New York ‘gender‑affirming care’ malpractice verdict sparks warning for New Zealand

A landmark medical-malpractice verdict in New York, where a detransitioned young woman has been awarded USD $2 million after undergoing a double mastectomy at age 16, is raising urgent questions about so-called “gender-affirming” treatment pathways for children and young people in New Zealand.

On 30 January 2026, a jury in Westchester County, New York, found psychologist Dr Kenneth Einhorn and plastic surgeon Dr Simon Chin liable for malpractice over their roles in approving and performing a gender-transition double mastectomy on then-16-year-old Fox Varian. Varian was experiencing severe psychological distress at the time and has since detransitioned.

The jury awarded Varian USD $1.6 million for past and future pain and suffering, and a further USD $400,000 for future medical treatment, including possible reconstructive surgery.

The civil case, Varian, Fox v. Einhorn PhD, Kenneth et al., Index No. 61150/2023, filed in the New York Supreme Court, Westchester County, is understood to be the first detransitioner malpractice lawsuit in the United States to proceed to a full trial and result in a plaintiff victory. The case focused not on ideology, but on whether basic standards of assessment, diagnosis, and informed consent were met when a distressed teenage girl was fast-tracked to irreversible surgery.

Teen in crisis, surgery fast-tracked

At age 16, Varian, a female who at the time identified as a “transgender boy”, sought help for intense psychological distress, including depression, anxiety, self-harm, and other serious mental-health issues. Instead of a cautious and exploratory therapeutic process, her care rapidly narrowed to a single option: “top surgery”, a double mastectomy presented as treatment for gender dysphoria.

After a brief period under Dr Einhorn’s care, he endorsed the surgery. Plastic surgeon Dr Chin then removed both of Varian’s healthy breasts, leaving permanent scars and irreversible loss of function. Now 22 and detransitioned, Varian regards the operation not as life-saving healthcare, but as a grave error carried out at a time when she most needed robust, trauma-informed mental-health support.

When ‘affirmation’ replaces assessment

For years, leading medical bodies have promoted “gender-affirming care” as the preferred model for young people experiencing gender-related distress. In practice, this has often meant prioritising affirmation and social transition as the primary guide, while deeper exploration of trauma, co-existing psychiatric conditions, developmental factors, or social pressures is sidelined.

The Varian case highlights the risks of this approach. Jurors were not asked to decide whether gender dysphoria is “real”, but whether competent clinicians can simply accept a vulnerable teenager’s desire for radical, body-altering procedures as decisive and then label that process “care”. By siding with Varian, the jury rejected the idea that affirmation can substitute for rigorous assessment, differential diagnosis, and transparent discussion of long-term risks and uncertainties, especially where the patient is still a child.

The price of irreversibility – and a message to institutions

At 16, Varian lost both healthy breasts to a procedure widely promoted to adolescents as “top surgery”. At 22, she lives with permanent scarring, altered sensation, potential loss of breastfeeding ability, and a changed relationship with her own body. The jury’s decision to allocate the majority of the USD $2 million award to pain and suffering, rather than medical costs, signals that this harm was not treated as an unfortunate but acceptable side-effect of treatment, but as compensable damage caused by professional negligence.

Significantly, the verdict did not stop with the two clinicians. By naming Carmel Psychological Associates and CareMount Medical alongside Dr Einhorn and Dr Chin, the case also places larger clinics and corporate providers on notice. Protocols that shortcut assessment, discourage thorough psychotherapeutic exploration, or treat a teenager’s self-diagnosis as determinative are not only ethically questionable, but legally risky.

Why this matters for New Zealand

“New Zealand health agencies and professional bodies have increasingly signalled support for “gender-affirming” models of care for children and young people, even as several European countries, including the United Kingdom, Sweden, and Finland, have moved to restrict puberty blockers and surgical interventions for minors following systematic evidence reviews and concerns about long-term outcomes”, advocacy group Let Kids Be Kids said in a press statement.

“The Varian verdict adds a further dimension: legal accountability. It demonstrates that when clinicians and institutions rely on an affirmation-first paradigm while failing to meet long-standing duties of assessment and informed consent, they may face malpractice findings and substantial financial penalties.

“For New Zealand’s hospitals, universities, professional colleges, and policymakers, the case raises pressing questions:

• Are current clinical pathways for gender-distressed youth driven by careful assessment, or by an expectation to affirm first and ask questions later?
• Do young patients and their families receive full and balanced information about risks, uncertainties, alternatives, and long-term outcomes before irreversible interventions are considered?
• Are existing systems robust enough to protect distressed minors from premature medicalisation when time, psychological support, and non-invasive care may be safer and more appropriate?

“At its core, Varian v Einhorn provides a concrete narrative with legal weight: a distressed girl, a model of care that equated agreement with compassion, clinicians and institutions that followed that script, and a jury that concluded the evidence showed not “affirming care”, but malpractice, with a very real price attached.”