The gender-affirming medical community is set to face a reckoning after a New York jury found two doctors liable for surgically mutilating a 16-year-old girl.
Last Friday, the first-ever verdict in a medical malpractice suit filed by a gender detransitioner was handed down, with a New York jury awarding 22-year-old Fox Varian $1.6 million in damages and $400,000 for future medical expenses. Varian had sued her psychologist and surgeon for uncritically diagnosing her with gender dysphoria and giving her a double mastectomy when she was just 16 years old.
Although the award was less than the $8 million sought by Varian and her attorneys, legal observers say the verdict likely marks a tipping point for the gender-affirming medical industry.
Within days of the announcement, the American Society of Plastic Surgeons (ASPS) issued a statement recommending that surgeons now delay “gender-related breast/chest, genital, and facial surgery” until patients are at least 19 years old.
Their conclusion? “Available evidence suggests that a substantial proportion of children with prepubertal onset gender dysphoria experience resolution or significant reduction of distress by the time they reach adulthood, absent medical or surgical intervention.”
In other words, just leave the children alone — time has a magical way of working these things out.
It’s the exact same conclusion reached by the United Kingdom nearly four years ago and affirmed in the landmark Cass Review in 2024, leading the U.K.’s National Health Service to ban all gender treatments in children — medical, surgical, and social.
But the U.S. gender-affirming medical community dismissed those findings, and they continued to insist that drugs and surgeries were the best — and only — way to effectively treat gender-confused children.
Not Too Big To Fail
But that’s all about to change and here’s why: Money, risk, and juries.
When those three factors come together in civil liability cases, they make for the kind of unpredictable outcomes that can upend whole industries.
Just ask the Big Tobacco executives who once thought they were untouchable.
The downfall of the tobacco industry in the late 20th century was also kicked off by one seemingly insignificant loss in court.
In 1984, the family of Rose Cippollone, a lifelong smoker, sued cigarette manufacturers after she succumbed to lung cancer. At that point, 16 cases had been litigated in court by cancer victim, and every single one of them had been a loser, as tobacco lawyers had easily convinced juries that the plaintiffs knew of the risks when they started or kept on smoking.
Marc Edell, who represented the Cippollones, tried a different tact, insisting that what really mattered wasn’t what Rose Cippollone knew about the risks but what the tobacco companies knew — and what they had hidden from consumers.
The case went to trial in 1987 and the jury, in a split decision, for the first time ever assigned some responsibility — 20 percent — to a cigarette manufacturer for a cancer death.
The Cippollones were awarded a meager $400,000 in compensatory damages, but the case shattered the myth of the tobacco industry’s invincibility and soon proved a turning point in tobacco litigation. In one fell swoop, the verdict put a human face to cigarette death statistics and laid the groundwork for future lawsuits.
Within a decade, Big Tobacco was on the ropes, forced to defend itself not just in consumer tort cases but also against multibillion dollar actions brought by states to recover health care costs. By 1997, the tobacco industry was so besieged that it voluntarily proposed a global settlement with the government, agreeing not only to massive financial payouts but unprecedented restrictions on advertising and lobbying.
Confusion and Pressure
While tobacco juries may have initially had a hard time sympathizing with lifelong smokers, it’s impossible not to feel sorry for Fox Varian. Her story is a tragic yet increasingly common tale in the era of surging gender dysphoria diagnoses among youth.
In 2019, when she was just 16 years old and struggling with her gender identity, a surgeon removed both of her healthy breasts. Her psychologist, Kenneth Einhorn, provided the referral letter greenlighting the surgery and plastic surgeon Dr. Simon Chin performed the procedure.
Varian later filed a lawsuit, arguing that Einhorn and Chin misdiagnosed her with gender dysphoria and failed to adhere to standards of care and informed consent.
Varian first expressed confusion over her gender after having her first period, which reportedly caused her to go into hysterics. The defense claimed that this was evidence that she had been properly diagnosed as gender dysphoric; however, as Varian testified, her condition was not that she believed she was male, it was that she was afraid to be a woman.
“I stopped feeling safe being female,” Varian said, discussing puberty and sexual attention from males. “I think being perceived as female bothered me, not because I was male, but because I didn’t want people seeing me as female.”
She added, “I think there’s a difference between wanting to be male versus just not wanting to be female and not wanting to face everything that comes with it.”
Varian, like many young women who present with gender confusion, had other comorbidities, among them autism, anxiety, body dysmorphia, and anorexia.
Her lawyers argued that Einhorn reflexively pushed her into the wrong treatment: gender transition.
Clarie Deacon, Varian’s mother, testified that she opposed the double mastectomy, vowing to Einhorn that it was “never gonna happen.” However, she claimed, the psychologist applied increasing amounts of pressure, insisting that Varian would eventually commit suicide if she did not get the surgery. Not wanting her daughter to die, Deacon finally signed off.
“This man was just so emphatic, and pushing and pushing, that I felt like there was no good decision,” she said. “I think it was a scare tactic. I don’t believe it was malice; I think he believed what he was saying … but he was very, very wrong.”
The defense for Einhorn and Chin argued that it was Varian who had threatened to harm herself, while Varian said that Einhorn was the one who first brought it up.
Non-Standard Standards
It’s important to note that the Varian jury was not asked to determine whether gender transitions are moral or effective, only to decide if Einhorn and Chin properly diagnosed Varian and followed standards of care.
However, the standards of care (SOCs) for gender transitions ended up being a primary point of debate at trial given their novel and experimental nature. In fact, journalist Benjamin Ryan, who attended the entire three-week trial, said that it was very difficult to get the defendants “to admit there even was a standard of care.”
The World Professional Association for Transgender Health (WPATH), the organization that developed the current SOCs for gender-affirming treatments, have guided medical professionals engaging in transgender treatments for decades. Among these were its seventh version (SOC-7), released in 2011. Among other things, it radically redefined biological sex as non-binary and gender identity as fluid and self-identifying; it also established the very first gender-affirming care protocols for women who believed themselves to be men.
The skyrocketing growth of children, especially girls like Fox Varian, being “confused” about their gender identify can be traced almost entirely to these changes.
Not surprisingly, as the WPATH files recently showed, the SOCs weren’t built on evidence but ideology.
This became painfully apparent during the trial when Einhorn and Chin claimed that it was Varian herself who pushed the gender transition, including the decision to use a new name, wear a chest binder, and later receive the double mastectomy.
Letting the patient self-diagnose her own gender dysphoria is technically in line with the protocols set out in SOC-7. For the first time, doctors were not required to use real-life tests to diagnose gender dysphoria nor to prescribe a year’s worth of psychotherapy before moving to drugs and surgery. As Varian’s attorneys noted in their closing arguments, gender-affirming doctors, including Einhorn and Chin, accurately translated the WPATH protocol to mean “whatever the kid wants, the kid gets.”
But they pushed back on that practice, saying that minor patients do not — by dint of their age and experience — have the knowledge, judgment, or legal status to truly understand or consent to the long-term consequences of gender-affirming treatments, much less decide if it’s in their own best interests.
Disfigured for Life
The smoking gun in the Varian case, according to Ryan, was that Einhorn was “out of his depth” and did not have experience treating transgender patients.
Some four months before Varian’s double mastectomy, Einhorn referred her to an LGBT organization called the Pride Center in Albany, New York, where Varian specifically told staff that she was unsure of her gender identity and that she felt pressure to decide.
Einhorn never requested the notes from the Pride Center before writing the letter recommending surgery, meaning that he and Chin never heard about Varian’s uncertainty. What’s more, Chin never spoke with Einhorn about Varian’s case and only spoke to Varian twice prior to the surgery.
Those realities left Varian emotionally devastated by the outcome. The surgery, she said, left her feeling empty and did nothing to improve her mental health issues. In fact, it did the opposite.
Ryan wrote that Varian testified that “Shame and cognitive dissonance…kept her from openly confessing her remorse until three years following the mastectomy. At 19, she finally stopped identifying and presenting as male and has since considered herself a woman. But an incomplete one.”
At trial, Varian stated, “It’s so hard to face that you are disfigured for life. No amount of reconstruction is ever going to bring back what I lost.”
There Will Be Justice
While Varian’s case is the first to go to trial and reach a verdict, there are at least 27 other detransitioner lawsuits waiting in the wings, according to Ryan, including that of Chloe Cole.
In early 2023, Cole filed the first-ever detransitioner suit, claiming that Permanente Medical Group, Kaiser Foundation Health Plan, and Kaiser Foundation Hospitals unquestioningly affirmed her “self-diagnosed gender dysphoria” when she was 13 and performed a double mastectomy when she was 15.
Like Varian, Cole also suffered from autism, an eating disorder, and mental health issues. Her lawsuit is expected to be heard in April in California.
In response to the verdict, Cole wrote on X, “I couldn’t be more happy for Fox Varian. Detransitioners need justice.”
They’re likely to start getting it. ASPS’s decision to issue guidance in the immediate aftermath of the verdict — effectively ordering its members to stop chopping up children — is the best indicator that the gender-affirming medical industry is panicking.
Why? Because they knew the risks and the harms — and they hid them from patients.
For more than a decade, the ASPS remained completely silent on this issue while surgeons violated their Hippocratic oath and “did harm” to vulnerable children. Whether its leadership was ideologically captured or simply afraid of being labeled “transphobic” is unknown.
But while ASPS sat on the fence, others like the American Medical Association, the American Academy of Pediatrics, and the American Psychological Association openly and aggressively pushed gender-affirming medical care on minors and manipulated parents with a pressure tactic they learned from gender activists.
This tactic was to tell parents their child’s treatment would end in one of two realities: gender transition or suicide. To the parents of gender-confused girls like Fox Varian and Chloe Cole, they got this idea across with a simple question: “Would you rather have a live son or a dead daughter?”
And nothing would change their beliefs or their commitment to the treatments.
Not the Cass Review nor the NHS decision to ban all gender treatments in children and teens in the U.K.
Not the public outrage after doctors at Vanderbilt University were caught on video describing child mutilation surgeries as “huge moneymakers.”
Not the efforts by 27 states, including Tennessee, to ban such procedures in children nor the Supreme Court’s affirmation that states have the right to protect children from medical harm.
Not the documentaries of detransitioners detailing horror stories of medical complications, irreversible impacts, pain, and regret.
Not the damning report in which journalist Michael Shellenberger exposed that WPATH officials had downplayed and hid evidence that gender transitions were harmful, while also making false claims regarding the risk of suicide to those who did not receive gender transition surgeries.
Not the studies finding that the large majority of children and teens identifying as transgender have numerous co-morbidities, including autism, trauma-related anxiety and depression, and eating disorders.
Not the medical studies showing that children put on puberty blockers and cross-sex hormones are more likely to have heart problems, blood clots, low bone density, sterility, and other long-term problems, including higher rates of depression and suicide.
Not the Trump administration’s executive orders threatening to investigate hospitals and physician practices that medically or surgically transition children and eliminating federal funding for those that do.
And not even the initial lawsuits that were filed by detransitioners.
Nothing made them blink — until this $2 million jury award.
The Coming Collapse
Why? The specter of money and accountability.
Like the Cippollone case so long ago, the Varian case sets the stage for future plaintiffs to also win in court. For example, one of the most damning things this trial offers future litigants is the testimony by Dr. Loren S. Schechter, a transgender plastic surgeon at Rush University and the incoming president of WPATH, admitting that gender transition surgeries do not prevent suicides.
With dozens of lawsuits pending or in the works, the dam is going to break wide open on doctors who may have adhered to the letter of WPATH standards but failed to adhere to the spirit of their Hippocratic oath.
And it’s not just doctors that have legal exposure for pushing children and their parents into experimental treatments that cause irreparable damage. It’s also hospitals, healthcare conglomerates, insurance companies, and medical associations that enabled and encouraged the manipulation and mutilation of minors.
Worse, the jury awards and litigation costs are unknowable and potentially endless: compensatory and punitive damages, payments for the lifelong healthcare issues that come with irreversibly altering and damaging children, and non-economic monies for pain and suffering and loss of enjoyment of life, not to mention the money, time, and other resources the defendants will spend in discovery, depositions, and courtrooms.
That’s the sort of uncertainty and exposure to financial and PR losses in court that insurance underwriters can’t stomach. As a result, doctors who continue to prescribe or perform gender-affirming treatments and procedures in children are likely to see, at the very least, their medical malpractice premiums skyrocket — if they manage to somehow not get dropped altogether.
It might take a while for many in the gender-affirming medical community to wake up to what’s coming. They are idealogues, after all, and quite dogmatic in their beliefs that by destroying children they are somehow saving them.
What’s more, until now, they’ve largely had their way in court as cases have been about the finer points of constitutional and regulatory law in front of judges who openly empathize with their ideology — judges like Justice Sonia Sotomayor who parrot debunked statistics and WPATH talking points about children being born in the wrong bodies and then making twisted legal conclusions for why denying experimental drugs and surgeries to mentally ill children is a form of discrimination.
Like the tobacco industry, these short-term victories led gender-affirming profiteers to believe they were somehow invincible in litigation matters.
But medical malpractice and tort cases are different than constitutional challenges. Under the Seventh Amendment, plaintiffs have the right to have their civil cases heard by a jury. That means regular people, not judges.
And right or wrong, when juries see pain and suffering, they demand that someone pay.
So in future lawsuits, when doctors justify their actions by insisting they were just following standards of care and doing what their minor patients wanted them to do, jurors are going to look over and see a young person rendered deformed, sterile, and facing a future of suffering and ongoing medical care because doctors never questioned those standards. Jurors won’t accept those excuses. And they certainly won’t blame a child plaintiff for somehow ignoring the risks.
Instead, they will recognize intuitively that doctors should have known better, that their Hippocratic oath to “first, do no harm” should have overruled their allegiance to WPATH ideology, that they had a responsibility to practice medicine, not follow trends — and their awards will reflect that recognition.
As the cases are heard and plaintiff wins are announced, the facts of what doctors knew, the evidence they hid, and the Frankensteinian results they enabled will trickle out and turn public perception against the industry and its practitioners, ensuring more lawsuits, more court losses, and more monetary hits.
Just like the tobacco industry in the late 1980s, the gender-affirming medical industry is heading fast into a downward litigation spiral. But while Big Tobacco was able to withstand the financial losses and pivot to other products and other markets, Big Gender Medicine, built on the shifting sand of delusion and deception, will collapse in on itself permanently. It’s just a matter of time.
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