34歲的米歇爾·紮奇尼亞 (Michelle Zacchigna) 是來自位於多倫多以北的安省小鎮奧裏利亞（Orillia）的一名變性者。她為了將其性別從女性改變為男性，從而切除了乳房和子宮。近日，她在渥太華向八名參與變性手術的衛生專業人員，包括醫生、心理學家、心理治療師和顧問提起訴訟。
Zacchigna訴訟稱，在她有患有嚴重心理問題的時期，她僅憑借自我診斷，認為自己是“生理性別與實際性別認知不符”。但醫療和健康從業者並沒有充分評估或提供鑒別診斷，以及代替療法的情況下就為自己開具治療處方。導致她踏上了現在這段後悔卻不可逆轉的人生。
去年11月，Zacchigna向法庭提交的訴狀中描述，她在小學時期就很難與同學相處，經常被欺負。直到她11歲時，她開始有自殘行為，包括用刀割傷自己的手臂，這種情況一直持續到成年也沒有好轉。當她20歲時，第一次試圖自殺，隨後被診斷為社交焦慮和抑鬱症，並開始接受心理治療。
根據她的說法，她的精神狀況每日俱下，導致她從大學退學，接受了一年的心理治療。自從她在網上參與了一個關於“性別不一致”的討論小組，這是她第一次覺得自己生錯了身體，但在這之前她從來沒有想過她是個男性。她更加相信，就是因為她的生理性別和性別認同之間的這種不匹配才導致了她抑鬱、自殘行為和身體不安。這種心理問題被稱之為“性別不安”。
Zacchigna在網上大量的搜索有關變性人的內容，愈發對號入座，她發現一旦接受這個“新身份”，她的抑鬱情緒就會有所好轉。Zacchigna開始在多倫多參加一個準備轉變性別的小組，這個組織裏有一位顧問告訴她可以通過手術來實現轉變性別。於是，Zacchigna在2010年正式受邀申請醫療幹預。
也正是這名顧問寫了一封推薦信，概述了她過去的病史，但內容並不完全真實。而且顧問沒有推薦任何代替方案，也沒有進一步證實這一診斷。同時，她的常規治療師也出具了一封過渡治療建議，稱她為"激素治療的理想人選"，還得到了他的上級，一位監督心理學家的支持。然而這名治療師此前並沒有這方麵經驗，那個心理學家甚至都沒有跟她直接交談過。這是Zacchigna在訴訟中提到的。
2010年，Zacchigna在多倫多一家健康中心接受了三次睾酮激素治療，那裏的醫生成為了她的家庭醫生。她聲明說，她的心理健康和谘詢記錄都沒有被查詢過，也沒有對“任何其他心理健康診斷或發育障礙”進行篩查。睾酮激素治療持續了三四年。訴訟稱，2012年，Zacchigna在醫生的推薦下，花錢請佛羅裏達州的一名外科醫生切除了她的乳房。到2016年，長期使用睾酮激素導致痤瘡，所以她不再關心身體是否能維持“男性化”。
據Zacchigna的說法，她曾向原來的治療師尋求心理評估，希望幫助她重返大學，隨後她被推薦給之前的哪位負責監督治療師的心理學家。2017年，在一份長達 25 頁的報告中，診斷出她患有多種疾病，包括注意力缺陷多動障礙、邊緣型人格、臨床抑鬱症、自閉症譜係障礙和創傷後應激障礙的特征。
她的聲明說，自從2008年自殺未遂後被正式推薦給治療師，以及經曆了她在 2009 年首次‘出櫃’成為跨性別者，整整九年的時間，才第一次接受這些正式診斷。
這位心理學家“沒有在評估報告中分析或考慮Zacchigna是否符合性別不安的診斷。 該報告也沒有與她的家庭醫生分享，她的家庭醫生在2017年將 Zacchigna推薦給另一位子宮切除術醫生。 她在2018年進行了部分子宮切除術，由於睾丸激素治療出現問題，她要求保留卵巢。她在聲明中說 ，大約在2020年11月20日左右，她開始質疑她是否曾經變性過，或者她是否曾經達到過需要變性的標準。
?目前，Zacchigna一直在努力接受激素治療和子宮切除手術給她身體造成的永久性變化：聲音低沉、禿頂、麵部毛發、陰蒂增大、胸部扁平，以及永遠無法懷孕。而所有這一切都導致她的抑鬱症惡化。
Zacchigna在訴訟中尋求$350,000的普通傷害賠償，包括疼痛、痛苦和生活享受的損失，以及過去和未來收入損失、過去和未來醫療及其他不確定費用的賠償。她還要求退還醫生向安大略省健康保險計劃收取的所有費用。
最後Zacchigna告訴國家郵報，她知道自己在訴訟中麵臨著一場艱苦的戰鬥。她說：“我的印象中所有醫療事故訴訟都具有挑戰性的。尤其在加拿大，往往醫生是那個獲勝方。”但盡管如此，她態度堅決，依然要堅持這場戰鬥。
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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