Dr. Annelu de Vries

And as Manon was learning about the blockers, she was also being monitored for any signs of puberty.

And as Manon was learning about the blockers, she was also being monitored for any signs of puberty.

This is what the Dutch thought of as one of the radical innovations of the blockers, that it was just a pause that could be undone. And meanwhile, Manon could think about what came next.

This is what the Dutch thought of as one of the radical innovations of the blockers, that it was just a pause that could be undone. And meanwhile, Manon could think about what came next.

At some point, she remembered there were some concerns about her bone health. She said she was told to eat more cheese and exercise. And then she turned 16, the age when doctors at the clinic said she could decide if she wanted to move on to cross-sex hormones. For Manon, this would mean taking estrogen, which would trigger female puberty.

At some point, she remembered there were some concerns about her bone health. She said she was told to eat more cheese and exercise. And then she turned 16, the age when doctors at the clinic said she could decide if she wanted to move on to cross-sex hormones. For Manon, this would mean taking estrogen, which would trigger female puberty.

And so now the conversation was about whether to move forward to a stage where treatment would have irreversible effects.

And so now the conversation was about whether to move forward to a stage where treatment would have irreversible effects.

If Manon wanted to keep the option of having biological kids down the line, she would have had to go off the blockers, delay the estrogen treatment, and let her body go through enough male puberty for her to develop and bank sperm.

If Manon wanted to keep the option of having biological kids down the line, she would have had to go off the blockers, delay the estrogen treatment, and let her body go through enough male puberty for her to develop and bank sperm.

In 2011, Analu published the results of her study that had followed Manon and the 69 other adolescents who received puberty blockers using the protocol.

In 2011, Analu published the results of her study that had followed Manon and the 69 other adolescents who received puberty blockers using the protocol.

She found that after an average of two years on the blockers, the psychological well-being of the participants was improved, writing that their, quote, behavioral and emotional problems and depressive symptoms decreased while general functioning improved significantly.

She found that after an average of two years on the blockers, the psychological well-being of the participants was improved, writing that their, quote, behavioral and emotional problems and depressive symptoms decreased while general functioning improved significantly.

Despite the improvements in general functioning, she found no change in their feelings of gender dysphoria, which she said made sense because the blockers hadn't actually changed their bodies.

Despite the improvements in general functioning, she found no change in their feelings of gender dysphoria, which she said made sense because the blockers hadn't actually changed their bodies.

But the study had continued to follow the group as they moved on to cross-sex hormones and, after they were 18, surgery. And Analu published another paper about how they were doing after these interventions. By this point, the group had narrowed to 55 of the original 70. Some patients weren't included because they didn't respond to questionnaires.

But the study had continued to follow the group as they moved on to cross-sex hormones and, after they were 18, surgery. And Analu published another paper about how they were doing after these interventions. By this point, the group had narrowed to 55 of the original 70. Some patients weren't included because they didn't respond to questionnaires.

Some weren't far enough out from their surgery to be included, or couldn't get surgery because of other medical issues. One patient died as a result of surgical complications. And in the follow-up paper, Analu found that the 55 patients she had been following for years, quote, were generally satisfied with their physical appearance and none regretted treatment.

Some weren't far enough out from their surgery to be included, or couldn't get surgery because of other medical issues. One patient died as a result of surgical complications. And in the follow-up paper, Analu found that the 55 patients she had been following for years, quote, were generally satisfied with their physical appearance and none regretted treatment.