Azeen Ghorayshi

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?

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But it is interesting thinking about that time and what you were saying about your anxiety increasing. That is when the splitting starts to happen, right? Both with puberty and with school and with sexuality and everything is... So was that all weighing on you at that time?

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Did your mom...

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And so you were 12, so that would have been 86? Yeah. Was your body changing?

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For adults, right? Yeah, yeah, yeah. Came up with like basically was a pioneer worldwide for adult care.

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Did they come up with the idea in response to meeting you? Is that your sense?

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They were. Yeah. So, I mean, you used the word guinea pig earlier. Were they aware? Aware. You don't think they were aware it was the first? You were the first?

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Really? Oh, wow. Okay.

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So are you going to be able to bring that inside? No.

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You think that would have scared you out of it?

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It was sort of irrelevant.

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So, so sorry. So you, so you started the blockers at 12. Yeah. Uh, 12, 13. Uh huh. Do you remember like the first time getting it and.

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That's why I wonder if they're going to even let our phones in.

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And had you met Peggy?

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Well, that's fabulous. what you went through as an adolescent is still with you. Oh, absolutely.

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I guess just this idea of wanting your whole life to blend in and blending in. And there's been such a sea change in views and attitudes towards gender since the 80s. So many of the young people now... want to visibly challenge the binary? And I don't know, what do you make of that? And what do you make of what that means for getting the medical treatment that you pioneered? I mean, you know?

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It's just interesting to me because you were once an adolescent who adults chose to take seriously.

The Daily

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How would you define the Dutch Protocol?

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Yeah, so there have always been a small number of young people who have felt this deep disconnect between their inner sense of themselves as boys or girls and their bodies, you know, how they're seen by society. But when it comes to the medical story and when these kids are actually beginning to interact with the medical community, there's actually a really clear beginning.

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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.

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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.

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And so if they got any health care at all, it would usually be from an analyst or a psychiatrist.

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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.

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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.

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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.

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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.

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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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And she found that, you know, while they were still struggling, that, you know, there was still a pretty high risk of suicide in the group. The vast majority of the patients reported feeling happy about their medical transitions. Yeah. And at the same time that Peggy was doing this research... But I was also a psychotherapist. She also had a clinical practice.

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And she started getting a few referrals for younger patients. who were, you know, 16, 17, and who were saying really similar things as the adult patients, that they had felt they were in the wrong body for as long as they could remember.

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But because they weren't 18, they couldn't get treatment.

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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.

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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.

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So she went to the lead endocrinologist overseeing hormone treatments for trans adults in the Netherlands.

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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.

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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.

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And so what Peggy was realizing was that puberty was this incredibly critical period in these patients' lives.

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Yeah, and their development, I mean, they're going through these, you know, irreversible changes that will be much harder to undo further down the line. And this was becoming even more clear to her as she started to see younger kids.

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Kids who were in extreme distress, kids who hadn't yet gone through puberty or were just starting to, and their distress was actually being exacerbated by that or even by the prospect of it. of going through puberty. So there's a scientific paper from around this time that talks about how in the years before puberty, these kids would engage with a kind of magical thinking.

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Being able to transition absolutely saved my life.

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And it was this belief that one day they would just wake up and their bodies would finally match the way they felt inside. And what Peggy was seeing was that puberty just shattered this magical thinking. And it made these kids feel like their bodies were basically betraying them. That they were actually becoming less and less the way they felt inside. And there was nothing they could do about it.

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And just as Peggy was starting to recognize the significance of this moment for her patients... And then I came across FGE. That's when a kid walked into her office and offered an unexpected solution.