An unprecedented verdict, a network of doctors in retreat: A turning point for trans surgeries on minors?

Fox Varian, a 22-year-old from Yorktown Heights, New York, just won $2 million in damages against the health professionals who led to her having both breasts removed (an operation called a mastectomy) when she was 16. This is the first court verdict against psychologists and doctors who guided a minor through trans treatment - an umbrella of medical interventions ranging from the prescription of hormones to surgeries such as Varian.

Just days later, two major health professional associations recommended postponing these operations until after the age of majority. The change in guidelines comes as more and more hospitals and hospital systems are abandoning these practices; in the last few weeks, more than thirty, according to official sources.

The ruling in New York was unprecedented. Will others follow?

The Fox Varian case

"I think being perceived as female bothered me not because I was male, but because I didn’t want people seeing me as female," Varian testified before Judge Robert S. Ondrovic during the jury trial. "I stopped feeling safe being female."

Thus the plaintiff described her puberty. Words that, like all the transcripts from behind closed doors, were compiled by reporter Benjamin Ryan, the only one in the courtroom during the three-week trial. The documents are under seal. His chronicle (backed by copies of court records) and the brief statements of a handful of protagonists are the only public accounts of the historic trial.

Ryan described, in his article of the verdict for The Free Press, Varian's "turbulent" childhood: her parents divorced when he was seven, followed by a court battle that dragged on for three years. She suffered a "constellation" of mental problems: depression, anxiety, social phobia. She was diagnosed with autism. She had eating disorders and body image issues. She was not even 15 years old.

Past that age, she changed her name from Isabella to Gabriel, because it seemed more androgynous. "Over the next two months, she cut her hair short, began binding her breasts, switched her name again, to Rowan, and started telling people she was transgender," wrote the reporter, who also worked for The New York Times, NBC News and The New York Sun.

Nine months after she announced that she wanted a surgical transition, her psychologist, Kenneth Einhorn, referred her case to plastic surgeon Dr. Simon Chin. Five years later, Varian would sue them both, getting them to pay her the million-dollar figure: $1.6 million for past and future damages, $400,000 for future medical expenses.

Today Varian says, according to Ryan: "I think there’s a difference between wanting to be male and versus just not wanting to be female and not wanting to face everything that comes with it." And that Einhorn and Chin pushed her to undergo the treatment without first explaining its consequences. The jurors agreed.

Another key testimony collected by the reporter is that of Varian's mother, Claire Deacon, who alleged pressure from the psychologist to move forward with the operation. Dr. Einhorn denied this version.

"Without Dr. Einhorn repeatedly, emphatically, consistently pushing me, telling me that this was going to, quote, 'cure' my daughter, make everything better in her life, I would never have made that decision," Deacon asserted on the stand.

The plaintiff herself said she ended up thinking that if she did not undergo a mastectomy, she would end up committing suicide.

The reporter also claims that Einhorn did not question Varian's decision. "I don't question people when they want to go through this," she reportedly told the then-patient's father in a recorded call, which served as evidence in the court proceedings.

Isolated case or precedent?

After the outcome of the trial was made public, the question began to circulate as to whether others who regretted their transition would follow Varian's path. The young New Yorker is not the first person to regret her transition, although the total number is unknown.

In recent years, cases have been sprouting up that follow a common pattern: minors who, driven by health professionals and sometimes also their parents, decide to take hormones or undergo surgery to align their concern or desire to belong to the opposite sex with their physical characteristics. But when they grow up, they regret it. They are known as detransitioners.

This pattern also includes complaints against doctors who enabled the treatments. Complaints that therapists, psychiatrists and surgeons avoid questioning the decision of minors, that they do not inform them correctly. That, sometimes, they even coerce them.

More for the result than the novelty of the claims, the Fox Varian case generated a stir, awakening two readings and two questions: is it an indictment of the transgender treatments themselves or only of Einhorn and Chin? Will similar rulings follow?

The law firm that represented Varian asserts that the legitimacy of gender-affirming care was not on trial: "This case was not a statement or referendum on the appropriateness of gender-affirming care for adults or minors. Instead, it was about whether physicians adhered to their professional and ethical obligations when providing that care to Fox."

A similar version to that held by the World Professional Association for Transgender Health (WPATH), the organization that sets the standards for trans medicine in the country: "This case was a medical malpractice case, not a referendum on gender-affirming care." "When care is delivered ethically and responsibly within these guidelines, the integrity of the field is strengthened," they said in a statement picked up by The New York Times.

However, former members of the organization itself, quoted by Benjamin Ryan, say the verdict is an example of the malpractice they have been calling for for years. Like Amy Tishelman: "Those providers who are unqualified to provide care to gender questioning adolescents who also ignore the standards of care will be held to account." Or Laura Edwards-Leeper:

"Providers are trapped: If they rely on their foundational training and encourage deeper exploration and true informed consent, they risk being branded transphobic. However, if they affirm unquestioningly, they risk inadvertently harming patients and landing in court."

Tishelman and Edwards-Leeper are not alone. They are joined by Kallie Fell, executive director of the Center for Bioethics and Culture (CBC): "We do not view this as an isolated instance of malpractice. This case reflects a deeper systemic failure and an abuse of the medical profession itself."

"What we are witnessing is institutional capture, where ideological commitments override clinical judgment, ethical safeguards are reframed as 'barriers to care,' and dissenting clinicians are pressured into silence," she added exclusively to VOZ.

"In such an environment, informed consent is compromised, uncertainty is minimized, and irreversible interventions are normalized without adequate evidence," she adds, noting that "for years, families and patients have raised serious ethical concerns only to be dismissed or silenced."

As part of her work in front of the CBC, Fell talked with dozens of detransitioners to learn and disseminate their stories. For several, she said, the case sounds "painfully familiar." She relates that "many" report "feeling rushed into medical decisions without adequate exploration of underlying distress or clear communication about permanent consequences."

"That is all too familiar for detransitioners," wrote Prisha Mosley about the Varian case, who as a teenager took testosterone and underwent breast-removal surgery. Today, she regrets it and takes aim at her doctors: "I suffered from anorexia, obsessive-compulsive disorder, borderline personality disorder, anxiety, and depression. And yet my doctors affirmed my confusion and led me down the path of permanent medical mutilation."

Chloe Cole, one of the country's best-known detransitioners, also claimed the court victory, but apostrophized, "As happy as I am for her, the bitter-sweet thing about this is that no amount of compensation is ever going to brick back time, is ever going to bring back our healthy bodies, our breasts, or our stolen innocence. But this is an amazing start for the future of the detransitioner movement."

"After Fox Varian's successful suit, the next generation of detransitioners can rest assured that justice will be theirs," she also assured in a video uploaded to her social media shortly after learning of the verdict.

'We do not expect this case to remain legally exceptional'

"To every psychologist, doctor, surgeon and medical board that has promoted child transgenderization: the children they have mutilated will see them in court," Chloe Cole asserted in the recent post. In it, she assures that there are at least 27 complaints similar to Varian's.

This includes Chloe Cole as well. When she was 15, she had her breasts removed. Proceedings against her doctors are still open. Prisha Mosley did the same in North Carolina. "While my lawsuit awaits its day in court as it is appealed to the state’s higher courts, Varian’s victory is a hopeful sign for detransitioners across the country," she said. Both believe the ruling will open the door to similar rulings.

The Varian case may have shown the strategic way. Attorney Charles LiMandri, who is prosecuting several complaints, including that of Chloe Cole, told the Times that the New York trial showed that juries could be won over by the argument that long-term risks had been poorly communicated.

"The case could be a model for other lawsuits over such surgeries performed on minors," opined jurist Jonathan Turley, a professor at George Washington University, noting that "there are more than two dozen such lawsuits currently pending in various courts."

"We do not expect this case to remain legally exceptional," the CBC's Fell predicted to VOZ. "I know that across the country, families, clinicians, attorneys, and advocates are working urgently to bring accountability to a system that has failed to self-correct."

"When regulatory and professional safeguards collapse, the courts often become the last avenue for truth and reform," she adds. "As more patients age, experience harm, or detransition, lawsuits are likely to play a central role in changing the tide and bringing these practices under sustained legal and public scrutiny."

The latter may come sooner rather than later: two major physician associations changed their treatment recommendations days after the Varian case.

Health care providers' backpedaling

The American Society of Plastic Surgeons (ASPS), which represents more than 11,000 plastic surgeons around the world, recommended last Tuesday that trans surgeries-mammary, thoracic, genital and facial-be deferred until the patient reaches the age of majority.

The next day, it was copied by the American Medical Association (AMA), the country's organization that represents the most physicians.

The ASPS argued that its new recommendations were the product of a review of long-term scientific data. The association based its recommendation on three observations:

"Currently, the evidence for gender-affirming surgical intervention in minors is insufficient for us to make a definitive statement," the AMA concurred in a statement collected by journalist Haley Strack. "In the absence of clear evidence, the AMA agrees with ASPS that surgical interventions in minors should be generally deferred to adulthood."