Two recent developments point to the fact that not just individual medical practitioners but even some important hospitals are facing the risk of having to pay substantial settlements in pending litigation over gender transitioning of minors. The first is a new declaration by the American Society for Plastic Surgery, which we have embedded at the end of this post. The second is that a jury just awarded $2 million to a plaintiff who had her breasts removed as part of her transition. Keep in mind that gender-affirming operations on minors are not frequent but breast removal is far and away the most common procedure. And as we will unpack soon, not just practitioners (and their malpractice insurers) but also certain big institutions will be on the hook as cases proceed and some seem likely to similarly garner hefty awards for plaintiffs.
American Society for Plastic Surgery document is not clinical guidance but merely a “position statement”. It explicitly says that is not retrospective. However, this ASPS paper will strengthen the case of detransitioning plaintiffs in cases against doctors that provided puberty-suppressing drugs and “gender affirming” surgeries to those under 19. ASPS clearly sets forth that the evidence supporting these interventions was and remains weak, and in many cases, they proved to be unwarranted. Key sections from the paper (emphasis theirs):
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…Importantly, clinicians, even those with extensive experience, currently lack reliable methods to distinguish those whose distress will persist from those whose distress will remit…
Consistent with ASPS’s August 2024 statement that the overall evidence base for gender-related endocrine and surgical interventions is low certainty, and in light of recent publications reporting very low/low certainty of evidence regarding mental health outcomes, along with emerging concerns about potential long-term harms and the irreversible nature of surgical interventions in a developmentally vulnerable population, ASPS concludes there is insufficient evidence demonstrating a favorable risk-benefit ratio for the pathway of gender-related endocrine and surgical interventions in children and adolescents. ASPS recommends that surgeons delay gender-related breast/chest, genital, and facial surgery until a patient is at least 19 years old.
Unherd has done important reporting on this ASPS position paper, including interviewing the current and penultimate president of ASPS. Please find the time to read Plastic surgeons ditch gender ideology in full. Author Benjamin Ryan points out the tide had been turning against “gender affirming” treatment of teen overseas overseas before the US:
Health authorities in a swath of European nations and the ruling Labour party in Britain sharply restricted minors’ access to gender-transition interventions. In the United States, just more than half of states, all of them red, have banned these practices. And on Friday, a jury in Westchester County awarded $2 million in damages to a detransitioner after her attorney convinced a jury that her psychologist and plastic surgeon had deviated from best practices and harmed her by removing her breasts when she was 16 years old. It was a landmark case — the first decision of its kind — and is expected to serve as a catalyst for others.
The New York ruling against psychologist Dr. Kenneth Einhorn and surgeon Dr. Simon H. Chin found they had not adequately assessed her mental health issues. The award consisted of $400,000 for reimbursement of medical expenses and $1.6 million for pain and suffering. consisted of $400,000 for reimbursement of medical expenses and $1.6 million for pain and suffering.
Ryan was also the only reporter to cover the trial and highlights the testimony that he believed the jury found persuasive:
On @CBSNews, I reported on the $2M judgment in the 1st detransitioner civil suit to go to trial. I recalled the mother saying her daughter’s psychologist browbeat her into consenting to a gender-transition mastectomy for the 16 year old. But then the president-elect of WPATH… pic.twitter.com/7zjlv6VN7H
— Benjamin Ryan (@benryanwriter) February 5, 2026
At Unherd, Ryan unpacks the ASPS reasoning:
The ASPS’s position statement calls into question the logic pushed by many transgender activists that patient autonomy should be paramount — even absolute — among minors seeking these interventions. The document states that “patient autonomy is more properly defined as the right of a patient to accept or refuse appropriate treatment; it does not create an obligation for a physician to provide interventions in the absence of a favorable risk-benefit profile.”
Neither he nor ASPS belabor the point that society as a whole does not regard minors under 18 as sufficiently competent to vote or drink; some states also have 18, as opposed to 16, as the age of consent. So given this view, how can they be treated as able to make permanent, life-altering decisions? This does not just extend to what can uncharitably be called selective amputation; taking puberty-suppressing drugs along with hormones can result in infertility.
Ryan contends that the ASPS drew the line for transition surgeries at 19 not out of political considerations (this is the preferred age for states banning these procedures) but per current ASPS president Dr. Scot Glasber, is when teens are “safely out of puberty”.
Ryan further points out that the ASPS has not been keen about trans surgeries on minors and in a 2024 statement had said it did not endorse these procedures and contends that pro-trans activists has misrepresented the ASPS stance:
Yet major LGBTQ and liberal nonprofits, including GLAAD, the Human Rights Campaign, and the ACLU, have continued to routinely make the false claim that all major medical organizations endorse what they call gender-affirming care for minors.
Regardless of your views of the merits of transitioning teens, a medical liability bomb is about to explode. As IM Doc said via e-mail:
This is the first time in medical history that this type of case has been won against the physicians. Also please note, the vast majority of these transition procedures in the USA have been done in big academic centers with faculty employed physicians. There are some outliers – but the vast majority are not. In our modern world, the majority of these big centers are completely self-insured. That means all of these judgements – and the tsunami is coming quick – will be paid out of their budget – there is no “insurance”. I have often wondered if this was not part of the freakout in the last year about budgets – the powers that be know they are entirely and completely screwed – they have messed up the lives of young kids – and this is going to be millions and millions and millions possibly billions at some places of settlement. I remember back home over the past 5 years – as this was becoming more of a problem many of the prestige academic places – and actually cooperated with the Biden Admin in prosecuting MDs who blew the whistle on them lying about consent, etc. Yes the Biden Admin prosecuted a whistleblower (look it up Ethan Haim, MD [all charges were eventually dropped]).
They are literally shitting bricks at the state level about the gigantic sums these kids will be suing for. Many of these procedures were done at public universities. It may put a serious dent in Texas Children’s in Houston.
Also note, as far as I can tell this kid got 2 million and all that was done was breast removal. Just wait until all the kids with pus bombs where their genitals used to be start their cases. All of my current patients are all now in active lawsuit mode. This will not end well – and there are cases as far as the eye can see. This will very likely be, along with COVID, the scandal of 21st century medicine.
And another FYI – medical malpractice cases against individual physicians do not go into class action lawsuits well. Medical cases against Pharma, equipment, devices etc and facilities absolutely do – individual physicians not at all. These places are absolutely screwed. The growing recognition of this even in the bluest of the blue has caused them all to begin cancelling these programs.
This is going to be a hell of a cost over the next 10-15 years as this all plays out.
And before you contest this view, I had pinged an attorney friend about the New York verdict, having embarrassingly managed to forget his personal experience. Via e-mail:
I can’t even imagine how many huge lawsuits are lurking out there behind the cult of transgender. I think that it was nothing but a horrific fad straight out of HG Wells Island of Dr Moreau. My kid was never “a man trapped in a woman’s body.”
The local MD physician and psychologist who were shaking us down for big money got smacked up hard by a Standards of Care panel when they got caught in a blatant lie about informed consent by a patient with an autism spectrum diagnosis. They are no longer allowed to practice “gender affirming” treatments.
My kid eventually admitted to me that this was all really just a ploy to “look cool” but by then who knows what damage had been done by taking bathtub hormones from compounding pharmacies and suffering medically unnecessary surgeries.
Mind you, his child has found a good partner and is not about to litigate. But how many will be so charitably disposed?
00 ASPS Position Statement on Gender Surgery
