Federal employees detail how 'gender affirming care' wrecked their bodies, in insurance lawsuit

In less than two years, the Supreme Court has rebuffed the encroachment of gender ideology in children's medicine, K-12 education, school sports and now prisons, ordering a Denver-based appeals court Monday to reconsider its revival of a male inmate's lawsuit demanding to be treated as a woman in housing, commissary items and even strip searches.

It's an ill omen for transgender federal employees, who days earlier asked a federal judge in Washington, D.C., to pause the Trump administration's elimination of their insurance coverage for so-called gender-affirming care, making a strategic concession: Treatment wrecked their bodies, and they cannot afford to mitigate the damage out of pocket.

The putative class action lawsuit, on behalf of pseudonymous federal employees and family members who seek new or ongoing medicalized transitions, argues the 2026 phaseout and 2027 elimination of coverage for surgeries and hormones to resemble the opposite sex, but not for other purposes, constitute sex discrimination.

But the motion for preliminary injunction by two class representatives, detailing the gruesome reality of their procedures as often acknowledged privately by gender doctors in professional settings, adds to growing recognition that the medical treatment protocol for gender dysphoria is far from settled science and carries lifelong consequences.

The World Professional Association for Transgender Health, cited as authoritative in the motion but oddly omitted in the class-action complaint, recast its standards of care for minors as "statements of opinion," no different from much-ballyhooed "conversion therapy," in response to Federal Trade Commission litigation for false and misleading practices.

The Biden administration intervened in the development of WPATH's latest standards for minors, browbeating the authors to remove recommended age minimums in the final version for legal and insurance purposes.

Detransitioners and parents of children who underwent medicalized transitions told their stories at a three-day conference in D.C. last week organized by the Society for Evidence-Based Gender Medicine, whose generally liberal members played a leading role in the Trump administration's systematic review of youth gender medicine.

Maddie Durbin, one of many detransitioners featured by Independent Women, recently went public with her story about how an "ayahuasca trip" convinced her she was a woman after years of doubts about her medical transition, which she undertook despite her parents pleading with her to first review "videos of people who detransitioned and medical research."

She shared the bodily damage she cannot fix, from double mastectomy scar tissue to a permanently lowered voice and leg pain from testosterone. Several detransitioners are suing their providers for allegedly rushing them into irreversible procedures without informed consent, emboldened by a New York jury's $2 million award for Fox Varian. 

Like cutting off 'insulin treatment for someone with diabetes'

Though Monday's order list simply directed the 10th U.S. Circuit Court of Appeals to review SCOTUS rulings upholding Tennessee and West Virginia bans on gender-affirming care for minors and males in girls' sports, respectively, the directive casts doubt on the viability of male inmate Darlene Griffith's challenge to El Paso County, Colorado's sex-based prison policies.

When the 10th Circuit ruled in February 2025 that "all" sex-based classifications must meet "intermediate scrutiny," citing the high court's ruling against the Virginia Military Institute's male-only admission policy, SCOTUS had yet to rule that Tennessee's law doesn't classify based on sex or that West Virginia's satisfies intermediate scrutiny.

By requiring the 10th Circuit to recognize "the constitutional significance of biological sex," SCOTUS confirmed that the "Constitution does not automatically require government institutions to disregard biological sex or create exceptions based on gender identity, particularly when the safety and privacy of women are at stake," Independent Women said.

The federal employees' class action complaint barely acknowledges SCOTUS, referring only twice to the 2020 Bostock precedent that transgender employment discrimination is "because of sex" under Title VII of the Civil Rights Act and saying it simply confirmed the Equal Employment Opportunity Commission's years of practice.

The lawsuit doesn't mention the next several years of SCOTUS precedents on gender identity, which limit Bostock to Title VII and refuse to make gender identity a protected class. 

Some parts are not scientifically accurate, conflating the biology of sex with the social condition of gender identity, and it doesn't identify authorities for its assertions about a "medical and scientific consensus that gender identity cannot be consciously changed or suppressed" and a "scientific consensus that it has biological roots."

Some of its class representatives are already on hormones but are now seeking insurance-paid surgery, while one has "not yet commenced any course of gender-affirming care," which the lawsuit characterizes as medically necessary.

Gender-affirming care "may include" hormonal and surgical interventions that are used to treat conditions apart from "gender incongruence and dysphoria," meaning the insurance exclusions are based on sex, it says. (SCOTUS rejected the same argument when it upheld Tennessee's ban on minors' medicalized gender transitions.)

The 2027 plan's "categorical denial of treatment for those who require continuing gender-affirming care is akin to denying continuing insulin treatment for someone with diabetes," the complaint says.

'Feels like a constant papercut' in the groin, any kind of sex is 'painful and dangerous'

An amended complaint filed Nov. 2 adds class reps including War Department researcher Vanessa Voe and treatment details about State Department IT specialist Charlotte Coe, whose procedures and ongoing care were vague in the original complaint. Both are male.

Coe had "postoperative complications from her 2025 gender-affirming surgery" that causes daily "significant pain and discomfort" and a risk of infection, and Coe needs another gender-affirming surgery to fix those problems, the amended complaint says.

The Nov. 4 motion for preliminary injunction against implementation of the 2027 exclusion, limited to Coe and Voe, provides graphic details about what the other class reps might face following surgery and hormones.

Coe has "developed a painful lesion in her urethral tissue following vaginoplasty" that "repeatedly reopens, makes even sitting painful," and the surgeon won't operate again without insurance coverage, the motion says, echoing a commonly reported adverse event for "gender affirming vaginoplasty."

Coe's declaration, which documents eight years of hormone replacement therapy and six years of surgeries including breast augmentation and "revision," facial feminization and testicle removal in addition to a neovagina, is even more graphic on the latter's problems.

The lesion bleeds when irritated and "feels like a constant papercut," Coe wrote. "I am at near-constant risk for infection when it opens, which makes sexual activity of any kind painful and dangerous, and means I must be very mindful of my sitting position, underwear tightness, and my daily activities to avoid reopening or prolonging opening of the lesion."

In addition to surgery to fix the lesion, Coe's doctor recommended "revision" of the labial and vulvar tissue, which still resemble and feel like "scrotal anatomy" and "exacerbate" Coe's gender dysphoria, Coe said. The procedures "could cost" tens of thousands of dollars.

The motion cites another class rep, Christine F., who "intends" to get a $100,000 colovaginoplasty – a neovagina made from the colon – but cannot afford it without insurance.

Christine's declaration calls this "medically necessary" and "ongoing care" related to previous testicle removal, leaving unstated the possibility that the procedure will cause Christine the same problems as Coe's.

Coe and Voe each "require ongoing hormone therapy because their bodies no longer produce the hormones they need," yet without insurance coverage they will have to "ration their prescribed hormones," followed by likely "debilitating symptoms, such as intrusive thoughts, mental and emotional upheaval, and withdrawal," the motion says.

Since neither can still produce sex hormones, they risk losing bone density in the absence of hormone replacement therapy, the motion says. Coe's declaration adds that muscle strength, energy and "emotional balance" would suffer without HRT.

Voe's declaration discloses the War Department researcher had facial feminization surgery and a vaginoplasty with no adverse events, and would still like to get "breast augmentation or electrolysis," but Voe most fears the consequences of losing insurance-paid hormones, based on previous lapses in treatment.

"[D]uring these periods I grew unwanted hair, had greasier skin and hair," suffered from "increased acne, brain fog, and invasive thoughts" and was "extremely irritable," Voe wrote. If it happens again, Voe fears "my friends and colleagues will perceive me as a different person" and that Voe will "withdraw from my marriage."

Unintentionally echoing journalist Abigail Shrier's documentation of the health costs of gender-affirming care for adolescent girls, Voe said that without HRT, "my body suffers irreversible harm."