Nebraska woman Luka Hein, 21, received gender-affirming care at the University of Nebraska Medical Center’s gender clinic as a teen, including a double mastectomy.
Hein is now suing for malpractice, alleging that she was too young to consent to the treatment properly.
Activists sometimes use Hein’s case and a handful of others like hers to support bills restricting access to gender-affirming care.
Luka Hein, now 21, is suing the University of Nebraska Medical Center (UNMC) for gender-affirming treatments she received as a teenager, including a double mastectomy at 16. In the lawsuit, Hein claims that professionals at the UNMC gender clinic “talked her into” irreversible medical changes that she was too young to understand fully.
Hein stemmed from a reportedly rough childhood and her parent’s 2015 divorce. Hein struggled in high school and experienced panic attacks, difficulties with concentration and motivation, and suicidal ideation. She self-harmed and was diagnosed with depression. During this time, she met an older man online who she says groomed her; he reportedly asked for sexually explicit pictures and threatened her when she stopped sending them.
Hein became very uncomfortable with her body after the trauma of the grooming incident, especially as her breast development increased. She found transgender influencers online and ordered a binder for her chest to alleviate her discomfort. In June 2017, Hein came out as transgender. Due to her mental health and trauma, Hein was already receiving treatment from a psychiatric care program, including prescription psychiatric medications. The program referred Hein to the UNMC gender clinic.
At UNMC, Hein was diagnosed with gender identity disorder. In October 2017, Hein had her first consultation with plastic surgeon Perry J. Johnson, MD, regarding the possibility of a double mastectomy. In his notes, Dr. Johnson wrote, “Typically, we would wait until the patient is a little bit older, but this would be influenced by the potential negative impact psychologically on the patient by prolonging the transition. […] I would require a letter from the patient’s therapist regarding the appropriateness of the operation and the appropriateness of the timing of the procedure.”
Hein and her parents consented to the double mastectomy procedure, but Hein’s lawsuit alleges that physicians at UNMC pushed the surgery on both her and her parents. She claims one physician asked her parents if they would rather have “a dead daughter or a living son?” Hein also insists that she did not express suicidal ideation at the time.
The mastectomy was conducted in July 2018. In November 2018, Hein was prescribed testosterone. A year later, physician Nahia J. Amoura, MD, recommended that Hein consider a hysterectomy. Hein’s parents did not consent to the procedure. Hein continued taking testosterone until late 2022. In early 2023, she resumed using her birth name and female pronouns.
Now, Hein is suing UNMC Physicians, the Nebraska Medical Center, Nebraska Medicine, and four physicians who were part of her treatment, including Dr. Amoura and Dr. Johnson. The lawsuit alleges that the actions taken by Hein’s physicians were negligent. It claims that UNMC failed to address her underlying mental health conditions and instead pushed gender-affirming care without giving her or her parents the information they needed to provide truly informed consent. The lawsuit also claims that in addition to removing Hein’s breasts, Hein is in constant joint pain after taking testosterone for four years.
Nebraska Medicine has not commented on the lawsuit.
A wider conversation about gender-affirming care and minors
Hein has become active in a larger discussion surrounding gender-affirming care and minors. She testified in hearings to support the passage of Nebraska’s LB 574 bill, which will ban gender-affirming surgeries for minors, and in support of similar bills around the country. The Nebraska bill, which goes into effect on October 1, 2023, is also expected to affect how minors are able to receive other types of gender-affirming care in the state.
This lawsuit adds to Hein’s well-known political activism on the topic, and, notably, she is being represented by multiple parties who have also spoken out against gender-affirming care in the past. This includes the Center for American Liberty, Nebraska malpractice attorney Jeff Downing, and the Thomas More Society. Hein’s lawsuit contains language often used to discredit the validity of transgender identities. 
Hein’s case is one of a handful that parties working to champion bills such as Nebraska’s LB 574 point to as evidence that minors should not be allowed to receive gender-affirming care. However, this position isn’t backed by most major medical organizations. In June 2023, the American Medical Association (AMA) passed a resolution, sponsored by the American Endocrine Association and co-sponsored by nearly a dozen additional medical organizations, resolving to increase its commitment to protect access to gender-affirming care.
In a press statement about the resolution, the Endocrine Society said,
“Due to widespread misinformation about medical care for transgender and gender-diverse teens, 18 states have passed laws or instituted policies banning gender-affirming care. More than 30 percent of the nation’s transgender and gender-diverse youth now live in states with gender-affirming care bans, according to the Human Rights Campaign. Some policies are even restricting transgender and gender-diverse adults’ access to care. These policies do not reflect the research landscape.”
Gender-affirming care for minors typically does not include any form of surgical intervention. Instead, supportive care first focuses on social transition and mental healthcare. It also focuses on taking puberty blockers and hormonal therapy, such as estrogen and testosterone. As affirmed in the AMA’s recent statement, the majority of the medical community has approved these steps—and considered them safe, appropriate, and necessary.
Additionally, studies have shown that while there are people, such as Hein, who later regret their transition, this experience is rare.
In fact, in a 2021 study that analyzed surgical regret rates of people who’d received gender-affirming care, it was found that less than 1% of people who received masculinizing gender procedures experienced regret, and only around 1% percent of people who received feminizing gender procedures experienced regret. Another 2021 study asked plastic surgeons about regret rates among their transgender patients. In this study, regret rates were between 0.2–0.3%. In comparison, regret rates for plastic surgery vary by study and type of surgery but are sometimes reported as high as 60%.