Over the winter, Dr. Mehmet Oz, the head of the Centers for Medicare and Medicaid Services, summoned the leaders of the country’s major medical societies to his office for what he called a “grand rounds” — a hospital term for a meeting where doctors discuss complex cases.
The topic was one of the most contentious in American medicine: transgender medical care for teenagers.
Oz pressed on a question that hangs over the entire field: Why did these organizations recommend medical intervention for young patients — including hormone treatment, puberty blockers and surgery — when the research on whether it helped young patients in the long term, especially on mental health, was inconclusive?
The meeting, which has not been widely reported, was remarkable for convening, in the same room, medical experts with such divergent opinions.
On one side were the medical societies, including the American Medical Association, the American Psychiatric Association and the American Society of Plastic Surgeons, which have helped set the policies and recommendations for doctors treating adolescents with gender dysphoria. Gender care providers and patients say that the treatments can help young people feel more aligned physically with their gender identity, leading to improved mental health and well-being.
On the other side were doctors and academics who have argued that gender clinicians have misrepresented the data. Oz himself has spoken harshly about these treatments, calling them “sex-rejecting” experiments performed on children as if they were “lab mice.”
At the meeting, his tone was more inquisitive than hostile, said Zhenya Abbruzzese, who attended along with several colleagues from a group she co-founded that funds and promotes research critical of the medical consensus, the Society for Evidence-Based Gender Medicine.
“What’s the barrier to engaging with the evidence?” Abbruzzese recalled Oz asking. “What gives?”
Oz’s goal, however, was lost on no one.
According to five people at the meeting, the leaders of the medical societies each took turns defending their guidelines. But the last speaker, representing the plastic surgeons, surprised many in the room. The society was changing its position, its official said, after determining that studies on the medical benefits of surgery in minors were limited and of low quality.
Going forward, the group would recommend that any gender-related surgeries, including mastectomies, the most common gender-related surgical procedures in minors, wait until patients turn at least 19.
For the better part of a decade, the American medical societies have endorsed medical intervention as an evidence-based and potentially lifesaving method of caring for adolescents diagnosed with gender dysphoria.
But several independent reviews have challenged the research underpinning those recommendations, finding gaps and deficiencies in many studies, including their size, length of follow-up, lack of adequate controls and the number of study participants who had dropped out.
In several countries, the independent reviews have led to major changes in the way gender medicine is practiced — a fact that Oz raised in the meeting. Health officials in Britain, Finland, Sweden and New Zealand have agreed to restrict medical treatments for youth, citing the reviews. At the same time, groups drafting guidelines in Germany, Austria and Switzerland have cautiously endorsed medical intervention, citing a consensus among clinicians and the lack of apparent alternatives while acknowledging the uncertain evidence.
In the U.S., however, the debate has become far more entangled in politics, as the Trump administration leverages the power of the federal government to try to halt the practice of pediatric gender medicine and, more broadly, to eliminate social accommodations and legal rights for transgender people by targeting institutions, including schools, universities, hospitals, the military and sports associations.
Many providers of transgender medicine worry that opponents of gender-affirming care are exploiting the ambiguity in the research for larger political reasons.
The American Society of Plastic Surgeons, which publicly announced its new position Feb. 3, has come under withering criticism.
Scott Leibowitz, a child psychiatrist who has spoken out against political efforts to restrict gender care, posted on social media that the group was “making an absolutist statement” that was in line with the Trump administration.
Leibowitz, who attended the grand rounds on behalf of the American Academy of Child and Adolescent Psychiatry, declined to comment for this article. The organization has not altered its guidance.
Stephanie Carlton, deputy administrator of the Centers for Medicare and Medicaid Services, said that the meeting was encouraging overall and that everyone “immediately and genuinely engaged.”
She added, “We are still in dialogue with some of the other groups.”
The American Medical Association has since announced a shift in its position, hedging its guidance on surgery for minors: “In the absence of clear evidence, the AMA agrees with ASPS that surgical interventions in minors should be generally deferred to adulthood,” the group said last month.
The AMA did not mention nonsurgical interventions, saying only that the organization “supports evidence-based treatment, including gender-affirming care.”
Other societies have fully reaffirmed their support for medical intervention, though some acknowledged the shifting understanding of the evidence.
The American Psychiatric Association continues to support gender-affirming care as a way to reduce the risk of depression, anxiety and suicidal ideation in youth, said Marketa M. Wills, association’s chief executive. Her group, she said, relied on the “best available evidence and expert consensus.”
Wills added, “we fully support more scientific study in this area of research.”
The American Academy of Family Physicians, which represents 128,000 doctors and attended the grand rounds meeting, has also maintained its support of gender-affirming care “as an evidence-informed intervention.”
For its part, the Society of Plastic Surgeons has faced a rebellion from members of its task force reviewing adolescent gender surgery guidelines. In a letter to the society’s board, seven task force members wrote that they expected their work would inform any “deliberation regarding any society position or policy statement.” Instead, they said they were left in the dark.
Some transgender rights activists questioned whether the politics of the board’s president, C. Bob Basu, who has made donations to Trump and other Republicans, had influenced the decision.
But Dr. Scot Glasberg, a former president of the society who attended the grand rounds, said the board had been working on changing the guidelines since 2024, when he was still president.
At the time, he said, he thought “the evidence here doesn’t seem to be very good, and there isn’t a lot of it.”
What did influence the change, Glasberg said, was the situation in Europe. “Politics had absolutely zero to do with how this policy came out,” he added.