Dr. Nicole Saphier examines the American Society of Plastic Surgeons’ new recommendation to delay gender-related surgeries until at least age 19, citing a lack of proven benefit and growing evidence of harm to minors. She breaks down the medical risks—including sterility, surgical complications, and long-term regret—and explains why earlier practices are now facing serious legal and ethical challenges, including a major malpractice case in New York.
Dr. Saphier also explores how countries across Europe have already reversed course with stricter, evidence-based guidelines, and why the U.S. medical establishment is now being forced to confront ideology-driven care.
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Speaker 1 (00:02):
Welcome to Wellness Unmasked. I'm doctor Nicole Sapphire and this
is your weekly rundown. Well Today's headline. It's one I'm
going to call important but painfully overdue. The American Society
of Plastic Surgeons, the largest US professional group for plastic surgeons,
has now recommended delaying gender related surgeries until at least
(00:22):
nineteen My first reaction is simple, where have you been
and finally welcome to reality. The ASPS position statement, it's
pretty direct and to the point. They cite the low
certainty of evidence for not just surgical interventions, but pediatric
endocurrent interventions. You know, the medications that they're starting to
(00:42):
give kids to stop puberty altogether and try and give
them characteristics of the opposite sex, and the overall just
growing uncertainty really about the benefits and the concerns about
the irreversibility and potential long term harms. Imagine that they're
going to do a surgical or endocrine intervention that's completely irreversible,
(01:05):
and at the time they were doing it and they
were like, well, let's just do it all in the
name of ideology. Of course, there's going to be damage.
So the ASPS has now concluded there's insufficient evidence of
a favorable risk benefit ratio for kids and adolescents, therefore
recommending surgeons delay chest, genital and facial procedures until the
(01:29):
age of nineteen. Now, let's break down the way they
worded it, insufficient evidence of a favorable risk benefit ratio.
That is the most wordy, garbage way of saying, we've
been doing something and there's no evidence that this is
actually for the good. And by the way, we're actually
(01:51):
causing a lot of harm. There you go. I set
it for you in Layman's terms. Now, their language is
not fringe language. It's a major medical says anxiety, essentially saying,
all right, we moved too fast with too little data
on irreversible interventions for developing bodies and brains full stop.
So the evidence problem what they are talking about, the
(02:14):
lack thereof good evidence and what harm may look like
in real life. So let's be precise. One of the
biggest issues here is that the best summaries of the literature,
when they try to look at all of these gender reassignments,
just repeatedly come back to the same theme uncertainty. A
recent large systematic review of puberty blockers concluded, well, there
(02:37):
remains considerable uncertainty about the effects across key outcomes, including
mental health measures and bone mineral density. Do you know
when in research we say, well, you know, we just
need more research. There's uncertainty. We essentially looked at things
and it didn't give us the outcome we wanted. So
(02:58):
we're like, we're going to keep finding it. You know,
Eventually we're going to get a study that's going to
prove what we're doing is right, even if it is
an entirely biased and poorly designed study. That's what they've
continued to do. So now let's just talk about the
harm for a minute. It's not just a spreadsheet of
side effects. It's the reality that these pathways can involve sterility,
(03:20):
sexual function changes, surgical complications, not to mention monetary financial strain,
but yes, regret and detransitioning for some patients later on.
You think that all fourteen fifteen, sixteen year olds know
exactly what they want when they are in that peak
adolescent peak piertal time, of course not. That's why they
(03:42):
can't drive cars, they can't vote, they can't get a tattoo,
they can't do any of these other things that mutilate
their body because we don't trust their decision making. I
don't know how or why medical professionals thought all of
a sudden, doing a mastectomy on a girl at the
age of fourteen was a good decision. She can't pierce
her tongue. But you're gonna do a masectomy? Are you
(04:04):
kidding me? Gosh, I just cannot believe how far we
went on this. So what the eighth SPS statement is
explicitly acknowledging right now is the whole real world landscape
clinicians must grapple with. You are actually causing harm with
no proven long term studies of benefit. That is the
(04:26):
exact opposite of the hippocratic oath that we all took.
And so this brings us to the whole medical legal reality.
Lawsuits no longer hypothetical. We used to say, well, what
happens in the future when if they regret their decision?
Well we know now because just this week in a
New York case reportedly described a jury awarding two million
(04:49):
dollars to a young woman in a malpractice suit tied
to gender related care received as a minor. She essentially
had a mastectomy at the age of sixteen, because I
guess at that time she just didn't want to breast anymore.
She thought she was a boy. Shocking, as soon as
her frontal lobe started to form a bit more, she
(05:09):
changed her mind. Whether you agree with every argument or not,
this signal something big. Medicine is being asked in court
to defend the wriger of its process, not just the
sincerity of the intentions, which means having some political ideology
is not going to save you from medical malpractice suits.
So you better be only doing things that are evidence based.
(05:32):
And guess what gender transition surgery and the hormone balkers
are anything but that, which is why you've already seen
other countries have hit the brakes on this. They're ahead
of the United States and England. The NHS stopped the
routine prescription of puberty walkers for under eighteen in March
twenty twenty four, following a big review's concerns about the
(05:53):
lack of evidence, and the UK government later moved to
make restrictions more Durabletional Board of Health and Welfare issued
updated guidance for miners that moves towards stricter criteria for
any sort of gender related stuff and greater caution, essentially
a warning saying we're not sure this is the right
thing to do. Even Reuters noted the broader trend UK, Sweden, Finland,
(06:16):
they've all shifted towards restriction and reassessment when it comes
to gender transitioning. So while US medical societies were projecting certainty,
Europe was rechecking the math. And now here we are
we are starting to see an about face, and all
of a sudden, we're seeing some medical societies change. So
the plastic surgery one was the first. The American Medical
(06:39):
Association actually came out with a comment to the National
Review saying that because the evidence for gender affirming surgical
intervention in miners is insufficient for us to make a
definitive statement, the AMA agrees with the ASPS that surgical
interventions in minors should be generally deferred to adulthood. Wow,
(07:01):
where was the AMA for the last five years? Why
didn't they speak up about the harm or not even
the harm? You know what, you don't even have to
go that far. Why don't you just say we don't
have data showing that there's benefit here, but we know
that there is at least some sort of irreversible harm
being done, not to talk about the potential long term
(07:22):
sequela of physical and mental health issues that come from this.
So I'm going to end this. Compassion is not the
same as science. If you're going to permanently alter a
child's body, you'd better be able to answer one question
with clarity. Where is the high quality, long term data
proving this helps more than at harms because the quote
(07:43):
unquote we meant well, this is not an outcomes measure,
and not only are you harming the children, but physicians,
you are going to be liable for some of these damages.
And parents, stop doing this to your children. I know
that sometimes adolescents are sough and they're confused, but don't
jump to something that has irreversible damage. Help get them
(08:05):
through that with whatever sort of counseling, therapy, social structure
in the household, outside of the household, whatever they need
to get to a better place mentally. And if they
still have a certain desire as they are older and
their brain is more formed, let them make that decision.
Then when they are children, let's guide them as adults
(08:26):
and let kids be kids. I'm doctor Nicole Safire. This
has been your weekly rundown on Wellness Unmasks. Make sure
to listen to Wellness unmass on iHeartRadio, Apple Podcasts, or
wherever you get your podcasts, and I'll see you next time.
Welcome to Wellness Unmasked. I'm doctor Nicole Sapphire and this
is your weekly rundown. Well Today's headline. It's one I'm
going to call important but painfully overdue. The American Society
of Plastic Surgeons, the largest US professional group for plastic surgeons,
has now recommended delaying gender related surgeries until at least
(00:22):
nineteen My first reaction is simple, where have you been
and finally welcome to reality. The ASPS position statement, it's
pretty direct and to the point. They cite the low
certainty of evidence for not just surgical interventions, but pediatric
endocurrent interventions. You know, the medications that they're starting to
(00:42):
give kids to stop puberty altogether and try and give
them characteristics of the opposite sex, and the overall just
growing uncertainty really about the benefits and the concerns about
the irreversibility and potential long term harms. Imagine that they're
going to do a surgical or endocrine intervention that's completely irreversible,
(01:05):
and at the time they were doing it and they
were like, well, let's just do it all in the
name of ideology. Of course, there's going to be damage.
So the ASPS has now concluded there's insufficient evidence of
a favorable risk benefit ratio for kids and adolescents, therefore
recommending surgeons delay chest, genital and facial procedures until the
(01:29):
age of nineteen. Now, let's break down the way they
worded it, insufficient evidence of a favorable risk benefit ratio.
That is the most wordy, garbage way of saying, we've
been doing something and there's no evidence that this is
actually for the good. And by the way, we're actually
(01:51):
causing a lot of harm. There you go. I set
it for you in Layman's terms. Now, their language is
not fringe language. It's a major medical says anxiety, essentially saying,
all right, we moved too fast with too little data
on irreversible interventions for developing bodies and brains full stop.
So the evidence problem what they are talking about, the
(02:14):
lack thereof good evidence and what harm may look like
in real life. So let's be precise. One of the
biggest issues here is that the best summaries of the literature,
when they try to look at all of these gender reassignments,
just repeatedly come back to the same theme uncertainty. A
recent large systematic review of puberty blockers concluded, well, there
(02:37):
remains considerable uncertainty about the effects across key outcomes, including
mental health measures and bone mineral density. Do you know
when in research we say, well, you know, we just
need more research. There's uncertainty. We essentially looked at things
and it didn't give us the outcome we wanted. So
(02:58):
we're like, we're going to keep finding it. You know,
Eventually we're going to get a study that's going to
prove what we're doing is right, even if it is
an entirely biased and poorly designed study. That's what they've
continued to do. So now let's just talk about the
harm for a minute. It's not just a spreadsheet of
side effects. It's the reality that these pathways can involve sterility,
(03:20):
sexual function changes, surgical complications, not to mention monetary financial strain,
but yes, regret and detransitioning for some patients later on.
You think that all fourteen fifteen, sixteen year olds know
exactly what they want when they are in that peak
adolescent peak piertal time, of course not. That's why they
(03:42):
can't drive cars, they can't vote, they can't get a tattoo,
they can't do any of these other things that mutilate
their body because we don't trust their decision making. I
don't know how or why medical professionals thought all of
a sudden, doing a mastectomy on a girl at the
age of fourteen was a good decision. She can't pierce
her tongue. But you're gonna do a masectomy? Are you
(04:04):
kidding me? Gosh, I just cannot believe how far we
went on this. So what the eighth SPS statement is
explicitly acknowledging right now is the whole real world landscape
clinicians must grapple with. You are actually causing harm with
no proven long term studies of benefit. That is the
(04:26):
exact opposite of the hippocratic oath that we all took.
And so this brings us to the whole medical legal reality.
Lawsuits no longer hypothetical. We used to say, well, what
happens in the future when if they regret their decision?
Well we know now because just this week in a
New York case reportedly described a jury awarding two million
(04:49):
dollars to a young woman in a malpractice suit tied
to gender related care received as a minor. She essentially
had a mastectomy at the age of sixteen, because I
guess at that time she just didn't want to breast anymore.
She thought she was a boy. Shocking, as soon as
her frontal lobe started to form a bit more, she
(05:09):
changed her mind. Whether you agree with every argument or not,
this signal something big. Medicine is being asked in court
to defend the wriger of its process, not just the
sincerity of the intentions, which means having some political ideology
is not going to save you from medical malpractice suits.
So you better be only doing things that are evidence based.
(05:32):
And guess what gender transition surgery and the hormone balkers
are anything but that, which is why you've already seen
other countries have hit the brakes on this. They're ahead
of the United States and England. The NHS stopped the
routine prescription of puberty walkers for under eighteen in March
twenty twenty four, following a big review's concerns about the
(05:53):
lack of evidence, and the UK government later moved to
make restrictions more Durabletional Board of Health and Welfare issued
updated guidance for miners that moves towards stricter criteria for
any sort of gender related stuff and greater caution, essentially
a warning saying we're not sure this is the right
thing to do. Even Reuters noted the broader trend UK, Sweden, Finland,
(06:16):
they've all shifted towards restriction and reassessment when it comes
to gender transitioning. So while US medical societies were projecting certainty,
Europe was rechecking the math. And now here we are
we are starting to see an about face, and all
of a sudden, we're seeing some medical societies change. So
the plastic surgery one was the first. The American Medical
(06:39):
Association actually came out with a comment to the National
Review saying that because the evidence for gender affirming surgical
intervention in miners is insufficient for us to make a
definitive statement, the AMA agrees with the ASPS that surgical
interventions in minors should be generally deferred to adulthood. Wow,
(07:01):
where was the AMA for the last five years? Why
didn't they speak up about the harm or not even
the harm? You know what, you don't even have to
go that far. Why don't you just say we don't
have data showing that there's benefit here, but we know
that there is at least some sort of irreversible harm
being done, not to talk about the potential long term
(07:22):
sequela of physical and mental health issues that come from this.
So I'm going to end this. Compassion is not the
same as science. If you're going to permanently alter a
child's body, you'd better be able to answer one question
with clarity. Where is the high quality, long term data
proving this helps more than at harms because the quote
(07:43):
unquote we meant well, this is not an outcomes measure,
and not only are you harming the children, but physicians,
you are going to be liable for some of these damages.
And parents, stop doing this to your children. I know
that sometimes adolescents are sough and they're confused, but don't
jump to something that has irreversible damage. Help get them
(08:05):
through that with whatever sort of counseling, therapy, social structure
in the household, outside of the household, whatever they need
to get to a better place mentally. And if they
still have a certain desire as they are older and
their brain is more formed, let them make that decision.
Then when they are children, let's guide them as adults
(08:26):
and let kids be kids. I'm doctor Nicole Safire. This
has been your weekly rundown on Wellness Unmasks. Make sure
to listen to Wellness unmass on iHeartRadio, Apple Podcasts, or
wherever you get your podcasts, and I'll see you next time.
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