Physician Exposure to Litigation in Gender Detransition Medical Malpractice Cases

BACKGROUND: Medical malpractice lawsuits in gender-affirming care have garnered significant media attention, already leading to increases in insurance premiums in the space.1 This study sought to analyze medical malpractice complaints in the United States dealing with the specific phenomenon of gender detransition, of which nearly all lawsuits have been filed since 2022. While past review articles have sought to analyze malpractice cases related to gender affirming care, they have yielded smaller sample sizes (n = 5).2 In this study, 16 cases with sufficient information were analyzed (n = 16). Collected data included defendant specialty, location, year, stated medications prescribed and procedures performed in lawsuit, and status/outcome of litigation where applicable.

METHODS: The Bloomberg Law Database was queried for all time using the keywords gender, de-transition or detransition, and malpractice. Out of the 60 cases, cases relating to employment, prisoner rights, health care coverage, or civil rights were excluded yielding 3 relevant cases. The list was combined with two published detransition lawsuit trackers with duplicates and two wrongful death lawsuits excluded to yield 20 lawsuits.3,4 Of these 20, 16 had sufficient complaint information on the legal websites Trellis, Justia, Bloomberg Law, or downloadable County Clerk Documents to analyze. Plaintiff Name was cross referenced with specialty through Physician's Hospital Webpages. The complaints were analyzed for medications and medical procedures listed in the lawsuits. For each case, the corresponding legal history was sought on Trellis, Justia, Bloomberg Law, or County Clerk offices to determine if the case was decided in favour of the plaintiff or defendant and if compensatory damages were awarded.

RESULTS: Of the 46 individually named defendants in the queried cases, 63% were MD or DO physicians and 37% were non-MD nurses, nurse practitioners, therapists, and social workers. The MD Physician Breakdown was as follows: 37.9% plastic surgery, 13.8% obstetrics and gynecology, 10.3% endocrinology, 6.9% pediatrics, 6.9% internal medicine, 6.9% psychiatry, 6.9% urology, 3.4% Pediatrics and Psychiatry, 3.4% Otolaryngology, 3.4% General Surgery. All lawsuits were filed after 2022. 100% of cases cited improper mental health evaluation in their complaints. 56.25% of the cases cited double mastectomy had been performed in their complaint. 87.5% stated transgender hormone therapy (either testosterone or estrogen) was prescribed in their complaint, while only 18.75% of cases stated puberty blockers were prescribed in their complaint. One complaint stated a facial feminization, vaginoplasty, clitoroplasty, perineal urethroplasty, and bilateral orchiectomy had been performed. 1 complaint stated a hysterectomy and oophorectomy had been performed.Of the 16 cases, none have been exclusively decided in favor of the plaintiffs in the courts. 12.5% of cases have been dismissed by plaintiffs, with possible binding arbitration in one. One more case has been requested to be dismissed by the plaintiffs. 81.25% of cases are either pending or do not have updated court dockets indicating pending dismissal. Notably, a number of the cases are being dismissed against specific defendants, a common practice in medical malpractice law. As of date in February 2025, no court compensatory damages have been required of the plaintiffs, although plaintiffs may choose to settle outside of court.

DISCUSSION: The number of detransition cases is in fact small, and no fault to date has been found with the defendants. The plurality of the individually named defendants are plastic surgeons (37.9%), demonstrating an increased risk exposure to lawsuits for this specialty in this space.