34岁的米歇尔·扎奇尼亚 (Michelle Zacchigna) 是来自位于多伦多以北的安省小镇奥里利亚（Orillia）的一名变性者。她为了将其性别从女性改变为男性，从而切除了乳房和子宫。近日，她在渥太华向八名参与变性手术的卫生专业人员，包括医生、心理学家、心理治疗师和顾问提起诉讼。
Zacchigna诉讼称，在她有患有严重心理问题的时期，她仅凭借自我诊断，认为自己是“生理性别与实际性别认知不符”。但医疗和健康从业者并没有充分评估或提供鉴别诊断，以及代替疗法的情况下就为自己开具治疗处方。导致她踏上了现在这段后悔却不可逆转的人生。
去年11月，Zacchigna向法庭提交的诉状中描述，她在小学时期就很难与同学相处，经常被欺负。直到她11岁时，她开始有自残行为，包括用刀割伤自己的手臂，这种情况一直持续到成年也没有好转。当她20岁时，第一次试图自杀，随后被诊断为社交焦虑和抑郁症，并开始接受心理治疗。
根据她的说法，她的精神状况每日俱下，导致她从大学退学，接受了一年的心理治疗。自从她在网上参与了一个关于“性别不一致”的讨论小组，这是她第一次觉得自己生错了身体，但在这之前她从来没有想过她是个男性。她更加相信，就是因为她的生理性别和性别认同之间的这种不匹配才导致了她抑郁、自残行为和身体不安。这种心理问题被称之为“性别不安”。
Zacchigna在网上大量的搜索有关变性人的内容，愈发对号入座，她发现一旦接受这个“新身份”，她的抑郁情绪就会有所好转。Zacchigna开始在多伦多参加一个准备转变性别的小组，这个组织里有一位顾问告诉她可以通过手术来实现转变性别。于是，Zacchigna在2010年正式受邀申请医疗干预。
也正是这名顾问写了一封推荐信，概述了她过去的病史，但内容并不完全真实。而且顾问没有推荐任何代替方案，也没有进一步证实这一诊断。同时，她的常规治疗师也出具了一封过渡治疗建议，称她为"激素治疗的理想人选"，还得到了他的上级，一位监督心理学家的支持。然而这名治疗师此前并没有这方面经验，那个心理学家甚至都没有跟她直接交谈过。这是Zacchigna在诉讼中提到的。
2010年，Zacchigna在多伦多一家健康中心接受了三次睾酮激素治疗，那里的医生成为了她的家庭医生。她声明说，她的心理健康和咨询记录都没有被查询过，也没有对“任何其他心理健康诊断或发育障碍”进行筛查。睾酮激素治疗持续了三四年。诉讼称，2012年，Zacchigna在医生的推荐下，花钱请佛罗里达州的一名外科医生切除了她的乳房。到2016年，长期使用睾酮激素导致痤疮，所以她不再关心身体是否能维持“男性化”。
据Zacchigna的说法，她曾向原来的治疗师寻求心理评估，希望帮助她重返大学，随后她被推荐给之前的哪位负责监督治疗师的心理学家。2017年，在一份长达 25 页的报告中，诊断出她患有多种疾病，包括注意力缺陷多动障碍、边缘型人格、临床抑郁症、自闭症谱系障碍和创伤后应激障碍的特征。
她的声明说，自从2008年自杀未遂后被正式推荐给治疗师，以及经历了她在 2009 年首次‘出柜’成为跨性别者，整整九年的时间，才第一次接受这些正式诊断。
这位心理学家“没有在评估报告中分析或考虑Zacchigna是否符合性别不安的诊断。 该报告也没有与她的家庭医生分享，她的家庭医生在2017年将 Zacchigna推荐给另一位子宫切除术医生。 她在2018年进行了部分子宫切除术，由于睾丸激素治疗出现问题，她要求保留卵巢。她在声明中说 ，大约在2020年11月20日左右，她开始质疑她是否曾经变性过，或者她是否曾经达到过需要变性的标准。
?目前，Zacchigna一直在努力接受激素治疗和子宫切除手术给她身体造成的永久性变化：声音低沉、秃顶、面部毛发、阴蒂增大、胸部扁平，以及永远无法怀孕。而所有这一切都导致她的抑郁症恶化。
Zacchigna在诉讼中寻求$350,000的普通伤害赔偿，包括疼痛、痛苦和生活享受的损失，以及过去和未来收入损失、过去和未来医疗及其他不确定费用的赔偿。她还要求退还医生向安大略省健康保险计划收取的所有费用。
最后Zacchigna告诉国家邮报，她知道自己在诉讼中面临着一场艰苦的战斗。她说：“我的印象中所有医疗事故诉讼都具有挑战性的。尤其在加拿大，往往医生是那个获胜方。”但尽管如此，她态度坚决，依然要坚持这场战斗。
Ontario detransitioner who had breasts and womb removed sues doctors
https://nationalpost.com/news/canada/michelle-zacchigna-ontario-detransitioner-sues-doctors
Michelle Zacchigna is suing doctors for failing to consider alternate treatments before ushering her on an irreversible journey that she now regrets
An Ontario detransitioning woman who had her breasts and womb removed to change her gender to male is suing medical and health practitioners for failing to consider other treatments during her mental health crisis before ushering her on an irreversible journey she regret
“Michelle’s stated desire to become transgender was never challenged and it was treated to the exclusion of her other serious mental health issues, closing the door to alternative treatment options,” her statement of claim says.
The claim says the defendants “permitted Michelle to self-diagnose as transgender and prescribe her own treatment without providing a differential diagnosis or proposing alternative treatments.”
Michelle’s stated desire to become transgender was never challenged
None of the defendants, who work or worked at various clinics and institutions in southern Ontario, responded to requests for comment on the lawsuit prior to deadline. Four of the defendants have filed notices of intent to defend against the suit in Ontario Superior Court, but no statements of defence have been filed.
None of the claims have been tested in court.
Zacchigna said she faces an uphill battle in her lawsuit.
“I’ve been under the impression that all medical malpractice suits are challenging. Doctors win the majority of cases in Canada,” she told National Post.
“It’s very much a David vs. Goliath undertaking.”
In her statement of claim filed in court in November, Zacchigna says she had difficulty forming relationships with classmates in elementary school and was often bullied.
By the time she was 11, she engaged in self-harming behaviour, including cutting her arm with a knife. This continued into early adulthood.
When she was 20, she tried to kill herself and she was referred by her family doctor for psychotherapy, where she was treated for social anxiety and clinical depression.
She remained unhappy and depressed, and her mental health decline led to her dropping out of university, according to her claim.
About a year into therapy, she engaged with an online community around gender nonconformity.
“Michelle came to believe that her biological sex of female did not match her true gender identity of male,” her claim says.
“She further came to believe that this mismatch between her biological sex and gender identity was causing her feelings of depression, self-harming behaviour and unease in her body, a mental health condition commonly known as gender dysphoria,” her claim states.
This was the first time Zacchigna felt she was born in the wrong body, and she had not previously identified as male, her claim says.
“However, as a result of what she read on the internet, she became convinced that she was a transgender man, and that once she embraced this new identity, her depression would subside.”
Zacchigna started attending a support group in Toronto for people considering gender transition. A counsellor there told her of opportunities to proceed through a medical transition, her claim says.
Zacchigna was invited to apply for medical intervention in 2010.
The counsellor wrote a recommendation letter outlining a medical history that didn’t fully match her real past, the claim says. The counsellor didn’t recommend any alternatives, or seek confirmation of Zacchigna’s own diagnosis of gender dysphoria.
Her regular therapist also wrote a recommendation for transition treatment, saying Zacchigna was an “ideal candidate for hormone therapy,” even though the therapist had no previous transgender clients, according to the claim.
That therapist’s supervising psychologist supported the therapist’s recommendation without speaking with Zacchigna, she says.
At a Toronto health centre, Zacchigna was prescribed testosterone hormone therapy in 2010 after three appointments. The doctor there became her family physician.
The claim said neither her mental health nor counselling records were consulted and there was no screening “for any other mental health diagnoses or developmental disabilities,” her claim says.
Testosterone therapy continued for three or four years, the claim says.
In 2012, Zacchigna paid to have her breasts removed by a surgeon in Florida, on the recommendation by her doctor, according to the claim.
By 2016, she was “disenchanted” with testosterone, which caused uncontrolled acne. “She no longer cared about the ongoing masculinization of her body,” the claim says.
Zacchigna then sought additional psychological assessment from her original therapist to help her return to university. She was referred to the psychologist supervising the therapist’s practice.
In 2017, in a 25-page report, a psychologist diagnosed her with several conditions, including attention deficiency hyperactivity disorder, borderline personality, clinical depression, autism spectrum disorder, and traits of post-traumatic stress disorder, according to her claim.
“Michelle received these formal diagnoses for the first time nine years after she was formally referred to the (therapist) following her suicide attempt in 2008, and eight years after she first ‘came out’ as transgender in 2009,” her claim says.
The psychologist “did not analyze or consider whether Michelle met the diagnosis for gender dysphoria in her assessment report.”
Nor was that report shared with her family doctor who, in 2017, referred Zacchigna to another doctor to explore hysterectomy surgery.
She had a partial hysterectomy in 2018, asking to keep her ovaries because of her problems with testosterone therapy.
“On or about Nov. 20, 2020, Michelle began to question whether she had ever been transgender, or if she had ever met the criteria for gender dysphoria,” her claim says.
“Since that time, she has commenced a process of detransition towards living life as a woman again.”
Zacchigna claims the defendants moved into delivering transgender therapy without adequately considering other factors.
Michelle has struggled to come to terms with the permanent changes from her hormone treatments and hysterectomy
“The Defendants failed to investigate or failed to adequately investigate and/or confirm that Michelle’s stated desire to transition to the male sex was rooted in a diagnosis of gender dysphoria or resulting from other factors in Michelle’s mental health including her history of clinical depression, anxiety, developmental disabilities, and social difficulties,” her claim says.
If alternatives were pursued, the claim says, Zacchigna could have ”learned to live with her body without surgical or hormonal treatments.
“Michelle has struggled to come to terms with the permanent changes from her hormone treatments and hysterectomy surgery have caused: a low voice, male-pattern balding, facial hair, an enlarged clitoris, a flat chest, and the inability to ever become pregnant. All of this has caused her to suffer from a worsening of her depression,” her claim says.
Zacchigna seeks $350,000 in general damages for pain, suffering and loss of enjoyment of life plus an undetermined amount for past and future loss of income, past and future medical treatment, and other expenses and costs. She also seeks a return of the money billed by doctors to the Ontario Health Insurance Plan.
The claim says a more precise accounting will be provided prior to any trial on the matter, which would likely be a year or more away.
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