Impossible to overstate just how momentous this moment is...and how welcome.
Myself, I think insurance companies may well decide this matter. If insurers jack up premiums on malpractice coverage to surgeons who perform these procedures, or even deny coverage altogether, lots of these providers will rethink their position.
(Having said this, I believe the "yeet the teats" surgeon in Florida does not carry malpractice insurance to prevent getting herself in a box. Without access to the deep pockets of an insurance provider, who'd bother to sue her?)
In regards to “Potential implications”, I largely disagree that this will lead to adults being protected and physicians distancing themselves from GAC in general. Since the statement was limited to surgeries in minors, it likely won’t affect adults or other treatments like puberty blockers in minors. Maybe it could lead to them becoming slightly more cautious, but I don’t expect them to fully abandon surgeries for adults or non surgical treatments for minors because of this.
I agree that it could lead to more lawsuits succeeding, but only ones about surgeries in minors that were filed after February 3, 2026. Medical malpractice cases have to go on what info they had at the time the malpractice incident occurred and they can’t use stuff that came out years later, so it probably won’t have much impact on current cases, but could potentially be helpful in future cases assuming of course any surgeon actually performs a gender surgery on a minor after this…
I’m unsure as to whether this will lead to other medical organizations following. AAP and WPATH have already doubled down so they obviously won’t follow at least not anytime soon, and AMA has doubled down on supporting puberty blockers. My guess is only ones that perform surgeries *might* follow, since ASPS and AMA only focused on surgeries in their statements. But I don’t see ones that only focused on hormones (like the Endocrine Society) or psychological care (like the APA) following since they don’t perform surgeries.
"Medical malpractice cases have to go on what info they had".
A couple of problems with the evidence they had, though. Experts having studied these phenomena, such as sexologists, and practitioners here and in other countries (such as Finland) had long noted that gender issues most frequently resolve with puberty. That data was disregarded in favor of a "children know who they are" or "who are we to say that they don't" framing, that should have given anyone pause. What was also troubling, was to disregard the fact that the population presenting with issues had radically changed, without examining why. How about basing such radical interventions on evidence that falls apart on closer examination? How about failing to notice that long term follow-up data is missing or questionable? This in combination with rejecting non-invasive therapies as "conversion therapy". This in combination with shortened individual assessments. This in combination with exaggerating the adverse outcomes of non-action to vulnerable children and parents. This in combination with ignoring or silencing those presenting differing viewpoints - or going after their careers.
Abandoning evidence based care in favor of activism is malpractice, on a systemic level.
Ok? And if those studies were around at the time the malpractice incident occurred then they could definitely use that. But that doesn’t change the fact that if the instance of malpractice occurred in 2021, for example, they can’t use a guideline from 2026 to argue it was malpractice. They have to go on what they had at the time. That’s how all medical malpractice cases work. They can’t use hindsight.
Things like failing to notice that long term follow-up data is missing and rejecting non-invasive therapies as "conversion therapy" is irrelevant to my point. My point is not about the specific arguments or the evidence for them, it’s about when they happened. So long as they have evidence of those things dated from before that malpractice incident occurred then they could use that too.
This, for sure is a big mess. I consider it a system problem, so hard to litigate, I imagine (not being a lawyer) - and hard to target the right people. Nonetheless, I don't think guidelines are a fig-leaf that covers all. In this case the guidelines make points that in many cases should already be obvious from basic principles of doing no harm.
Sure, some practitioners in the assembly line may have a good defense. But this has been a controversial issue for a while now, so the general observation that never has such radical treatments been prescribed on the basis of such a poor evidence base, creates vulnerabilities for all levels of practitioners, I would think.
To apply any guideline it is on you to make sure it is the proper one for the individual patient. So you have to know what constitutes a proper assessment and ensure one is thoroughly done, prior to going forward. You then have to provide accurate information to the patient, and inform them of all possible benefits and downsides. You will have to inform them of alternative treatments and approaches, because there is information not included in the guidelines. You will have to tell them what is known and what is not.
Then come the very unique circumstances of this case: A conscientious practitioner should be a critical reader as to what constitutes good evidence, and should have red flags go up when inconsistencies are present, such as that gender is both known early and immutable, and changeable and subject to "journeying". You can be expected to be aware that serious ethical concerns have been raised around ability to consent, and the unprecedented practice of removing healthy tissue. You have no excuse for not knowing that both the evidence base of your practice, and its implementation is under critique, that whistleblowers have thrown up red flags all over the place, and that this is a new field of practice with a changing patient population. If you didn't negotiate all these mine fields humbly and impeccably, I think you are vulnerable.
I think this is where some individual cases are going. Improper assessment, improper consent, improper information. And of course, botched surgeries or adverse side effects.
I never said the practitioners have a good defense. Having to rely on info and guidelines from the time a malpractice incident occurred is a procedural thing that applies to both sides and has nothing to do with merits. The defense could still suck for a variety of other reasons. But I wasn’t talking about whether they have a good defense though.
I don't really care if it affects adults. Adults can do whatever they like as long as I don't have to pay for it. Agree with the rest.
Those other organizations have to double down to maintain face & authority, they don't have a choice, but perhaps when they start getting sued it will change. Could take a long time though. But strange things happen when people & orgs get hit in the pocketbook.
But you do have to pay for it indirectly. The rate of emergency hospital visits is unacceptably high for the sex modification surgeries. We pay for these medical expenses through taxes and higher insurance premiums, as well as higher fees doctors have to charge in order to pay their malpractice premiums.
I don’t really care what adults do either as long as I don’t have to pay for it. I only mentioned that because this article predicted that it would discourage doctors from offering it to adults, which I personally don’t think it will, but to each their own.
Hard to say. You did raise some great points. I do wonder about the lawsuits being restricted to minors after 2/3/26. Physical changes after long-term steroid use can be permanent also. The women who change their mind never lose the gravely voice, & the men continue to have boobs bigger than mine.
Detransitioning men can and sometimes do have breast reductions. The effects of high doses of testosterone on girls are dramatic, irreversible and can be substantial within a few months.
Impossible to overstate just how momentous this moment is...and how welcome.
Myself, I think insurance companies may well decide this matter. If insurers jack up premiums on malpractice coverage to surgeons who perform these procedures, or even deny coverage altogether, lots of these providers will rethink their position.
(Having said this, I believe the "yeet the teats" surgeon in Florida does not carry malpractice insurance to prevent getting herself in a box. Without access to the deep pockets of an insurance provider, who'd bother to sue her?)
Good heavens, a professional body in the US actually taking a responsible stand on this? I'm shocked and appalled.
In regards to “Potential implications”, I largely disagree that this will lead to adults being protected and physicians distancing themselves from GAC in general. Since the statement was limited to surgeries in minors, it likely won’t affect adults or other treatments like puberty blockers in minors. Maybe it could lead to them becoming slightly more cautious, but I don’t expect them to fully abandon surgeries for adults or non surgical treatments for minors because of this.
I agree that it could lead to more lawsuits succeeding, but only ones about surgeries in minors that were filed after February 3, 2026. Medical malpractice cases have to go on what info they had at the time the malpractice incident occurred and they can’t use stuff that came out years later, so it probably won’t have much impact on current cases, but could potentially be helpful in future cases assuming of course any surgeon actually performs a gender surgery on a minor after this…
I’m unsure as to whether this will lead to other medical organizations following. AAP and WPATH have already doubled down so they obviously won’t follow at least not anytime soon, and AMA has doubled down on supporting puberty blockers. My guess is only ones that perform surgeries *might* follow, since ASPS and AMA only focused on surgeries in their statements. But I don’t see ones that only focused on hormones (like the Endocrine Society) or psychological care (like the APA) following since they don’t perform surgeries.
Good article overall though!
"Medical malpractice cases have to go on what info they had".
A couple of problems with the evidence they had, though. Experts having studied these phenomena, such as sexologists, and practitioners here and in other countries (such as Finland) had long noted that gender issues most frequently resolve with puberty. That data was disregarded in favor of a "children know who they are" or "who are we to say that they don't" framing, that should have given anyone pause. What was also troubling, was to disregard the fact that the population presenting with issues had radically changed, without examining why. How about basing such radical interventions on evidence that falls apart on closer examination? How about failing to notice that long term follow-up data is missing or questionable? This in combination with rejecting non-invasive therapies as "conversion therapy". This in combination with shortened individual assessments. This in combination with exaggerating the adverse outcomes of non-action to vulnerable children and parents. This in combination with ignoring or silencing those presenting differing viewpoints - or going after their careers.
Abandoning evidence based care in favor of activism is malpractice, on a systemic level.
Ok? And if those studies were around at the time the malpractice incident occurred then they could definitely use that. But that doesn’t change the fact that if the instance of malpractice occurred in 2021, for example, they can’t use a guideline from 2026 to argue it was malpractice. They have to go on what they had at the time. That’s how all medical malpractice cases work. They can’t use hindsight.
Things like failing to notice that long term follow-up data is missing and rejecting non-invasive therapies as "conversion therapy" is irrelevant to my point. My point is not about the specific arguments or the evidence for them, it’s about when they happened. So long as they have evidence of those things dated from before that malpractice incident occurred then they could use that too.
This, for sure is a big mess. I consider it a system problem, so hard to litigate, I imagine (not being a lawyer) - and hard to target the right people. Nonetheless, I don't think guidelines are a fig-leaf that covers all. In this case the guidelines make points that in many cases should already be obvious from basic principles of doing no harm.
Sure, some practitioners in the assembly line may have a good defense. But this has been a controversial issue for a while now, so the general observation that never has such radical treatments been prescribed on the basis of such a poor evidence base, creates vulnerabilities for all levels of practitioners, I would think.
To apply any guideline it is on you to make sure it is the proper one for the individual patient. So you have to know what constitutes a proper assessment and ensure one is thoroughly done, prior to going forward. You then have to provide accurate information to the patient, and inform them of all possible benefits and downsides. You will have to inform them of alternative treatments and approaches, because there is information not included in the guidelines. You will have to tell them what is known and what is not.
Then come the very unique circumstances of this case: A conscientious practitioner should be a critical reader as to what constitutes good evidence, and should have red flags go up when inconsistencies are present, such as that gender is both known early and immutable, and changeable and subject to "journeying". You can be expected to be aware that serious ethical concerns have been raised around ability to consent, and the unprecedented practice of removing healthy tissue. You have no excuse for not knowing that both the evidence base of your practice, and its implementation is under critique, that whistleblowers have thrown up red flags all over the place, and that this is a new field of practice with a changing patient population. If you didn't negotiate all these mine fields humbly and impeccably, I think you are vulnerable.
I think this is where some individual cases are going. Improper assessment, improper consent, improper information. And of course, botched surgeries or adverse side effects.
I never said the practitioners have a good defense. Having to rely on info and guidelines from the time a malpractice incident occurred is a procedural thing that applies to both sides and has nothing to do with merits. The defense could still suck for a variety of other reasons. But I wasn’t talking about whether they have a good defense though.
I don't really care if it affects adults. Adults can do whatever they like as long as I don't have to pay for it. Agree with the rest.
Those other organizations have to double down to maintain face & authority, they don't have a choice, but perhaps when they start getting sued it will change. Could take a long time though. But strange things happen when people & orgs get hit in the pocketbook.
But you do have to pay for it indirectly. The rate of emergency hospital visits is unacceptably high for the sex modification surgeries. We pay for these medical expenses through taxes and higher insurance premiums, as well as higher fees doctors have to charge in order to pay their malpractice premiums.
I don’t really care what adults do either as long as I don’t have to pay for it. I only mentioned that because this article predicted that it would discourage doctors from offering it to adults, which I personally don’t think it will, but to each their own.
Hard to say. You did raise some great points. I do wonder about the lawsuits being restricted to minors after 2/3/26. Physical changes after long-term steroid use can be permanent also. The women who change their mind never lose the gravely voice, & the men continue to have boobs bigger than mine.
Detransitioning men can and sometimes do have breast reductions. The effects of high doses of testosterone on girls are dramatic, irreversible and can be substantial within a few months.
Remarkable. Clearly they are trying to resurrect the reputation of their branch of medicine.