A New York jury has returned a verdict against two healthcare workers who provided gender-affirming care to a minor in what is believed to be the first lawsuit of its kind, reports Becker’s Hospital Review.
Filed in September 2023 in Westchester Supreme Court, the lawsuit centred on inadequate communication between a New York psychologist, Kenneth Einhorn, PhD, and plastic surgeon Simon Chin, MD.
Fox Varian, a 22-year-old who underwent a double mastectomy in 2019, accused the healthcare providers of deviating from the standard of care and failing to obtain adequate consent.
According to The New York Times, at 15, Varian began questioning her gender and talked to her psychologist, who had been treating her for more than two years, about surgically transitioning to male, according to court documents.
As an adolescent, she was diagnosed with depression, anxiety, social phobia, an eating disorder and autism.
Her psychologist, Einhorn, recommended hormone blockers, but Varian insisted on gender-affirming surgery.
Einhorn also advised Varian to seek additional counselling at an LGBTQ non-profit group, according to court documents. Varian’s attorney said she told a counsellor at the non-profit that she was unsure of her gender identity, but the psychologist never followed up.
Varian underwent the double mastectomy about five months later. She later de-transitioned, according to the lawsuit.
After a three-week trial, on 30 January the jury awarded Varian $2m in damages, according to the Times. Lawyers representing Einhorn and Chin declined to comment.
National trends
Four days after the verdict, the American Society of Plastic Surgeons published a position statement on gender-affirming surgeries for minors that it had sent to its 11 000 members, recommending that surgeons “delay gender-related breast/chest, genital and facial surgery until a patient is at least 19-years-old”.
The ASPS said its understanding has evolved in light of “additional comprehensive evidence reviews” on gender dysphoria, including a Department of Health & Human Services (HHS) report that was issued last May, according to MedPage Today.
Both the HHS report and the UK’s Cass Review concluded that the “natural course of paediatric gender dysphoria remains poorly understood”, according to the position statement.
ASPS emphasised that its advice comes in the form of a policy statement, not a clinical practice guideline, given the “current state of the evidence and variability in legal and regulatory environments”.
It also advised its members to “remain aware of state laws concerning transgender and gender-diverse individuals that may impact their practices”, as many states have banned gender-affirming care in youths.
Most US healthcare organisations, including the American Medical Association and American Academy of Paediatrics, support transition-related care for minors with gender dysphoria.
The ASPS is the first major medical association to shift its guidance on gender transition surgery for paediatric patients. In 2024, the society said it was reviewing evidence-based practices and had not endorsed any practice recommendations.
Its new position aligns with a strained environment across America. The federal government has increased scrutiny on healthcare organisations for providing gender-affirming care to minors, including potentially limiting reimbursements to hospitals and requesting patient information on minors who received gender-affirming care.
Health systems, in turn, have increasingly halted or reduced gender-affirming care, particularly surgeries, to paediatric patients.
In August, 16 states and Washington, DC, filed a lawsuit against the federal government, alleging it has illegally blocked necessary medical care for transgender minors. That case is ongoing.
See more from MedicalBrief archives:
Gender-affirming healthcare matters in SA
Cass Review slammed by transgender associations
Medical community at a crossroads on child gender-affirming care