‘Money And Ideology’: Plastic Surgeons Association Fought To Stop Bills Banning Child Sex Changes

• The American Society of Plastic Surgeons (ASPS) has been fighting against legislation restricting child sex change surgeries at the state level since at least 2017.
• Beyond legislative activity, the group emphasized cross-sex surgeries on its website and on social media, consistently advertising the procedures as a key component of a fulfilling life for transgender people.
• "There is no question that financial rewards play a role in the adoption of gender affirming care. Hospitals and physicians generate substantial payments from insurers or self pay patients when children enter into the transition protocols," Dr. Stanley Goldfarb, board chair of Do No Harm, told the Daily Caller News Foundation. "No matter what other motives come into play, there is no way that the surgical and medical activities would be embraced by various gender clinics and hospitals if they were financially harmed by these clinical activities."

The American Society of Plastic Surgeons (ASPS), a professional association, has been fighting against legislation banning child sex change surgeries performed by plastic surgeons, according to a Daily Caller News Foundation investigation.

The ASPS actively opposes legislation restricting cross-sex surgical procedures for minors in Missouri, Montana, Alabama and Pennsylvania, according to the group's website and emails reviewed by the DCNF. While the sex change surgery business has been booming in recent years amid soaring rates of transgender identification, the ASPS has used its platform to endorse these procedures' safety and efficacy at improving the lives of people who identify as transgender.

The group has fought against the passage of bills restricting child sex change surgeries, encouraged the expansion of insurance coverage of the procedures and promoted cross-sex surgeries through conferences, social media posts and its website.

While cross-sex genital surgeries are rare for both children and adults, hospitals and private practices routinely offer mastectomies to girls under 18. At least 56 genital surgeries and 776 mastectomies were performed on minors aged 13 to 17 who had gender dysphoria diagnoses in the U.S. from 2017-2019, according to insurance data analyzed by health technology company Komodo Health Inc and originally reported by Reuters; this data doesn't include children who underwent surgery without a formal gender dysphoria diagnosis or without insurance coverage, and it excludes the likely higher numbers of children undergoing such surgeries in more recent years.

Cross-sex surgeries including mastectomies, facial feminization and genital surgeries, are often performed by plastic surgeons , often with the help of other medical specialists.

"There is no question that financial rewards play a role in the adoption of gender affirming care. Hospitals and physicians generate substantial payments from insurers or self pay patients when children enter into the transition protocols," Dr. Stanley Goldfarb, board chair of Do No Harm, a group opposed to divisive and discriminatory ideologies in healthcare, told the Daily Caller News Foundation. "Moreover, the pharmaceutical companies that produce the puberty blockers and gender-altering hormones also benefit from 'gender affirming care.' No matter what other motives come into play, there is no way that the surgical and medical activities would be embraced by various gender clinics and hospitals if they were financially harmed by these clinical activities."

The gender reassignment surgery market was valued at $1.9 billion in 2019 and is projected to rise to $5 billion by 2023, according to Grand View Research, which attributed rising market value to the increased prevalence of transgender identification and improved insurance coverage for the procedures. Male-to female and female-to-male chest surgeries can cost up to about $10,000, genital surgeries cost about $25,000 and facial feminization surgeries can range from $20,000 to $50,000.

Go inside the operating room for a gender affirming top surgery and get answers to frequently asked questions from ASPS member Julie Hansen, MD. https://t.co/eSxkSkKR8G #TrustASPS #PlasticSurgery pic.twitter.com/8DdbHOci34

— American Society of Plastic Surgeons (ASPS) (@ASPS_News) March 14, 2019

The ASPS, along with the Robert H. Ivy Pennsylvania Society of Plastic Surgeons, were part of a successful fight against a Pennsylvania bill barring state-funded insurance programs from covering sex changes for minors in 2017, according to emails obtained by parental rights activist Megan Brock and shared with the DCNF. The groups urged state legislators not to pass the bill in a joint letter to Pennsylvania legislators which claimed that it would make sex change surgeries "unattainable for many transgender people who need them, depriving them of lasting concordance with their gendered self." (RELATED: Yes, Doctors Are Performing Sex Change Surgeries On Kids)

"Our mission is to advance quality care for plastic surgery patients, including those patients experiencing gender dysphoria," their letter to Pennsylvania legislators read . "Care of individuals with gender dysphoria requires a multidisciplinary approach that may include mental health professionals, primary care physicians, endocrinologists and plastic surgeons. The breadth of the process demands comprehensive coverage from third party payers."

The group fought against bills barring doctors from performing "gender affirmation surgery" on minors in Missouri, Montana and Alabama in the early months of 2021 and said it was preparing "engagement" in other states considering such legislation, according to a post on its website . It's unclear precisely what this activism entailed, and the ASPS did not respond to the DCNF's inquiries about their activities.

With younger generations of all genders wearing their plastic surgery procedures like a badge of honor, the question remains… Is plastic surgery still taboo? https://t.co/LQgVym3XU9 #PlasticSurgery pic.twitter.com/7c7HuEtCxd

— American Society of Plastic Surgeons (ASPS) (@ASPS_News) August 9, 2022

The organization's 2023 legislative priorities include "opposing attempts to criminalize gender affirmation" and continuing their push for increased insurance coverage of gender-related plastic surgeries.

The group's emphasis on the growing gender surgery market extends beyond legislative efforts. ASPS has taken to social media to promote the supposed benefits of cross-sex surgeries, fought for more relaxed rules for advertising the procedures and even advertised cross-sex facial surgery as beneficial for women without gender identity issues to improve their appearance.

ASPS has shared several articles on social media promoting gender-related plastic surgery procedures including facial feminization and mastectomies . It also published guides to various gender surgeries on its website which offer patients information on preparation and finding a surgeon.

Facial feminization surgery is always tailored to the individual, but as ASPS member @drjustineleemd , explains there are general characteristics such as hairline, brow bones, cheeks and jawline that many patients note and plastic surgeons plan for. #TrustASPS #PlasticSurgery pic.twitter.com/g6M3Vrjq8O

— American Society of Plastic Surgeons (ASPS) (@ASPS_News) June 18, 2020

Three separate talks at the ASPS 2022 conference were about cross-sex surgeries; panelists discusses how to open a gender affirmation clinic and detecting breast cancer in patients who undergo gender-related mastectomies, and one surgeon discussed the experience of performing 2,500 penile inversion vaginoplasty surgeries over 21 years, according to the conference website.

After Facebook began censoring ads for transgender medical procedures in 2021 due to concerns that they violated their policy against political ads, ASPS joined a pressure campaign to get the ads reinstated.

"Gender dysphoria is a medical diagnosis, not a political choice," their comments read , according to a post on their website. ASPS also said plastic surgery was "an important step in aligning [individuals with gender dysphoria's] bodies with whom they know themselves to be."

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