WHITE PLAINS, N.Y.—Two health care providers told jurors on Jan. 14 that they acted ethically when they approved a mastectomy for a girl who identified as a transgender male when she was 16.

Their testimonies came as part of a case brought by their former patient, Fox Varian, who no longer describes herself as male. Varian has accused the doctors—psychologist Dr. Kenneth Einhorn and plastic surgeon Dr. Simon Chin—of malpractice, but they testified in court that they lacked key information when approving the mastectomy.

So far in the trial, arguments have centered on a letter Einhorn sent Chin on Oct. 14, 2019, about two months before the surgery. In it, Einhorn gave approval for the procedure, also known as “top surgery.”

Varian’s attorney, Adam Deutsch, suggested the letter was filled with inaccuracies and omissions that might have prevented Chin from going through with the surgery—but the surgeon and the psychologist never spoke to each other.

Einhorn said that he was missing key information when he approved the surgery.

For example, it was later revealed that ahead of the surgery, Varian had told specialists at the Albany Pride Center that she “felt pressure to decide” on a male identity or a female identity “by family, friends, and culture.” She also said she continued to question her gender identity, but was afraid she might “lose credibility” if she discussed it with her mom.

Einhorn said that knowledge would have spurred a “big conversation,” and he might not have written the letter.

On Jan. 13, Chin said that although Einhorn’s letter did not contain the exact words “gender dysphoria,” it clearly described the symptoms, including use of male pronouns, distress at being called the “wrong” gender, and anxiety at seeing her breasts in the mirror.

“This is the core of gender dysphoria,” Chin said. He told the jurors that this was corroborated by his consultation with Varian—who had purportedly researched the surgery to the point of knowing which kind of incision she wanted—and her mother. These factors led him to believe that Varian had gender dysphoria and was a candidate for the surgery.

What Chin didn’t know at the time, he told the court, was that Varian was still questioning her gender only a few months earlier, and had shifted between using “he,” “she,” and “they” pronouns.

He would not have performed the surgery at that time had he known, he said.

“Hindsight is 2020,” he said when asked if he still thought Varian had been a candidate for the procedure. “We can’t know the future. This is why there is a percentage” of patients who regret the surgery.

The plaintiffs have implied that the gender issue was a result of her therapy with Einhorn, but Chin testified that Varian told him she had considered it for years.

Einhorn told the court that he never pressured her about her gender identity, and that she had independently taken the decision to purchase a “chest binder” to conceal her breasts. She wore the device so tightly that it restricted her breathing and left bruises, he said.

She also told him she would commit suicide if she did not receive the surgery.

The case is sensitive on a political and social level, and Judge Robert Ondrovic has taken the unusual step of sealing most of the related court records.

“The jury is to disregard any snarky comments unless they’re coming from me,” the judge said.

Although there is a national debate about whether or not such procedures should be performed on minors—or adults—that’s not the legal question in this case. Deutsch told the court on Monday that it’s about whether the doctors were correct in thinking Varian had gender dysphoria: distress at feeling one’s biology is mismatched to their internal gender identity.

Deutsch was careful to distinguish this from body dysmorphia, an unreasonable fixation on some physical flaw. He has suggested that Varian was not a viable candidate for the breast removal because she was still deciding if she wanted to identify as male, female, or non-binary in the months leading up to the surgery.

Chin noted that Varian had six follow-up visits and was “overall happy” with the results at that time, despite some complaints about excess skin and scarring.

Neither Varian, her mother, nor Einhorn’s letter informed him that Varian’s father objected—both verbally and in writing—to the procedure, Chin said. Chin said this knowledge might have also warranted “further conversation.”

Einhorn told the court that he had not included this information in his letter to Chin because Varian and her father were estranged and had not spoken to each other in years.

During the Jan. 14 hearing, Einhorn admitted to telling him he would never see his daughter again if he did not consent to the surgery; Varian’s father secretly recorded that phone conversation with Einhorn.

Both parents are expected to testify in the trial.

Deutsch criticized Einhorn about his imprecise note-keeping; his notes contained typos and some imprecise terminology, like using the word “sexuality” when he meant “gender.”

He also questioned the psychologist’s expertise in dealing with patients who had gender dysphoria: Einhorn testified on Jan. 15 that of the hundreds of patients he had treated, perhaps 10–20 had gender dysphoria.

Varian’s attorney additionally spent a significant amount of time pointing to discrepancies between Einhorn’s in-court testimony and what he had said at a deposition earlier in the case.

Einhorn did not deny his errors, noting at the outset of his testimony that he had been “too nervous” when answering questions at the deposition, and that his notes were meant as a “bridge” between sessions and did not contain every bit of important information.

“I think we’ve already covered that my memory of verbal information is not great,” Einhorn told Deutsch. “I’m not a verbal thinker.”

The Epoch Times reached out to attorneys for both sides ahead of the trial, and they declined to comment.