Caring for patients is a profound responsibility. Every decision I make as a surgeon must be grounded in one central question: What is truly in the best long-term interest of this patient?
That responsibility becomes even more important when caring for children and adolescents.
After careful review of the most current medical evidence, thoughtful ethical reflection and consideration of my legal and professional obligations, I have decided that I will no longer perform gender-affirming chest (top) surgery for patients under the age of 19.
I want to explain this decision openly and clearly, especially for patients and families who may be affected.
This decision is not made lightly. It reflects my commitment to patient safety, responsible medical practice and doing what I believe is best for my patients over the course of their lives.
What Has Changed?
Medicine evolves. As physicians, we are obligated to reassess our practices as new, higher-quality evidence becomes available.
Recently, the American Society of Plastic Surgeons (ASPS) released an updated position statement after reviewing multiple large, independent evidence reviews from the United States and internationally. These reviews examined outcomes of gender-related medical and surgical interventions in children and adolescents.
The key conclusion was this: the scientific evidence demonstrating clear long-term benefit of gender-affirming surgery in patients under the age of 19 is limited and uncertain, particularly when weighed against the known and potential risks of irreversible surgery. In some areas, the evidence quality is considered low or very low, meaning that we do not yet have strong confidence that the reported benefits outweigh the possible harms.
Importantly, these reviews also highlight gaps in our understanding of long-term physical, emotional and psychosocial outcomes for younger patients.
When evidence is uncertain—especially for irreversible procedures—greater caution is not only reasonable, it is ethically required.
Why Age Matters
Adolescence is a period of rapid physical, emotional and cognitive development. Identity, self-understanding and future goals can and often do evolve during this time.
While some individuals experience persistent gender dysphoria into adulthood, others experience a reduction or resolution of distress as they mature.
At this time, there is no reliable way for clinicians to predict with certainty which adolescents will continue to experience distress and which will not. This uncertainty matters greatly when considering a permanent surgical intervention.
Top surgery is “effectively” irreversible. It permanently alters the body, may affect future sensation and function and can have lifelong implications. When we cannot confidently predict long-term benefits—and when the patient is still developing—it is my responsibility as a surgeon to pause.
Delaying surgery is not a denial of care. It is a protective step with my patients’ best interests at heart which is absolutely my number one priority.
Ethics and Informed Consent
Respecting patients means being honest about uncertainty.
True informed consent requires that a patient fully understands not only the potential benefits of a procedure but also its risks, limitations and unknowns. In younger patients, this process is more complex. Decision-making abilities are still developing, and distress—while very real—can make it harder to fully weigh long-term consequences.
Ethical medical care does not mean providing every requested intervention. It means offering treatments only when there is a reasonable expectation that benefits outweigh risks. When that balance is unclear, especially for minors, caution is the ethical choice.
My responsibility is not just to honor patient wishes in the present moment but to protect their future well-being.
What This Does Not Mean
This decision does not mean:
- That I doubt or dismiss any patient’s experience of distress and dysphoria
- That I lack compassion for transgender and gender-diverse patients
- That I am unwilling to provide care or support
I believe deeply in treating every patient with dignity, respect and compassion. Distress and dysphoria related to gender identity is real and all patients deserve to be taken seriously and treated humanely.
Choosing not to operate on minors is not a rejection of patients—it is an expression of my duty to protect them.
Ongoing Care and the Path Forward
I remain committed to caring for patients who seek gender-affirming top surgery once they reach the age of 19. At that stage, patients are better positioned—developmentally and legally—to engage in complex decision-making about irreversible procedures.
In the meantime, I encourage patients and families to continue working with qualified mental health professionals and medical providers who can offer support, counseling and guidance during this important developmental period.
As evidence evolves, I will continue to review new research with care and integrity. If high-quality data emerges demonstrating clear benefits with acceptable risk for younger patients, I will reassess my approach—as any responsible physician should.
My Guiding Principle
At the end of the day, my guiding principle is simple:
Patient care comes first.
That means practicing medicine with humility, honesty and caution—especially when the stakes are high and the outcomes are permanent. This decision reflects my commitment to doing what I believe is safest, most ethical and most responsible for the patients who place their trust in me.
If you have questions or concerns, I welcome respectful conversation. My goal is, and always will be, to care for my patients with integrity and compassion.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
