Open letter to the American Society of Plastic Surgeons and to national and international professional health societies

Contact: transyouthtrajectories@gmail.com

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Dear Sir or Madam,

On February 3, 2026, the American Society of Plastic Surgeons (ASPS) issued a position statement recommending that gender-affirming surgeries, including mastectomies, be deferred until the age of 19. This widely circulated recommendation, which directly affects access to care for certain adolescents, in our view calls for thorough scientific and ethical discussion.

Trans Youth Trajectories – a platform coordinating care pathways for trans minors in the Paris region – together with healthcare professionals, researchers, and representatives of healthcare system users, wish to express their concerns regarding the empirical and methodological foundations of this position. We do not dispute the existence of uncertainties in the available data. However, we consider that the normative conclusion implying a systematic postponement of interventions is not sufficiently supported.

Our analysis highlights several major points:

• an international politico-institutional context liable to indirectly influence professional positions and the organization of healthcare provision;
• inaccurate or incomplete interpretations of certain national guidelines and of the international bodies of evidence cited as an empirical foundation;
• the invocation of reports or reviews that do not include a direct evaluation of gender-affirming mastectomies in minors, or whose findings do not support the conclusion adopted;
• a confusion between certainty about the rarity of harms and the certain presence of harms;
• a problematic interpretation of surgical safety data that are nonetheless overall reassuring;
• the absence of explicit consideration of the direction and magnitude of observed effects when they suggest clinical improvements or high patient satisfaction;
• an application of the precautionary principle transformed into a generally restrictive rule, without sufficient room for individualized clinical assessment;
• an implicit shift in the evidentiary threshold required to intervene, without satisfactory justification or consistency with other comparable pediatric practices.

Taken together, these elements suggest that the recommendation of systematic postponement rests less on direct empirical demonstration than on a particular interpretation of scientific uncertainty.

We call on learned societies and professional institutions to re-examine transparently the empirical foundations of their recommendations, to clearly distinguish uncertainty from the presence of risks, and to preserve the central role of individualized and multidisciplinary clinical assessment. In a field as sensitive as the health of transgender adolescents, methodological rigor and ethical proportionality are essential.

We submit this letter in a spirit of scientific dialogue, professional responsibility, and the protection of quality of care. We remain available for a possible meeting to discuss these points.

Please find in appendix the detailed critical analysis of the ASPS position statement.

Please accept the expression of our highest consideration.

Trans Youth Trajectories
and the individual signatories (healthcare professionals, researchers, and representatives of healthcare system users), listed below.

• Claire Vandendriessche, associative coordinator at Trans Youth Trajectories, PhD candidate in social epidemiology at Sorbonne Université
• Hélène Rogozyk, general practitioner
• Agnès Condat, psychiatrist, PhD in cognitive sciences
• Sophie Cassier, plastic surgeon
• Alexandre Vairinho, surgeon
• Clément Moreau, psychologist
• Laurence Hérault, university professor, anthropologist
• Nicolas Mendes, clinical psychologist, PhD in psychology, sexologist
• Chrystelle Lagrange, PhD in psychology
• Karine Espineira, sociologist
• Florence Lelièvre, medical gynecologist, practicing in abortion care, gynecology, and CeGIDD services at the Intercommunal Hospital of Villeneuve-Saint-Georges
• Anaïs Perrin-Prevelle, director of the OUTrans association, member of the French National Authority for Health working group on trans identities
• Lise Morin, clinical psychologist
• Laszlo Blanquart, director of the ACCEPTESS-T association, a national organization representing healthcare system users
• Claire Versini, psychomotor therapist, sexologist
• Axel Descamps, general practitioner
• Vincent Warnery, couple and family counselor, trainer
• Laetitia Martinerie, professor of pediatrics
• Béatrice Denaes, co-president of Trans Santé France
• Camille Sauvée, gynecologist
• Céline Rogez, social worker
• Lee Ferrero, coordinator of Transat, a trans association in Marseille and Avignon
• Mina Minvielle, psychologist
• Jean Chambry, child and adolescent psychiatrist
• Angéline Charmet, psychologist
• Olivier Ouvry, child and adolescent psychiatrist
• Armelle Grangé-Cabane, general practitioner
• Julie Brunelle, child and adolescent psychiatrist
• Laura de Salas Prado, general practitioner
• Charlotte Mouton, general practitioner
• Gabrièle Azouz, primary school teacher
• Nicolaï Johnson, endocrinologist
• Mallory Cottret, general practitioner
• Tom Reucher, psychologist
• Rémi Cappanera, general practitioner
• Andrés Ramírez Zamudio, gynecologic surgeon
• Blanca Bermudo, general practitioner
• Romain Soubise, president of the OUTrans association
• Maliana Margain, project officer, OUTrans association
• Mathilde Lafaysse, general practitioner
• Hadrien Guiollot, general practitioner
• Fanny Poirier, PhD in psychology, Espace Santé Trans association
• Sophie Gibert, general practitioner in Bordeaux

Download the appendix: https://trajectoiresjeunestrans.fr/wp-content/uploads/2026/02/aspsen.pdf

Appendix: