AMA Urges Caution on Gender Surgeries for Children, Renewing Debate Over Safeguarding and Consent

The American Medical Association has announced that most gender-related surgeries for children should be postponed until adulthood, citing limited long-term evidence about outcomes and risks. The guidance aligns with a similar position recently taken by the American Society of Plastic Surgeons.

The AMA emphasized that it continues to support access to gender-related care for children. However, it said irreversible surgical interventions require stronger research before becoming more common in this age group.

Balancing Protection and Autonomy

At the heart of the debate is a safeguarding question: how to protect children from potential long-term harm while also respecting their right to participate in decisions about their own bodies.

Children have evolving capacities. As they grow, they develop the ability to understand medical information, weigh consequences, and express informed views. International child rights principles affirm that children capable of forming opinions have the right to be heard in matters affecting them.

But safeguarding frameworks also recognize that adolescence is a period of ongoing cognitive and emotional development. Decisions involving irreversible medical procedures carry lifelong implications. Protecting children means ensuring that decisions are not rushed, pressured, or based on incomplete evidence.

The Role of Evidence and Long-Term Outcomes

Between 2016 and 2020, about 3,600 patients aged 12 to 18 underwent gender-related surgeries in the United States, most involving chest procedures. Some clinicians argue that early physical development can cause significant distress for transgender adolescents.

However, medical groups now point to gaps in long-term research on surgical outcomes. Concerns include potential complications, the permanence of procedures, and the possibility that some individuals may later regret the intervention.

From a child protection perspective, strong evidence is essential. Safeguarding children requires decisions grounded in reliable data, not evolving trends or political pressure.

Strengthening Safeguards in Medical Decision-Making

Experts suggest several measures to ensure that children are both protected and respected.

Comprehensive psychological assessments should precede any major intervention. Multidisciplinary teams, including mental health professionals and pediatric specialists, should be involved in evaluating each case. Consent processes must be developmentally appropriate, ensuring children truly understand potential benefits and risks.

Clear clinical guidelines and independent ethics reviews can provide additional oversight. Long-term follow-up care and mental health support should also be standard practice, allowing children to receive continuous guidance as they mature.

Avoiding Political Polarization

The American Academy of Pediatrics has reiterated that decisions about gender-related care should involve patients, families, and physicians rather than politicians. Meanwhile, more than 25 states have passed laws restricting certain forms of care for children.

From a safeguarding standpoint, polarized political debates risk overshadowing the central issue: the well-being of children. Policies should focus on evidence-based care, transparency, and systems that prevent harm.

A Safeguarding Framework for the Future

Child protection does not mean silencing children. It means building systems that allow children to be heard within safe, structured, and evidence-based frameworks.

As medical organizations refine their guidance, the goal must remain clear. Children deserve protection from irreversible harm, access to compassionate care, and the opportunity to participate meaningfully in decisions that shape their future.

Balancing these principles requires caution, research, empathy, and above all, a steadfast commitment to the safety and dignity of every child.