Gender surgery verdict a wake-up call

Last week, an important legal "first" was reached in New York State: a jury in White Plains awarded $2 million in damages to Fox Varian, a 22-year-old woman who transitioned to a male identity as a teenager and had a double mastectomy at 16, only to regret it later and reverse the transition. Varian accused her psychologist and plastic surgeon of rushing her into the procedure without adequate consent. This is the first malpractice award to a "detransitioner" — one that critics of pediatric gender care hope will set a trend.

The case takes place amid extraordinarily acrimonious politics around gender identity, with much of the Republican right — and the Trump administration — trying to undo all legal and social recognition of gender transition. At such a time, many are understandably sensitive of joining in calls for restrictions on gender-transition care. But it's worth noting that a number of people supportive of trans rights, such as Erica Anderson, a gender care specialist and transgender woman (who testified for Varian as an expert witness), have been warning for some time about troubling trends in this practice.

Anderson and some of her colleagues reported spiking numbers of teenagers, most of them biological females, struggling with their gender in situations that raised various red flags. Some were part of a group — in school or online — in which several teens rapidly embraced transgender identities, suggesting the role of peer pressure. Some had mental health conditions unrelated to gender dysphoria, or had been traumatized by events in their personal lives.

Varian, whose case was covered in detail by independent science journalist Benjamin Ryan for The Free Press, fits the profile. Her parents divorced when she was 7; a three-year custody battle and estrangement from her father ensued. In adolescence, Varian suffered from depression and anxiety; she developed eating disorders and was diagnosed with autism. At 15, she started questioning her gender in sessions with psychologist Kenneth Einhorn. She says Einhorn repeatedly assured her that breast removal would improve her well-being. Varian's mother also testified that Einhorn pressured her into consenting to her daughter's surgery with warnings of suicide risk. (While this risk is frequently invoked to defend the urgency of gender transition, recent research suggests that gender-dysphoric teens are not, in fact, at elevated risk for suicide.)

Laura Edwards-Leeper, another youth gender care psychologist who has warned about the lack of adequate safeguards in the field, has told Ryan that the verdict "should be a wake-up call to American medical and mental health organizations." And in fact, the American Society of Plastic Surgeons and the American Medical Association have issued statements saying that gender-related surgeries should generally be deferred until adulthood. The plastic surgeons' society also urged more caution with regard to "social transition, puberty suppression, and cross-sex hormones," whose effects are still poorly understood.

It's tempting to see these moves as attempts to appease a right wing backlash. But similar reassessments have been happening in other countries, including socially progressive ones such as Sweden, Finland and New Zealand.

Attempts to infringe on the personal choices or legal rights of adults should be firmly resisted, though some trans rights advocates support a return to better mental health screening for adult transitions as well. But the idea that gender-distressed children, even ones with multiple personal crises, are equipped to know what's best for them was always shockingly misguided. Some 30 lawsuits similar to Varian's have already been filed, and her win will likely open the way to more. Let the wake-up calls keep coming.

Opinions expressed by Cathy Young, a writer for The Bulwark, are her own.

By Cathy Young

Cathy Young is a writer for The Bulwark.