The American Society of Plastic Surgeons has become the first major association of medical professionals to break with the American medical establishment’s consensus that gender transitions for children are appropriate for treating gender dysphoria.

According to a report released Monday by the Manhattan Institute, ASPS acknowledged “considerable uncertainty as to the long-term efficacy for the use of chest and genital surgical interventions” and “the existing evidence base is viewed as low quality/low certainty.”

ASPS is a professional organization that represents 90%, or roughly 11,000 members, of plastic surgeons in the United States and Canada, and it told pediatric gender medicine expert Leor Sapir that it has not endorsed the medical consensus claimed by much of the American medical establishment.

Often, that consensus is presented by activist doctors and special interest groups as an insurmountable display of evidence that gender transitions for children are not only justifiable but safe and effective. A large and growing body of evidence suggests the opposite.

That consensus was eroded further recently by the fact that the World Professional Association for Transgender Health, or WPATH, which writes the standards of care for gender transitions, was caught admitting that many of the transition interventions once claimed to be “reversible” are in fact not and may cause long-term problems. The group was also caught manipulating scientific research in order to justify their claims.

“Those pushing for puberty blockers, cross-sex hormones, and surgery on minors have grossly oversimplified something which is incredibly complex and poorly understood as though this is ‘settled science,'” said Dr. Richard Bosshardt, a board-certified plastic surgeon, ASPS member, and senior fellow at medical advocacy group Do No Harm. “Plastic surgeons understand better than any other specialist the unique and daunting challenges of transexual surgery. Even in the best of hands and under ideal circumstances these are among the most complex and challenging surgeries.”

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Harm from the medical interventions can include infertility and sexual dysfunction, but many hospital systems across the country accept the WPATH standards of care, which require doctors to affirm patients’ claims of transgender identity through drugs and surgeries.

While ASPS did not condemn gender transitions for children, its move not to accept the consensus around medical interventions for minors is a significant rebuke of many other medical associations that openly advocate the procedures. Despite the heavy support for the interventions in the U.S., many Western European countries have become skeptical of them, either limiting or completely canceling minors’ access to the procedures and drugs.