighed in, saying there is 'no good evidence' showing puberty blockers help trans children, highlighting a new study that found they damage the testes and sperm of the boys who take them.

Sex change surgery rates have shot up in recent years, with one in six trans adults in the US opting to have gender-affirming surgery. The majority of those who go under the knife have genital surgery (84 percent between 2006-2011), but almost half of the people who have vagina construction surgery suffer complications years later. Most transmen (64 percent) who have penis construction surgery also have issues

Grossman said blockers may be 'helpful' to some trans kids, but that the drugs were too risky to be dolled out to the 'greatly increased' number of young people who identify as trans nowadays.

He added: 'Routine puberty blocking treatment for this use has not yet been adequately studied, and many of these children may have other problems for which they need help,' he added, hinting at a growing body of evidence showing gender confused youngsters often have other, underlying mental health issues.

Norway, Finland, Sweden, Holland, and the UK are among a growing list of countries to have restricted or wholesale stopped trans interventions on children.

But the US, whose healthcare system is run by both the government and the private sector, has no such blanket regulations, allowing different doctors in various states to operate at their discretion.

Dr Sheila Nazarian, a board-certified plastic surgeon based in Beverly Hills, said: ‘I think some physicians and some medical associations have been overtaken by a vocal minority and they are politicized.

‘This is 100 percent an American political issue. If we look at Europe, very progressive governments have backed off of these procedures in minors because they’re just analyzing the data — as we should with every procedure. Why is it that for this procedure, in this patient population, we just have to shut up?’