IN-DEPTH: Misdiagnosis of Gender Dysphoria in Patient With Mental Health Issues Led to Reassignment Surgery

Demonstrators promote Detransition Awareness Day near the Golden Gate Bridge in San Francisco on March 12, 2022. Courtesy of protesters

By the time Richard Anumene was approved for gender reassignment surgery, he had accumulated a litany of mental health problems his attorney argues should have disqualified him from the procedure.

Still, in March 2021, Anumene—who had changed his name to Rika Ila Abbir—underwent a series of operations that left him with what some call only an imitation of female sex organs and a sinking feeling of regret for the now 28-year-old.

“At the heart of this is nothing short of an atrocity,” Anumene’s attorney Dan Watkins told The Epoch Times.

Watkins is the founder of Declare Truth, a grassroots movement of citizens in California who advocate for religious and medical freedom.

Declare Truth offers legal support to those who have suffered from firings due to COVID-19 vaccine mandates, the malpractice of COVID-19 hospital protocols, and complications related to gender reassignment surgeries.

Watkins’ lawsuit (pdf) against Kaiser Permanente describes Anumene as a person “with several comorbidities from a mental health perspective,” but was diagnosed and treated for gender dysphoria, nonetheless.

This addresses a growing concern among health officials who aren’t on board with gender-affirming care; that is, if those who have been diagnosed with gender dysphoria are, in fact, suffering from another condition and being misdiagnosed.

Anumene has been diagnosed with bipolar disorder, schizophrenia, depression, and post-traumatic stress disorder resulting from his deceased brother’s sexual abuse and physical and emotional abuse from his father when he was a child.

The diagnoses are listed in Anumene’s medical records, so it wasn’t a mystery to Kaiser, Watkins said.

“Yet in a matter of a few months after he arrived at the clinic, he went from hormonal treatment to surgery,” Watkins said. “They conducted a vaginoplasty and face feminization surgery all with this idea that it would somehow help him, but all it did was make matters worse.”

A Life Burdened With Suffering

Tina Payne, a nurse paralegal for Declare Truth, Watkins, and others with the group, took Anumene under their wing to assist him after he decided to detransition.

From conducting interviews and reviewing his medical records, Payne was able to piece together a life burdened with suffering.

Anumene grew up in Northern California in the shadow of an abusive family, which left him with little coping skills, Payne said.

“I can say with almost certainty that he’s been in every single ER in that part of the country,” Payne said.

Anumene often struggled to assimilate into normalcy, but his disorders inevitably caught up to him, leaving him homeless in the streets of San Francisco’s Haight Ashbury, on drugs, and confused about his sexual identity, often wearing women’s clothing.

Before his brother committed suicide, he had indoctrinated Anumene with abuse and pornography, in addition to bringing him into a network of a transient LGBT community, Payne said.

Anumene frequented a gender clinic in Sacramento, where he was prescribed female hormones “at a very young age” and treated by students in training to be psychologists but not psychologists, Payne said.

“Those types of medications change your chemical makeup and the way your brain works,” Payne said. “It can be very euphoric at first.”

He would take those and his psych meds “on and off,” Payne said, without the guidance of a physician.

But these aren’t the kind of drugs one can just stop taking without severe emotional, mental, and physical side effects, Payne said.

Anumene eventually found his way to Kaiser Permeante’s San Francisco Gender Pathways clinic, where he was put on the fast track toward surgery during the onset of COVID-19.

“He wasn’t in his right mind at all,” Payne said. “From his medical records, it’s clear he was manic.”

Because of his multiple diagnoses, Anumene’s treatment was covered by his disability income and Medi-Cal, which reimbursed the gender clinic up to $150,000 for the vaginoplasty alone, according to Watkins’ discovery.

“All along the way, he’s having second thoughts, and there are periods of time when he takes himself off all of the hormones and decides that this isn’t the right path for him,” Payne said. “He’ll start going to the gym, wanting a girlfriend, feeling better about himself until he meets with the therapist again, and then he’s back on the program.”

No Support for Detransitioners

Payne connected with him through Watkins after Anumene had fully transitioned and was living in a subsidized LGBT community.

“He was just starting to realize that the procedure didn’t fix the issues he was having,” Payne said. “He was still having depression, PTSD, and suicidal ideation.”

Because he had decided to detransition, Anumene reported to Payne that it was a hostile environment because he was living among young people who were transitioning and viewed him as a traitor.

While there’s ample assistance for those wishing to transition, Payne said she found no support for those who desired to detransition.

“Everybody I called sent me to a gender clinic,” Payne said. “I couldn’t find anyone to sit down and listen to this young man because he had already been through that and realized it was a mistake, and he needed help to deal with it.”

Payne and a group of nurses with Declare Truth started a text thread for Anumene so that he would have support.

Watkins got Anumene into a crisis center in Orange County, where he and Payne were able to interact with him more in person.

While in a crisis center, Anumene was assaulted by another resident who was having a psychotic episode, Payne said, which landed Anumene in another ER.

After some tests, a neurologist determined that Anumene had hydrocephalus—or water on the brain—since he was a child, which Payne said could account for his autistic behavior and shuffled gait.

“So far, I haven’t been able to find any earlier documentation that shows he had this,” Payne said, adding that it answers many questions.

‘A Lifetime of Treatment’

Written in his records, Watkins said, was Anumene’s wish to someday be a father.

“Where once was a man with the great hope of fathering and raising a child, Defendants left a faux woman lacking any capacity to procreate,” Watkins wrote in the lawsuit.

Anumene wanted to be a father, Watkins said, to right the wrongs of his past.

Now, Anumene faces “a lifetime of treatment,” Watkins said, adding that there’s no true successful reversion.

“They’ll tell you it’s reversible, but it doesn’t work,” Watkins said.

He’s taking testosterone to restore himself to a place of balance, but he’s far from the possibility of exploring a phalloplasty because of health problems the previous surgery caused, Watkins said.

The phalloplasty itself involves the removal of skin from the arm or another part of the body to cover the prosthetic phallus, Watkins said.

“It’s horrifying what they have to go through to go backward,” Watkins said.

‘It’s a Horror Show’

The suicide argument is frequently used to defend gender-reassignment surgery. Those who have been diagnosed with gender dysphoria, according to the argument, are at risk of taking their own lives as a result of the depression stemming from living in what they perceive to be the incorrect body.

Dr. Miriam Grossman, a psychiatrist and author of several books on the issue, including “You’re Teaching My Child WHAT?” and the newly published “Lost in Trans Nation,” told The Epoch Times in a previous interview that children who are confused about their gender often have other issues, and if one were to compare the suicide rate of kids who say they are trans, or nonbinary, the suicide rates would be similar.

It is often argued that gender dysphoric people who don’t get the surgery will commit suicide; however, Grossman referenced a study that suggests the opposite is true.

In the study, those who went through sexual reassignment procedures were reported to face a higher risk of suicide (pdf).

The study examined 324 sex-reassigned persons (191 male-to-females and 133 female-to-males) in Sweden and concluded that people “with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behavior, and psychiatric morbidity than the general population.”

The study defines transsexualism, or gender identity disorder, as a condition in which a person’s gender identity “contradicts his or her bodily sex characteristics.”

“The study followed people for 30 years,” Grossman said. “Again, this wasn’t the same population we’re talking about now.”

One important point about the study is the length of time it took for people to regret what they’d done, she said.

“It took them years to get to that point to where they realize they may have not made the best decision,” Grossman said. “So, when we’re studying these adolescents, we can’t just follow them for six to 12 months, but that’s what’s happening now. These medical organizations are looking at them for a very short term.”

Much of the available evidence of the negative effects is coming from the testimonies of “detransitioners” who are beginning to speak up.

“I’ve been working as a psychiatrist for almost 40 years, so I’ve seen everything, but these stories of young 17-year-olds who have had their breasts removed, they’re growing a beard, their voices dropped, and they’re suicidal because they’ve gone through these irreversible procedures—it’s a horror show,” Grossman said.

‘Bring it to Light’

Watkins is suing Kaiser for medical malpractice and battery and was initially seeking a trial by jury.

However, Kaiser filed a motion to compel the arbitration, to which Watkins objected.

The judge sided with Kaiser, pushing the case into arbitration and “on their turf.”

Though Watkins said this gives Kaiser a legal advantage, he still plans on videotaping physicians’ testimonies to “bring it to light and publishing it all.”

“More than anything, this is an opportunity to get the decision-makers, the people who committed this atrocity under sworn testimony,” Watkins said.

Today, Anumene continues to battle demons, Payne said, like many others, who aren’t helped by the propagation of gender ideologies claiming to offer a cure.

“I believe that this rush to transition people is permanently harming them and leading them down a path of darkness into depression and ultimately suicide,” Payne said. “My hope for Richard is that he wins his case to secure resources that will provide him the stability as he continues to deal with his mental and now physical health issues.”

The Epoch Times contacted Kaiser Permanente for comment.