Bizarre Lawsuit Accuses American Academy of Pediatrics of Conspiracy

Detransitioner Isabelle Ayala is suing her doctors and the AAP for medical malpractice on the theory that gender affirming care as a field is based on a conspiracy to harm kids.

by Evan Urquhart

Isabelle Ayala is a 20-year-old detransitioned woman suing the doctors iin Rhode Island who once treated her for gender dysphoria as an adolescent, as well as the entire American Academy of Pediatrics, who developed the guidelines under which her treatment was conducted, according to a story in the Daily Wire last week, which included a linked copy of the suit that was been provided to them. The lawsuit claims the now-detransitioned Ayala first expressed a desire to be a boy when she was 12, but was in a mental hospital for suicidality at the age of 14 before she received a diagnosis, and later treatment with testosterone. It claims that treating Ayala under the standards of care for gender dysphoria was inappropriate, because those standards of care were the result of an ideologically motivated conspiracy on the part of the AAP.

This bizarre gambit at least provides a way around the problems with many detransition lawsuits: They don’t allege any medical malpractice. These suits, which are backed by conservative activist law firms, make claims about the medical treatment their plaintiffs underwent that would seem to apply equally to all medical transitions, whether they resulted in detransition or not. This is different from a more typical malpractice suit, where some failure or mistake by the particular doctor is alleged. 

In addition to the Daily Wire story the suit was subsequently covered by the National Review, the Daily Mail, Fox News, the Christian Post, and other similar sites.

In addition to Ayala’s, there are at least five other active lawsuits by detransitioned women of this type, and all five have been widely covered in the right wing press. These include the suits of Chloe Cole, Kayla Lovdahl, Soren Aldaco, Luka Hein, and Layton Ulery. While the number of lawsuits backed by ideologically motivated conservative firms seems to be growing (likely because these firms have aggressively pursued detransitioned women as clients), there remains no evidence that the percentage of people who detransition has increased from the low rate that has been observed in the past. While there’s no one definitive rate of detransition (because detransition can be defined in multiple ways), to pick one metric, experts largely agree that regret after transgender surgery is lower than regret after most surgical procedures, and is in the neighborhood of 1 percent.

Like the other lawsuits, Ayala’s does not claim that her doctors diverged from the standards of care. The suit paints a picture of a child with stable, persistent feelings of gender dysphoria that lasted for years before she ultimately receiving treatment after a suicide attempt that landed her in the hospital. The innovation here is to present a theory of why gender-affirming care could be considered malpractice, by invoking a conspiracy at the AAP to push the treatment for ideological reasons.

For this the suit relies on the criticism of a fringe psychology researcher (and pedophilia apologist), James Cantor. Cantor disagreed with the AAP’s decision to recommend treating adolescent gender dysphoria with puberty blockers and hormones when the guidelines were published. In the suit, the existence of Cantor’s opposing view, as a researcher who had never treated a pediatric patient with gender dysphoria, is presented as proof that the mainstream medical establishment as represented by the AAP somehow engaged in fraud by drafting and following guidelines Cantor had disagreed with.

screenshot from the lawsuit as shared by the Daily Wire

As usual, the suit (and conservative rhetoric about gender affirming care) seeks to present the ordinary way medical care works as if it were somehow nefarious in the case of transition-related treatments. It presents the evolution of standards for treating gender dysphria in the light of improved evidence as a conspiracy, and the existence of disagreement with the new standards (by a researcher from outside the field) as unusual, while all of this is just how medical standards evolve. The suit repeatedly claims there’s no evidence supporting the affirming approach, but of course there’s ample evidence–and no evidence that any other approach leads to better outcomes in patients with gender dysphoria.

While there’s no sign within the lawsuit that they recognize how outlandish their claims are, there’s tangential evidence that the leaders of the anti-trans movement are well aware that under normal malpractice rules a patient can’t sue a doctor because an established, effective treatment that works for others didn’t work for them, leading them to experience regret. Such tacit recognition is demonstrated in the attempt to push for new laws that do away with the standards for malpractice in the area of gender-transition medicine alone, allowing detransitioners a right to sue their doctors that goes far beyond what any other patient would have. 

Legislation to give detransitioners a special right to sue over and above a normal medical malpractice suit is being pushed by the anti-trans group Do No Harm as a “Detransitioner Bill of Rights” according to another Daily Wire story from earlier this month.

screenshot from the Daily Wire

This legislation would create allow any person who detransitioned to sue their doctors, even if their providers followed all relevant standards of care, and even if the detransitioned person gave fully informed consent. Such a law would make it difficult, perhaps impossible, for providers to offer these treatments, because like all medical treatment transition is not 100 percent effective. In effect, the legislation would allow the tiny percentage of patients who the treatment didn’t work for to ban the treatment for the vast majority for whom it was lifesaving care.

Such extraordinary shenanigans are necessary because by the normal standards of medicine gender affirming care is safe, effective, and appropriately used. If it wasn’t, the anti-trans side wouldn’t need to resort to conspiracy theories and unprecedented laws to limit it. No one wants trans people, particularly trans youth, to be harmed. It’s not radical to suggest following normal medical practices, with normal medical evidence and normal malpractice standards, in this case.