By DEVI SHASTRI

The nation’s largest professional organization for plastic surgeons recommended that gender-affirming surgeries be delayed until patients turn 19, changing the group’s stance on the politically charged issue and diverging from several other major medical organizations’ guidance.

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The American Society of Plastic Surgeons said Tuesday that it found “insufficient evidence” that the benefits of chest, genital and facial surgeries on minors experiencing gender dysphoria outweigh the risks. It leaned on two recent and heavily debated publications on the topic, the Cass Review by a senior doctor in England and a 2025 report issued by the U.S. Department of Health and Human Services.

“This position statement doesn’t seek to deny or minimize the reality of any patient’s distress, and it does not question the authenticity of any patient’s experience,” the position statement reads. “Instead, ASPS affirms that truly humane, ethical, and just care, particularly for children and adolescents, must balance compassion with scientific rigor, developmental considerations and concern for long-term welfare.”

The statement is not a clinical guideline, the document notes. The society also did not do an independent evidence assessment or take other steps that would be involved in setting new care guidelines.

Other medical groups stand by their guidance

The shift comes as President Donald Trump’s administration pressures health care providers to limit or stop gender-affirming care for transgender people, particularly children.

“Today marks another victory for biological truth in the Trump administration,” Deputy Health and Human Services Secretary Jim O’Neill said in a statement. “The American Society of Plastic Surgeons has set the scientific and medical standard for all provider groups to follow.”

Other major medical associations stood their ground, noting current guidelines already call for caution around surgery for minors.

Gender-affirming surgery is rare among U.S. children, research shows. And fewer than 1 in 1,000 U.S. adolescents receive gender-affirming medications.

The American Academy of Pediatrics “does not include a blanket recommendation for surgery for minors” with gender dysphoria, said its president, Dr. Andrew Racine. “The AAP continues to hold to the principle that patients, their families, and their physicians — not politicians — should be the ones to make decisions together about what care is best for them.”

The World Professional Association for Transgender Health, which develops standards of care for transgender patients globally, reiterated its support for access to surgical care for minors under “cautious guidelines and criteria.”

The group’s guidelines oppose a “definitive age or ‘one-size-fits-all’ approach for every patient.” Decisions should be case-by-case, based on the evaluations of multiple types of health experts and experts in adolescent development.

“WPATH stands firm in its commitment to advancing evidence-informed clinical guidelines to help improve the lives and well-being of transgender people around the world,” the group said in a statement.

Hospitals halt gender-affirming care for kids

Gender-affirming care for transgender youth under standards widely used in the U.S. entails developing a plan with medical experts and family members that includes supportive talk therapy and can — but does not always — involve puberty blockers or hormone treatment. Many U.S. adolescents with gender dysphoria may decide not to proceed with medications or surgeries.

Still, the Trump administration moved in December to cut off gender-affirming care for minors, prompting a third of states to sue. It was the latest in a series of clashes between an administration that says transgender health care can be harmful to children and advocates who say it’s medically necessary.

Under pressure from the administration, hospitals across the country have suspended gender-affirming care for minors, most recently Children’s Minnesota, which plans to pause prescribing puberty-suppressing medications and hormones for patients under age 18 citing federal “threats.”

“This is not the decision we wanted to make,” the health system said in a statement. “This is the decision we had to make to protect our hospital and our providers. We stand firmly behind the fact that gender-affirming care is evidence-based, safe and lifesaving.”

The plastic surgeons group also acknowledged that “variability in regulatory and legal environments” played a role in the decision to issue a statement, saying the lack of evidence on the benefits of gender-affirming care means “surgical decision-making carries heightened ethical, clinical and legal risk.”

Dr. Scot Glasberg, who helped develop the statement, said deliberations over the language started in 2024 and were not politically influenced, despite the issue being highly charged.

“This was an iterative process that took time, with no outside pressure,” said Glasberg, a past president of the surgeons group. “We understand there will be different opinions about it and we respect those opinions.”

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

By LAURAN NEERGAARD

WASHINGTON (AP) — A new kind of pill sharply reduced artery-clogging cholesterol in people who remain at high risk of heart attacks despite taking statins, researchers reported Wednesday.

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It’s still experimental but the pill helps rid the body of cholesterol in a way that today can be done only with injected medicines. If approved by the Food and Drug Administration, the pill, named enlicitide, could offer an easier-to-use option for millions of people.

Statins block some of the liver’s production of cholesterol and are the cornerstone of treatment. But even taking the highest doses, many people need additional help lowering their LDL, or “bad,” cholesterol enough to meet medical guidelines.

In a major study, more than 2,900 high-risk patients were randomly assigned to add a daily enlicitide pill or a dummy drug to their standard treatment. The enlicitide users saw their LDL cholesterol drop by as much as 60% over six months, researchers reported in the New England Journal of Medicine.

There are other pills that patients can add to their statins “but none come close to the degree of LDL cholesterol lowering that we see with enlicitide,” said study lead author Dr. Ann Marie Navar, a cardiologist at UT Southwestern Medical Center.

That benefit dropped only slightly over a year, and there was no safety difference between those taking the pill or placebo, researchers found. One caveat: The pill must be taken on an empty stomach.

Heart disease is the nation’s leading cause of death and high LDL cholesterol, which causes plaque to build up in arteries, is a top risk factor for heart attacks and strokes. While an LDL level of 100 is considered fine for healthy people, doctors recommend lowering it to at least 70 once people develop high cholesterol or heart disease — and even lower for those at very high risk.

Statin pills like Lipitor and Crestor, or their cheap generic equivalents, are highly effective at lowering LDL. For additional help, some powerful injected drugs work differently, blocking a liver protein named PCSK9 that limits the body’s ability to clear cholesterol from blood. Yet only a small fraction of people who could benefit from PCSK9 inhibitors use them. While prices for the costly shots have dropped recently, patients still may dislike administering shots and Navar said they’re more complex for doctors to prescribe.

Merck funded Wednesday’s study, which provides some of the final data needed to seek FDA approval of enlicitide. The FDA has added the drug to a program promising ultra-fast reviews.

The research offers “compelling evidence” that the new pill lowers cholesterol about as much as those PCSK9 shots, Dr. William Boden of Boston University and the VA New England Healthcare System, who wasn’t involved with the study, wrote in the journal.

Boden cautioned there’s no data yet showing the pill’s cholesterol-reduction translates into fewer heart attacks, strokes and death. That takes much longer than a year to prove. Merck has a study of more than 14,000 patients underway to tell.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

With many federal officers wearing face coverings during an immigration enforcement surge in Minnesota, the St. Paul City Council on Wednesday introduced an ordinance requiring law enforcement to be unmasked.

The city council has said they’re taking a phased approached to introducing a series of ordinances in response to the enforcement, and Wednesday’s was the third brought forward in as many weeks.

The city council discussion began after an Immigration and Customs Enforcement operation on Nov. 25 on Rose Avenue near Payne Avenue. St. Paul police said they were called to assist as protesters gathered. They used chemical irritants and less-lethal munitions, which drew criticism from all city council members and community members.

Since then, “federal immigration enforcement tactics have changed rapidly,” the city council said in a statement on Jan. 21. “As a result, residents and the City cannot wait for a single comprehensive update to the City’s existing separation ordinance. … The Council’s phased approach allows swifter action while providing stronger legal protection for ordinance changes.”

The city council unanimously approved on Wednesday an ordinance introduced on Jan. 21 to prohibit law enforcement from staging on city-owned property for federal immigration enforcement and to limit access to non-public spaces. It will take effect 30 days after publication.

Face masking, identification

An ordinance introduced by the council last week would require law enforcement officers to have the name of their law enforcement agency on the outermost layer of their uniform. It would also require either a name or badge number, or both, on the uniform.

Another ordinance brought forward Wednesday by the city council says a law enforcement officer “shall not wear a face covering … that conceals or obscures their facial identity in the performance of law enforcement duties.” There will be a public hearing on the matter during the city council’s meeting next Wednesday and the council will likely vote on it Feb. 18.

The city council says in the proposed ordinance that “the routine and ubiquitous use of facial coverings by law enforcement officers has a significant and unquestioned impact on public safety, including: implications for public perception, officer-community interactions, and accountability, and increases the risk of impersonation by unauthorized individuals.”

There are exemptions in the masking and identification requirements for undercover operations and, in the face-covering ordinance, when “protective gear is required for physical safety.”

California passed laws last year that ban federal law enforcement from wearing masks and require visible identification, which led to the U.S. Justice Department to file a federal lawsuit.

“Law enforcement officers risk their lives every day to keep Americans safe, and they do not deserve to be doxed or harassed simply for carrying out their duties,” Attorney General Pam Bondi said in a statement in November.

St. Paul City Council Member Anika Bowie said Wednesday she’s aware of legal challenges that masking bans have faced.

“But I think the biggest risk right now is making sure that our neighbors feel safe,” she said, adding they’re not tolerating “anyone to come into our neighborhoods and not show their face.”

Separation ordinance not yet taken up

Two St. Paul residents who testified at a public hearing Wednesday about the identification requirement urged the city council to make exemptions as specific as possible to avoid potential loopholes.

John Benda, co-chair of the Minnesota Interfaith Coalition on Immigration, said he was present during the ICE operations in St. Paul in November at Bro-Tex Inc. and on Rose Avenue.

“I am disappointed that it’s taken this long for the City Council to get around to making some changes,” he said, but thanked the council for the actions they’re taking now. “… We’d like to see the council work within different levels of government and influence … them to do everything in their power to advocate for protections from ICE in our hospitals, schools, daycares and churches.”

The new ordinances introduced in St. Paul have not been part of the city’s separation ordinance, which was enacted in 2004 and “establishes a clear line of separation between the actions of local law enforcement and those of federal immigration authorities.”

The city council said in its statement last month that it would consider “key updates” to the city’s separation ordinance at the Feb. 4 meeting, but they did not come up Wednesday.

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City Council President Rebecca Noecker said the issue has been that the U.S. Department of Justice in September filed a federal lawsuit against the state of Minnesota, the Minnesota Attorney General’s Office, the cities of St. Paul and Minneapolis, Hennepin County and the Hennepin County Sheriff’s Office over so-called “sanctuary city” policies that it alleges interfere with federal immigration enforcement. The lawsuit is ongoing.

“What we are trying to do is find a way to strengthen it without endangering it wholesale,” Noecker said. “The concern from our attorneys is that any changes open us up to legal risk in that lawsuit.”

The council said in its statement last month that it would consider updates to its separation ordinance, including strengthening training and reporting requirements related to the ordinance; clarifying that the city’s policy is to not assist ICE or employ crowd control tactics during ICE operations; and clarifying that nothing in the ordinance prevents public safety officials from responding to calls for aid from St. Paul residents in the presence of ICE.