Irreversibility, Evidence, and Age Threshold in Gender-Affirming Surgery: A Surgical Ethics Perspective
Journal of Sex and Marital Therapy, 2026 (SSCI, Scopus)
- Yayın Türü: Makale / Teknik Not
- Basım Tarihi: 2026
- Doi Numarası: 10.1080/0092623x.2026.2678257
- Dergi Adı: Journal of Sex and Marital Therapy
- Derginin Tarandığı İndeksler: Social Sciences Citation Index (SSCI), Scopus, CINAHL, EMBASE, Gender Studies Database, MEDLINE, Psycinfo, Academic Search Ultimate (EBSCO), Social Science Premium Collection (ProQuest), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest), Psychology & Behavioral Sciences Collection (EBSCO), Religion Database (ProQuest), Sociology Source Ultimate (EBSCO)
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
In its recent position statement, the American Society of Plastic Surgeons (ASPS) emphasized that the evidence base for gender-related surgeries in pediatric and adolescent patients is limited, mental health benefits are supported by low-certainty evidence, and irreversible interventions carry potential long-term harms, recommending a minimum age threshold of 19 years for surgery. This article evaluates the ethical basis of irreversible gender-affirming surgeries in young adults aged 19 and above, considering mental health outcomes, mortality, complication profiles, and neurodevelopmental maturation. The discussion is framed around three normative axes: evidential sufficiency, the irreversible nature of the intervention, and developmental continuity of decision-making capacity. Current literature indicates that some individuals may experience short-term subjective well-being or relief of dysphoria, yet high-certainty evidence for long-term mental health normalization or reduction of psychiatric risk is lacking. This asymmetry necessitates caution in the timing of irreversible gender-affirming surgery (GAS) procedures. Consequently, when evaluated through the lenses of the precautionary principle, nonmaleficence, and proportionality, establishing a minimum age threshold of 25 for irreversible GAS appears ethically and normatively justified.