In the first malpractice verdict against providers of gender-affirming care for minors, a jury in New York State has awarded a woman $2 million in damages for a double mastectomy she received as a teenager that she said had left her disfigured.
The plaintiff, Fox Varian, 22, of Yorktown Heights, had accused her psychologist and the plastic surgeon who performed the operation of failing to obtain adequate consent about the risks before she agreed to undergo the procedure in 2019.
She also claimed that the providers had deviated from standard practices governing gender-related medical care.
Ms. Varian, who was 16 at the time of the surgery, was assigned female at birth but as a teenager identified as a man. She later came to regret the decision to transition and now identifies as a woman, an example of a process known as detransitioning.
The verdict, which was announced on Friday following a three-week trial in White Plains, was first reported by the Free Press.
Individuals who decide to detransition have often been cited by the Trump administration in its efforts to ban gender-affirming care for minors.
Last summer, the Supreme Court upheld a Tennessee law that prohibits some medical treatments for transgender youth, rejecting arguments that the measure violated the Constitution and preserving similar laws in more than 20 other states.
In December, the Department of Health and Human Services announced that it would pull federal funding from any hospital that offered such treatment.
While there is limited research, a few recent studies have suggested that between 5 and 10 percent of minors who had undergone medical transitions later detransitioned.
According to Kinnon MacKinnon, who studies transgender care at York University in Toronto, a vast majority of young people who opt for a medical transition say the procedure resolves their gender dysphoria and improves the quality of their lives.
Gender treatments for minors, which can include puberty-blocking drugs, hormone therapies and, in rarer cases, surgeries, have been a subject of fierce debate worldwide but are endorsed by most medical groups in the United States.
On Tuesday, however, the American Society of Plastic Surgeons became the first major medical association to shift its guidance on gender transition surgery for minors.
In a statement to its members, the organization recommended that gender-related chest, genital and facial surgeries not be performed until a patient reaches 19.
Adam Deutsch, the lawyer who represented Ms. Varian, sought to downplay the significance of the verdict, framing it as a simple case of medical malpractice.
“This was never a debate over the legitimacy of gender-affirming care,” he said. “It was about whether medical professionals met the standards that covered their own profession.”
Many transgender care advocates agreed. Dr. Loren Schechter, a leading expert on gender-affirming surgery, testified on behalf of Ms. Varian.
Dr. Schechter, the president-elect of the World Professional Association for Transgender Health, a nonprofit organization that develops and promotes standards for gender-related care, told the court he thought the decision to approve the initial surgery was based on “assumption and inference.”
In a statement after the verdict, WPATH emphasized that the case was about the health providers’ failure to follow the standards of care that the organization has sought to promulgate.
“This case was a medical malpractice case, not a referendum on gender-affirming care,” the group said. “When care is delivered ethically and responsibly within these guidelines, the integrity of the field is strengthened.”
Court documents portrayed Ms. Varian as a troubled adolescent grappling with a welter of mental health issues, including depression, anxiety, social phobia and an eating disorder. At 14, she was diagnosed with autism.
At 15, Ms. Varian began questioning her gender, according to court documents. She changed her name to Rowan, began binding her breasts and expressed an interest in transitioning to her psychologist, Kenneth Einhorn, who had been treating her for more than two years but had no formal training in transgender care.
In court documents, Dr. Einhorn said that he had suggested hormone blockers as a first step, but that Ms. Varian had insisted on so-called top surgery. Nine months after she first announced a desire to transition, Dr. Einhorn referred her to a plastic surgeon, Dr. Simon Chin. Both providers are based in Westchester County.
In his referral letter, however, Dr. Einhorn described Ms. Varian’s diagnosis as body dysmorphia, not gender dysphoria, an error that proved pivotal in the jury’s decision.
Body dysmorphia refers to a distressing preoccupation with perceived physical flaws. Dr. Einhorn said he had only used the term for insurance billing purposes.
Ms. Varian’s mother, Claire Deacon, a licensed practical nurse, testified that she had felt pressure to consent to the surgery by Dr. Einhorn, who had given his assurance that it would improve her daughter’s mental health.
Without the procedure, she recalled him saying, Ms. Varian might take her own life. Dr. Einhorn denied telling her this.
But the crux of the case rested on what Mr. Deutsch described as inadequate communication between Dr. Einhorn and Dr. Chin.
In an acknowledgment of his limited expertise, Dr. Einhorn recommended that Ms. Varian seek additional counseling at an L.G.B.T.Q. nonprofit, but he never followed up, according to court documents.
If he had, Mr. Deutsch said, he would have discovered that Ms. Varian had told a counselor there that she was still unsure of her gender identity. Less than five months later, she underwent the surgery.
“They just didn’t have the experience to deal with someone questioning their gender identity,” Mr. Deutsch said of Dr. Einhorn and Dr. Chin. “At the bottom of all of this was a lack of collaboration between the two of them, and lack of communication to follow through.”
Dr. Einhorn and Dr. Chin did not respond to messages seeking comment. Lawyers representing the men declined to comment.
It is unclear what impact the verdict might have on similar suits moving through the legal system.
Charles LiMandri, a lawyer in California representing four detransitioners who claim they were harmed by the care they received, said that Ms. Varian’s case suggested that juries would be sympathetic to plaintiffs who claim neither that they nor their parents had fully understood the long-term risks of their treatments — despite having given their consent.
Among those Mr. LiMandri represents is Chloe Cole, a high-profile detransitioner who has been outspoken on right-wing media about her opposition to gender treatments for minors.
Dr. Marci Bowers, an expert in gender-affirming surgery and a former president of WPATH, said she that hoped the case would have a constructive impact on a field that had been subjected to years of disinformation and politicized vitriol.
Although the association emphasizes that its guidelines should be tailored to the individual needs of a patient, the guidelines note that adolescents should be fully informed about the potential risks of surgery, including the loss of fertility, and that their experience of gender dysphoria should be long-lasting before any surgical procedure.
Other recommendations underscore that young patients should have the emotional and cognitive maturity to provide informed consent, and adding that other mental health challenges, like depression or autism, should not be allowed to cloud their decision-making process.
“The standards of care need to be followed,” Dr. Bowers said. “This is a vulnerable age group. You have to get it right. And so often, when standards are not followed, you get disappointing outcomes.”
Andrew Jacobs is a Times reporter focused on how healthcare policy, politics and corporate interests affect people’s lives.
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