This episode contains strong language.Since 2021, nearly half the states in the U.S. have passed bans on medical treatments for transgender minors. The Trump administration is now targeting the care, and in the coming weeks, the Supreme Court is expected to weigh in.Against that backdrop, “The Daily” is running the first episode of a six-part series from NYT Audio about the story of youth gender medicine — where it came from, whom it was meant to help, and what may come next in the legal and political fights over its future.It starts in the Netherlands, with a clinical psychologist and a 16 year-old who was determined to go through life as the gender he had long felt he was.Guests: Azeen Ghorayshi is a reporter for The New York Times covering the intersection of sex, gender and science. Austin Mitchell is a supervising audio producer for The New York Times.You can find all six episodes of “The Protocol,” along with additional reading material, at nytimes.com/theprotocol.For more information on today’s episode, visit nytimes.com/thedaily. Transcripts of each episode will be made available by the next workday. Unlock full access to New York Times podcasts and explore everything from politics to pop culture. Subscribe today at nytimes.com/podcasts or on Apple Podcasts and Spotify.
Chapter 1: What is 'The Protocol' series about?
From The New York Times, I'm Michael Barbaro. Today, the first episode of our new series, The Protocol.
With a stroke of my pen on day one, we're going to stop the transgender lunacy.
I am so hated for just existing and being who I am.
It will henceforth be the official policy of the United States government that there are only two genders, male and female.
Chapter 2: How do political decisions affect transgender youth care?
How has this impacted us? Well, it was already not a safe place, but now we feel like asylum seekers in our own country.
And now I want Congress to pass a bill permanently banning and criminalizing sex changes on children and forever ending the lie that any child is trapped in the wrong body. This is a big lie.
Being able to transition absolutely saved my life.
It's only been about two decades since trans and gender nonconforming kids in the U.S. have been able to get medical treatment to transition. Now, the federal government is looking to end it. And the Supreme Court is expected to rule on the issue in the coming weeks.
If the treatment's barred, some kids will suffer because they can't access the treatment. If the treatment is allowed, some kids will suffer who get the treatment and later wish they hadn't. And then the question becomes, how does the court choose which group?
You do not have the right to abuse your kids. I'm scared for myself, for my own health care.
There's not enough evidence to put our children out on a huge experiment. If they cannot get treatment, children will die. These treatments do much more harm than good. Trans kids are under attack. What do we do? We are not going to rest until every child is protected, until trans ideology is entirely erased from the earth. We are trans people. We are trans human. And we will never be eradicated.
So are you going to be able to bring that inside? No.
I don't think so. No. I'm going to leave it out here. This is a story of how we got here.
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Chapter 3: What led to the medical treatment of transgender youth?
And it's one that pretty much everyone in the field knows about and points to. And it starts in the Netherlands. The Netherlands is this small, very socially liberal country. And back in the 1950s, they were among the few countries in the world that were actually treating trans patients, so at this point, just adults, medically. Mm-hmm.
So at the time, the mainstream medical establishment really viewed trans people with a lot of suspicion. So if a trans person came into a doctor's office saying that they felt like they were in the wrong body, often those doctors would assess those patients as being mentally disturbed or sexually deviant or even psychotic.
And so if they got any health care at all, it would usually be from an analyst or a psychiatrist.
And those professionals would be trying to kind of convince these people that they... Yeah, kind of talk them out of it.
I mean, it was sort of corrective, trying to convince them to let go of the idea that they could ever live as the opposite sex. But there were a small number of doctors around this time who felt like that approach was actually failing these patients, that it was completely ineffective in addressing the pain that they were feeling.
There's a foundational medical book from around this time on trans medicine that talks about this one second. It says that, you know, these patients that were treated with psychotherapy languished and that, quote, the majority were miserable, unhappy members of the community unless they committed suicide. So, you know.
What some of these doctors were doing at around this time was actually listening to what these patients were saying and believing them that what they needed was to change their bodies.
And so these doctors were treating these patients with hormones, giving trans women estrogen so that they developed female characteristics, giving trans men testosterone so they developed male characteristics, and they also performed surgeries.
And so by the 1980s, as these treatments were becoming a little less fringe, a clinical psychologist named Peggy Cohen-Ketnes started to research how these patients were actually doing.
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Chapter 4: What is the significance of puberty blockers?
But because they weren't 18, they couldn't get treatment.
And I thought, that is a bit silly. For years and years, they very well know what they want. But because they don't have the right age, they have to wait.
And, you know, Peggy knew that there was already all this skepticism about treating trans patients at all. And she knew it was going to be way more controversial if she tried to treat these kids who were under 18. Adolescence was known to be this period of great flux and identity exploration. And she knew there would be a lot of skepticism about whether they could make a decision like this.
But she also saw that not every teenager could handle their distress for a prolonged period of time. That having to wait to get medical treatment could lead to the same dire outcomes that she saw in the adults that she'd been working with. So in her mind, if a 16 or a 17 year old was expressing as much clarity about who they are as an 18 year old, they should be able to get help.
So she went to the lead endocrinologist overseeing hormone treatments for trans adults in the Netherlands.
Couldn't we do something about that age limit? And he said, OK, we can start it a little bit earlier.
And together, they decide they're going to lower the age that patients can receive hormones from 18 to 16 and actually study it to see if it helps. And what they found was really interesting because... The kids who got hormones were doing better psychologically than the adults they'd been treating.
And she thought that part of the reason why was because they had what she called, and she wrote this in the paper, a convincing appearance. She wrote that they could more easily pass in society because intervening earlier had managed to block some of the effects of their natal puberty before it had fully set in.
And so what Peggy was realizing was that puberty was this incredibly critical period in these patients' lives.
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Chapter 5: How did early treatments for trans youth begin?
Can I get you coffee or tea or something? I have coffee.
He brought out some coffee, some pastries, and gestured to us to sit at the dining room table.
And what is your comfort level with your name? FG is what we're sticking with? Yeah, okay.
FG is not his real name. It's what he's called in some of the medical and historical literature about him. And it's what we've agreed to call him to protect his identity.
And I spent my whole life being, you know, covert and... Right. Yeah.
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Chapter 6: What challenges do transgender youth face today?
Yeah. What is your... Do you share with people in your professional space?
No, I don't. You're just a man in the world. I try to get away with a murder. I literally don't tell people that knew me before my transition.
So they don't know that you played this... Do you feel like you played a seminal role? I did.
Yeah, you did. That's one of my bragging rights. I was the first person, so I was like the guinea pig.
So some people do know that.
No, the people that are close to me and the people that need to know or I've told, oh, then I love to share because it's, you know, it's something that there's so much that's happened and it explains so much of your personality, your character, your decision making. It's nice to be able to have somebody to talk to about that, but it doesn't need to be common knowledge. Right.
FG asked that we protect many of the identifying details of his life today.
And if you do mention my profession, then kind of make it a medical profession rather than... Very vague.
But he was ready to talk about his experience with Peggy, which was documented in two foundational case reports that she authored. In one of them, she wrote that he had gone on to become some kind of doctor.
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Chapter 7: Who is FG and why is his story important?
Maybe to start, tell me a little bit about just your life growing up, like early childhood.
My mother was English because she died. My father's Italian. And they're quite... Well, I think my mother was more liberal than my father because he came from a small village and he's Italian. You probably read that in the case report as well. But, you know, more or less I had a pretty happy childhood. But I was very aware of my... Frustrations, which at the time I didn't see as frustrations.
I just didn't understand. I just assumed that would sort itself out.
When you say frustrations and sort itself out, you mean sort of the things that you were drawn to or the people you were drawn to? Like what?
Well, in the sense that being a boy or a girl. In the first case report, Peggy noted that FG, who was born female, quote, wished to be a boy from early on.
And I was, I remember being five and coming down and I had to wear like a, like a dress thing. And I put a safety pin in between because I wanted to, I wanted to be like knickerbockers.
Oh, so you put like, do you connect in the front?
Yeah, yeah, yeah, exactly. Why am I wearing a dress?
That's very innovative.
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Chapter 8: What is the future of transgender care for minors?
And then I started to become really anxious, which just, I think, translated to being even more aggressive, like even more difficult and demanding and opinionated and axes to grind.
And then... Were you angry?
Yeah, I was angry. But like I said, that made me, you know, at school, I talked with my fists. I also talk with my mouth because it's also very argumentative, but I wouldn't tolerate anything. And if anyone said anything to me that I didn't like, I'd smack them. But I would always smack people that were bigger than me.
Never punch down.
No, exactly, which wasn't very difficult because I was small anyway. But no, I was quite explosive.
And your friends, you said they were mostly boys? Yeah. And was, do you have any memory of it, of anything about your gender coming up with them? Or did they just accept you as you were?
It did, well, it came up, but probably, and I don't know what happened behind my back. I don't care. But, you know, there was a, I met, when I was 12, I met a girl. She was in my class. And she was also a bit of a tomboy. And we became very close very quickly. And it was at that time that the gym lessons were separated to boys and girls.
So the very first gym lesson where we had to do it, I was there with this person. And I felt such resistance. It felt wrong. I said, I'm not doing this. I'm not doing this. She said, no, I don't want to do it either. And so I went to do it. I said, I want gym on the other side. And I went, okay. And ever since then, I always did gym with the boys. But so did she.
And at the time, we both decided that we were boys. And I was convinced that she was the same. And she just turned out to be quite a butch lesbian. But we didn't think anything of it. We didn't feel foolish about doing that. And so it became, I think half of the people were just confused at that point. They're like, what is this? What are they? Yeah.
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