The Inconvenient Truth About the City Journal ASPS Article

Hey there, guys, gals, and non-binary pals! Today we need to talk about a recent article from the City Journal that's been going around in certain circles. Now, I want to start off by saying that this isn't a news reporting site. I don't cover current events or do any kind of journalistic work. So sometimes, the data I pull from might not be the most up-to-date scientific study/paper/journal. And that's okay. When a sharp-eyed reader points out something I've missed or asks why I haven't responded to certain things, it's usually because I simply wasn't aware.1 Most of the time, there are other folks out there who are much better at covering and fact-checking the latest headlines than I am.

However, since I wrote “An Open Letter to Gender Critical Parents,” I've been getting some criticism for not mentioning the recent press releases from the American Society of Plastic Surgeons or the City Journal article about them. And you know what? Those critics are right. I didn't talk about those press releases or that article. But here's the thing - I wrote that letter before any of those statements were released. Even if I had written it afterwards, it wouldn't change the fact that the City Journal and every right-wing and 'gender critical' ideologue out there has twisted the ASPS statement into something misleading and just plain wrong.

For those who do not know or have not read it in its entirety, here is the full press release so you can see for yourself what they actually said::

The following is the ASPS statement in its entirety provided to the reporter prior to publication:

ASPS has not endorsed any organization's practice recommendations for the treatment of adolescents with gender dysphoria. ASPS currently understands that there is considerable uncertainty as to the long-term efficacy for the use of chest and genital surgical interventions for the treatment of adolescents with gender dysphoria, and the existing evidence base is viewed as low quality/low certainty. This patient population requires specific considerations.

ASPS is reviewing and prioritizing several initiatives that best support evidence-based gender surgical care to provide guidance to plastic surgeons.

As members of the multidisciplinary care team, plastic surgeons have a responsibility to provide comprehensive patient education and maintain a robust and evidence-based informed consent process, so patients and their families can set realistic expectations in the shared decision-making context.

From their website where they updated the press statement, this follows the above quote (emphasis mine):

Guided by evidence

It's important to note that, as an organization and specialty guided by evidence, the Society's stance on this issue has remained consistent: More high-quality research in this rapidly evolving area of healthcare is needed.

To that end, ASPS efforts in this area include capturing clinical data on gender surgery procedures for adults and the development of practice resources to better aid members in implementing best practices in offering gender-surgery services when higher quality evidence is available. ASPS supports transgender patients' constitutional protections and right to dignity, privacy and humane medical care.

Further, it has always been the Society's position that members should be able to provide medical care without fear of government-sanctioned penalties and criminalization – and ASPS opposes any attempts at legal encroachment into the practice of medicine.

Now, in their article, the City Journal and other conservative media outlets completely misrepresented this statement. They claimed that the ASPS had broken ranks with the medical consensus on gender-affirming care for transgender youth, all because the ASPS used the term "low quality" to describe the evidence around gender-affirming surgeries for adolescents. But here's the thing - in the context of medical research, "low quality" has a specific technical meaning. It's talking about the lack of certain types of studies, like randomized controlled trials, which aren't always possible or ethical to do with this population. It doesn't mean the care itself is bad or ineffective. Plus, the ASPS statement was specifically talking about the rare cases of surgical interventions for transgender youth, not gender-affirming care as a whole. And considering how rare these surgeries are2, it's not surprising that there haven't been a bunch of big clinical trials done on them yet.

So when you look at the ASPS statement as a whole, it's clear that it doesn't represent any kind of big shift or break from the current medical consensus on gender-affirming care for adolescents. It's just the ASPS being consistent in their evidence-based approach and highlighting the need for more high-quality research in this rapidly evolving area of healthcare.

The way the City Journal article framed this statement, claiming it was "the first major medical association to challenge the 'consensus' of medical groups over gender surgery for minors," is a gross overstatement that misrepresents what the ASPS actually said. The ASPS's position isn't a rejection of gender-affirming care for adolescents. It's a call for caution, further research, and evidence-based practice.

And you know what? The ASPS isn't alone in this. When you look at the big picture and the consensus of major medical organizations, the ASPS's position lines up with everyone else. Groups like the Endocrine Society, WPATH, and the American Academy of Pediatrics all recognize the need for more high-quality studies and evidence-based practice, even as they continue to support gender-affirming care based on the best evidence and expert consensus we have right now.

The ASPS acknowledging the "considerable uncertainty" around long-term outcomes of surgical interventions for adolescents and calling the current evidence base "low quality/low certainty" is just good science. It's how evidence-based medicine works. And the ASPS statement also emphasizes the importance of comprehensive patient education, informed consent, and individualized care, which align with the principles of patient-centered care endorsed by other medical organizations.

But here's the kicker that a lot of the critics seem to conveniently ignore: the ASPS statement directly affirms the Society's support for transgender patients' rights, dignity, and access to humane medical care. They even oppose government interference in the practice of medicine. This is completely in line with the stances taken by every other major medical organization that supports gender-affirming care.

So is this really a break from the consensus? Not even close. The City Journal article and the 'gender critical' activists who've latched onto it are overstating things to push a particular narrative, not to accurately represent the ASPS's position or the current state of medical knowledge and consensus on gender-affirming care for adolescents. Even a quick comparison of the various organizations' statements would've made this crystal clear to the reporter and the activists. No matter how many times they repeat it, it doesn't change the fact that the ASPS statement aligns with all the other major organizations. But of course, seeing that would require looking at the topic of transgender people, both adults and youth, as more than just a simple "right" or "wrong" binary.