Woman who lost breasts, uterus to sex change sues doctors, mental health providers who facilitated her transition

A detransitioned Ontario woman who was prescribed testosterone and underwent both a bilateral mastectomy and a hysterectomy during a mental health crisis in which she believed herself to be a man is suing the healthcare providers who allegedly facilitated her medical transition.

Michelle Zacchigna, 34, of Orillia has filed legal action against a total of eight doctors and mental health professionals who treated her during the years that she identified as transgender. Zacchigna alleges that each failed to address her complex mental health needs and instead allowed her to self-diagnose as transgender and undergo irreversible procedures that she now deeply regrets.

“I will live the rest of my life without breasts, with a deepened voice and male-pattern balding, and without the ability to get pregnant. Removing my completely healthy uterus is my greatest regret,” wrote Zacchigna.

The Statement of Claim filed to the Ontario Superior Court of Justice documents a series of what Zacchigna said are failings spanning years of treatment. Zacchigna began pursuing medical transition in 2010 when the affirmative model of gender care was still in its infancy. Under this model, clinicians affirm a patient’s self-diagnosis of a transgender identity and provide medical interventions such as hormone therapy and surgeries rather than the traditional exploratory psychotherapy.

Zacchigna endured severe bullying as a child and experienced serious mental health issues throughout her teenage years as a result. 

“Later, I would learn that what I experienced in childhood was developmental trauma,” she wrote. “It affected the trajectory of my life. My personality completely changed. I went from a loud, fierce, opinionated child to a passive, shy teenager with low self-esteem.”

In 2009, at the age of 21 and after years of depression, anxiety, self-harm, and a suicide attempt, she discovered the concept of gender identity on Tumblr, and became convinced that all her problems were because she was transgender.

“Online, I was sucked into a world where it felt like I was finally somewhere I belonged. In places like Tumblr, there was constant reassurance that only trans people spend so much time thinking about their gender (not actually true) and that every trans person has doubts about transitioning,” she explained.

Zacchigna also became convinced that embracing this new identity was the solution to all her problems and in spring of 2010 attended a support group at the Sherbourne Health Centre in Toronto called "Gender Journeys."

Here she met Defendant Rupert Raj, who was one of the therapists running the group. Zacchigna says Raj announced to the group that he had connections with a general practitioner who was willing to take on two patients (one biologically male, and one biologically female) in order for their resident doctors to gain experience with transgender healthcare. 

The claim states that Raj referred Zacchigna for male hormone therapy after just one appointment lasting under an hour.

Zacchigna also received a recommendation from her regular therapist, Defendant Nadine Lulu, whom she had started to see following her suicide attempt in 2008. In July 2010, the lawsuit states that Lulu concluded that Zacchigna was an "ideal candidate for hormone therapy" despite being aware of her long history of serious mental health issues.

Dr. Rick Lindal, also a defendant, signed the July letter in his role as Lulu’s supervisor recommending Zacchigna for hormone therapy even though he had never met her. 

After three appointments at St. James Town Health Centre with Defendant Dr. Pamela Leece, Zacchigna was prescribed testosterone. Neither Leece, nor her supervisor, Defendant Dr. Cavacuiti consulted with a psychiatrist or psychologist prior to initiating the powerful male hormone.

In 2012, Cavacuiti and/or Leece wrote a letter recommending Zacchigna for a medically unnecessary bilateral mastectomy. As the surgery was not covered by Ontario health insurance at the time, Zacchigna chose a surgeon in Florida and paid out of pocket to have her healthy breasts removed.

Cavacuiti and Leece continued to prescribe Zacchigna testosterone until Cavacuiti’s departure from the centre around 2014 when defendant Dr. Suzanne Turner took over being Zacchigna’s testosterone provider, also allegedly without attention to her patient’s complex mental health needs.

In 2015, 9 years after her suicide attempt and 8 years after coming out as transgender, Lulu finally referred Zacchigna for a full psychological and diagnostic assessment, and the resulting 25-page document revealed ADHD, tic disorder, borderline personality disorder, anxiety disorders, autism spectrum disorder, and traits of PTSD.

Defendant Dr. Lynda Rowden, the supervising psychologist who performed the diagnostic assessment, reportedly did not analyze or consider whether Zacchigna met the diagnosis of gender dysphoria, nor whether there was a link between her patient’s gender distress and her multiple comorbidities. At this point, Zacchigna had stopped taking testosterone and was identifying as non-binary.

In 2017, Turner referred Zacchigna to Defendant Dr. Rajiv Shah to explore a potential hysterectomy procedure. Noting her history of depression and ADHD, and the fact that she was identifying as non-binary and not on any hormones, Shah removed Zacchigna’s uterus in May 2018.

"I wasn’t in a great place mentally at the time, so I can’t really remember why I thought it was a good idea except that, for trans people, it was covered by provincial insurance, and I liked the idea of not having any more periods or pap exams," Zacchinga later said of her hysterectomy.

Two years after her hysterectomy, Zacchigna realized that her mental health diagnoses and her developmental disabilities explained everything she had been through "much more succinctly than identifying as transgender ever had." She then made the decision to detransition.

Zacchigna alleges that all the defendants failed to address her serious mental health issues and developmental disabilities and instead only offered her irreversible medical interventions. She alleges that her desire to become transgender was never challenged, and alternative treatment options were never offered. 

"The Defendants permitted Michelle to self-diagnose as transgender and prescribe her own treatment without providing a differential diagnosis or proposing alternative treatments," reads the claim.

Zacchigna 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. 

"It’s been eleven years since my mastectomy. About 99% of the time, I’ve accepted what my chest looks like," Zacchigna wrote in a recent blog post. "But there are still moments where I remove my shirt to change, my breath catches, and my mind leaves my body. And I have no way of predicting when it will happen. This reality will never go away for me. I will still be living in this body long after everyone has moved on to whatever the next big scandal is."

"Acknowledging that I cannot bear my own children has been devastating. Some days, the pain of what I’ve done to myself is overwhelming. I cry and I can’t stop. Other days, I’m angry that I wasn’t screened for the diagnoses I later received before I was prescribed hormones."

Zacchigna says her advocacy is largely not done for herself because what happened to her cannot be undone, but rather it is in the hopes of preventing it from happening to someone else.

"It took me 10 years to figure out why I could have falsely believed something like this, and why so many professionals could have wrongly encouraged it. I can imagine that there are a lot of people who will eventually find themselves in my position, some of them vulnerable adults like I was and some of them too young to understand the long term consequences," she said in her crowdfunding video. 

"Through this action. I am not only seeking justice for myself, but also hoping to raise awareness about the recklessness of gender affirming health care."

Zacchigna is being represented by Frances Shapiro Munn, on a contingency basis, but is crowdfunding for out of pocket expenses such as obtaining medical records and hiring experts. 

Zacchigna is one of several detransitioned people bringing legal action against the gender-affirming care providers whom they allege harmed them by failing to address underlying mental health needs. In the US, Chloe Cole and Camille Kiefel are suing the healthcare providers who facilitated their medical transition. Kiefel, like Zacchigna, was a vulnerable mentally ill adult when allowed to consent irreversible medical interventions. Cole was just a child of 13. 

In Australia, Jay Langadinos is suing the psychiatrist who allowed her to begin medical transition while she too was going through a mental health crisis, and in England, Ritchie Herron is bring legal action against the doctors who allowed him to consent to hormone therapy and the amputation of his penis while he was in a similar state of mental distress.

This article has been edited to include additional information about the Gender Journeys group and to correct the spelling of Zacchigna's lawyer, who is Frances Shapiro Munn, not Francis.