The new treatment is codified into a protocol, and the Dutch publish a landmark study that launches the field of youth gender medicine. A former patient describes the benefit of early treatment in a society that is still hostile to trans people.
Chapter 1: What is the Dutch Protocol for youth gender treatment?
Dr. Annelu de Vries was one of the first people to join Peggy's new team at the Amsterdam Clinic. At the time, Peggy was still developing her set of rules for providing this new medical intervention to young people, what came to be known as the Dutch Protocol. Puberty blockers when puberty started, usually around 12, hormones as early as 16, and surgeries in adulthood.
And critically, the mental health assessments that were designed to help figure out which kids should get medical intervention.
Chapter 2: How are mental health assessments conducted for trans youth?
That assessment was several sessions over a longer period of time and actually really get to know the family, get to know the kids.
And how long typically would you say you spoke with them?
So it takes at least half a year. But what we say, we take the time we need. So you cannot pinpoint me on how much time we have.
Some kids might need more than that. And over time, as a growing number of kids were being referred to the clinic... It was obviously a radical new idea, a new option. What were sort of your concerns and questions you wanted to answer?
Well, yeah, of course we needed proof of the effectiveness of the treatment.
Analu started to study the kids they were treating.
What research had been published by 2003 when you started working with the group?
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Chapter 3: What evidence supports the use of puberty blockers?
There was the case publication. The FG case study? Yeah, yeah.
At that point, there wasn't any data to support using puberty blockers for kids with gender dysphoria. There was Peggy's case report on FG, but that was just an account of a single kid who had been given the blockers before the Dutch protocol even existed. There was no way to know how well they would work for other kids or what risks there might be.
So Analu set out to look at a group of patients who were getting the treatment at the clinic. What ended up being 70 patients over the course of the study.
That's the 2011 study.
The famous.
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Chapter 4: How did early treatment impact the lives of trans kids?
Yeah, well, that was the first one that did some evaluation of really the medical intervention. The Dutch protocol. The Dutch protocol.
The idea was to see how the kids were doing psychologically before they started puberty blockers and follow up with them over time to see how the blockers and then hormones and surgeries impacted their well-being and whether the kids they thought would benefit from the treatment actually were doing better. And what Analu found launched the field of youth gender medicine.
In general, I think people were sort of convinced, yeah, this is so clear-cut if you look at this. Yeah.
Analu got up and led us to her nearby office and dug around her shelves.
She pulled out an enormous coffee table book.
On the cover, it said, gender kinderen, gender kids.
So these were the very first children that were treated here. They called themselves gender kids. I have gender because the whole word gender identity disorder was too complicated. So they just said, I have gender.
Wow. Are these patients that you saw? Yes.
She flipped through. It was filled with full-page color photographs of some of the kids who took part in her research.
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Chapter 5: What role do family dynamics play in the transition process?
Yeah, and if there's anything that you're like, you don't want to be public or that... There are not a lot of people in Manon's life who know the role she played in Analu's study.
Have you ever talked to the media before?
Yeah, when I was a kid and with the book, but later I worked with a Dutch program.
But as one of the first kids to go through the Dutch protocol, she's had some experience with the media, including one where she said her full name was published without permission.
It happened that I had a new job and someone Googled me. Then I heard later that, oh, your video is going through the whole company. So that was very unsafe. That was not nice.
So we've agreed to use only her first name.
And I thought also I believe that if Analu speaks with you, then it's for me safe to also speak with you. Yeah, I did wonder.
I mean, I want to hear your whole life story, getting, you know, getting into everything, meeting Annelu. Yeah, yeah.
I can remember it was literally Wednesday afternoon, a few hours, and they were with a few colleagues, Peggy, Annelu, and the other doctor, and I think another few. So it was all very small, and I did realize I was a, yeah, how do you call it? Yeah, we say proofkunijn, a trial... A rabbit that they test makeup. Yeah, like where they test things on. So yeah, they have to test it on someone.
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Chapter 6: How do societal perceptions affect trans youth?
kids had to meet a certain set of criteria.
The first thing that was mentioned in all the papers was an early history of what at the time was called gender identity disorder.
So from a very young age, kids had to have a strong identification with the opposite sex, as well as a persistent discomfort with their sex at birth.
Always walking in my mom's clothes, wearing towels as skirts or long hair. I wanted to play with girls' stuff. And then, yeah, she always said, yeah, but you're a boy and you have a penis. And then I said, no, I'm not a boy, I'm a girl. and the penis will fall off. I always believed that.
Do you remember? Yeah, yeah, absolutely, yeah.
And I can also remember, I don't know if it's also in the USA, but like in Holland, if you don't close your zipper from your trousers, they say, ah, then it will fly away. So I always walked with my zipper open and I was so, yeah, convinced that... Yeah, something was wrong and it will get fixed. Then I came like the... Realization. Realization that it will not fall off or fly away.
Ah, shit, it's not going to fly off. And I am a boy, but I do not feel like one. And then I really did everything to be the best boy in the world. So I had like... this sharp hair and with the gel and very boy clothes. And I climbed trees and hit people and was fighting. And yeah, so my mom said, I saw that you were so struggling being a boy, literally.
So yeah, I can also remember the face that I was very... Yeah, really, really unhappy. Yeah, and that I really said that. I said, oh, I will cut it off. Then they have to help me. My parents were really scared that I would maybe hurt myself.
Were you, I mean, in terms of how your parents reacted, were they kind of steering you back towards boy things and trying to just...
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Chapter 7: What challenges do young trans individuals face in society?
Analu wrote that family support mattered because, quote, parents can play a significant role in creating an environment in which their child can grow up safely and develop optimally.
In Manon's case, her parents had started to let her dress as a girl when she was in elementary school. As soon as I came out of school, curtains, clothes, and then I changed. And I think I changed every day 10, 15 times.
You mean you had to just like put on different outfits?
Yeah. And also my dad said a while ago, like, you were looking in the mirror the whole day.
At first, just at home.
And then shortly after.
And then in public.
I said, I want to go to my friend. Her name was Brenda. And to show the new me.
That was like really my... Manon remembers going to her friend's house nearby. It was just on the other side of a playground where the neighborhood kids hung out.
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Chapter 8: What are the long-term outcomes of the Dutch Protocol?
In the beginning, it was only questions, questions, questions.
Oh, so the evaluations, assessments.
She wrote that the process was designed to track how a child's gender dysphoria developed over time.
How do you feel? How are you at school?
And to rule out any other psychological issues or things going on in their life that might be another explanation for their distress.
questions but my dad really can remember very well what really made impact on him a lot of children who are sexual abused like a small girl is abused they can also have these feelings that they prefer to be a boy with the feeling that oh if i were a boy the person did not abuse me or yeah
So, yeah, my dad really can remember that they asked me a few times different ways if I was all sexual abused, if my dad touched me strange or my granddad or... Yeah, and he thought that was really heavy. And also that he had meetings on his own together with my mother or my mother on her own. So... Yeah, he said sometimes it felt like an investigation on us as parents.
Yeah, I thought that was very, but worth it, of course. But I think it was, yeah, around one year that we, yeah, they got, we received like the diagnostization. The diagnosis? Yeah, the diagnosis, gender dysphoria. And then it was more like, okay, we just keep in touch. Mm-hmm.
At this point, Manon was a strong candidate for puberty blockers. She had felt gender dysphoria from a very early age. She had a supportive family. She didn't have any other psychological issues that needed to be addressed first. And crucially, as she approached puberty, her dysphoria was not going away.
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