The story of youth gender medicine starts in The Netherlands, with a clinical psychologist and a 16 year-old who was determined to go through life as the gender he long felt he was.
Chapter 1: What is the beginning of youth gender medicine?
With the 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. Thank you.
How has this impacted us? Well, it was already not a safe place, but now we feel like asylum seekers in our own country.
Chapter 2: How has U.S. policy affected transgender youth?
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?
Chapter 3: What challenges do transgender kids face today?
You do not have the right to abuse your kids.
This is cutting off. 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 humans. And we will never be eradicated.
So are you going to be able to bring that inside?
No. I don't think so. This is a story of how we got here. It's a story I've been reporting with my colleague Azeen Gureshi, a science and gender reporter, for nearly two years. And it's a story she's been reporting for much longer. And from the beginning, she's been telling me this is not just a story about politics. It's a story about medicine.
About a new kind of treatment for a small group of kids. How it came to be. Who it was meant to help. How that was codified into a protocol that spread around the world. and how, in the time since, the medicine and the politics have become impossibly entangled. From the New York Times, I'm Austin Mitchell. This is The Protocol with Azeem Qureshi. Part One. The Beginning.
Okay, so where does this story start then in your mind?
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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Chapter 4: How did the Netherlands lead in gender treatments?
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 cancer. 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.
This is for adults. For adults. Yeah. Yeah. Because children were no way that anyone would do something with children.
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Chapter 5: What was the significance of puberty blockers?
And what Peggy realized when she saw him would transform the field of youth gender medicine. He's now in his early 50s, and his role in the history of this care has been closely protected. But he did agree to tell us his story.
So we're coming up on this number.
And that's how we found ourselves on a quiet street in a European city we've agreed not to name, to meet with the first person ever given puberty blockers to treat gender dysphoria. Dodging the dog, we stepped into a bright upper floor apartment. I love these big windows.
I know, it's beautiful. The light is so nice.
The walls were covered in bookshelves, the floor was covered in dog toys, and there were cats, too, somewhere, we'd been told.
Can I get you coffee or tea or something?
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.
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Chapter 6: How did early medical interventions impact youth?
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: What personal stories shape the narrative of gender medicine?
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.
Yeah, that's quite smart. Then I was, now I'm not. And when I had a choice in the matter, I had my hair cut short.
i've never had it uh long again wow um and so i think i think my parents just thought i was a tomboy i was pretty uh rough and ready and uh rambunctious and i i tussled i fought all my friends were boys you know the usual cliche i did uh i played football blah blah did judo all these things but i was quite aggressive because i was very uh
And I guess in retrospect, very geared at proving myself as a, you know, so that we didn't have to go into the formalities. And this is who I am. And I was so overwhelming that people just had to deal with me. And half of them didn't even know if I was a boy or a girl. Right. And that was my protection. But I was not unhappy when I was little.
You weren't unhappy, but was it an expression of frustration or was it more just an assertion?
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Chapter 8: What are the current debates surrounding transgender rights?
I was really worried about what was happening, what was going to happen, because I could see it around me. And I was... Puberty. Puberty, yeah. And that was something that I voiced to my parents in the usual prepubescent, adolescent, ridiculous, soppy way of writing poems. and leaving notes, hoping that they'd read them.
And then so my mum found one of these really pathetic poems, which clearly I'd left there. And then she addressed it and she... Do you remember kind of like what the poem said? It was along the lines of, you know, if I can just lay down my sword and blah, blah, blah. It was about battling this life and not being able to see a way out.
And I think it was like with the undertone of suicide, but it wasn't at all. It wasn't at all. I can't remember the exact, but I think I blocked it from my memory. Except that was the general sense of it. I was feeling hopeless and desperate and blah, blah, blah, blah.
The first case report on FG treated this note with significance. Peggy, still using female pronouns to refer to FG in the report, wrote, When she was 12, her mother found a suicidal note telling that she did not want to live any longer if she would enter puberty.
Did your mom... react in the way that you wanted, which is together.
Yeah, yeah, because she took it very seriously. And also my aunt, bless her, who did nothing but lie in bed and read, but read a lot. She happened to have just read a book on transsexuality. And she sent this to my mom. And for a couple of hours, she goes, don't you think that this might be what is the case? And I guess my mom thought, yes. So made an appointment with a psychologist.
And I started talking to her.
And so you were 12, so that would have been 86? Yeah. Was your body changing?
It was changing, but it was just like it was pre-pubescent. And I can't remember how long I was in conversation with this psychologist, but she put me on to Delamar, who sadly has passed away.
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