What "The Protocol" Got Wrong, Left Out, and Misrepresented

The wrong bad guys, the wrong victims

Many of us who write about gender issues waited with bated breath for “The Protocol,” The New York Times’ six-part podcast on youth gender medicine. Two years in the making, it promised to tell the origin story of what we now call “gender-affirming care”—and how we came to be waging political battles over it. I was especially interested, as I’m writing a book about that very topic.

Science reporter Azeen Ghorayshi and audio producer Austin Mitchell succeeded somewhat at that first part of their mission. They showcased the first person ever prescribed puberty blockers for gender dysphoria as a minor—an experiment Dutch clinicians devised in the early 1990s. Patient zero, known as FG, then progressed to cross-sex hormones and surgeries—a mastectomy and some kind of “bottom surgery” that wasn’t identified, but apparently landed FG in the hospital because he couldn’t pee.

Blockers at the onset of puberty, followed by hormones and surgeries for those who wanted them, became known as the “Dutch protocol.” The podcast asserts that the Dutch knew how to discern which kids truly needed these medical interventions and which did not. It’s based on the premise that some kids are born in the wrong body.

The problem, according to them, emerges when that protocol migrates to America. The first US pediatric gender clinic opened in Boston in 2007. Its part-time psychologist, Dr. Laura Edwards-Leeper, spent a mere week in the Netherlands learning how to assess kids, to weed out those who might be suffering from other problems that could conceivably present as gender dysphoria, like internalized homophobia or trauma after sexual assault. That would onstensibly ensure that only those who’d be certain to benefit from treatment partook of the protocol.

Putting aside for a minute the questions about whether kids are born in the wrong body, and whether these interventions were “needed,” let’s continue with how The Protocol frames the story—because this part I agree with, and it’s chronicled in my project, too.

It was impossible to replicate the Dutch approach in the US. They had robust, government-funded healthcare. Americans did not. Our unregulated, consumer-oriented medical system—if we can call it a system—never allowed for the same kind of evaluation and oversight. Then, the protocol, and the system, intersected with activist clinicians like Johanna Olson-Kennedy, who saw children’s medical gender transition as a right—as opposed to a medical solution to emotional distress.

Olson-Kennedy, and other affirming doctors like her, insisted that kids knew their own gender, and that clinicians’ job was to follow their lead, to help them change their bodies to match their minds. Any attempt to limit these interventions was “gatekeeping”—which supposedly increased the suicide risk.

Indeed, the justification for child-led gender medicine, as well as the justification for FG’s initial experimental treatment, is the specter of suicide. Affirming doctors in the podcast invoke what many kids and parents have heard: the choice between a living trans child or a dead cisgender one. The first paper published about FG reads: “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.”

So I was astonished to learn from FG himself that he in fact left a brooding poem for his mother, not a suicide note. He was not in any danger of taking his own life, but that’s just glossed over in the podcast.

The most important point about suicide that we don’t learn from The Protocol is that the Dutch had started working with kids because the adult trans people themselves were suicidal after transition. They didn’t turn to kids because transition worked well for adults, but because it didn’t. The assumption was that if doctors interfered before puberty, especially with natal males, these young people would grow up to pass as the opposite sex. They would no longer be gender nonconforming teens, but grow to be gender conforming adults. They would also be straight; almost every kid in the original Dutch studies was same-sex attracted, hence many gay adults asserting that transition is a form of conversion therapy.

By episode four, we learned that the guardrails were fully off, and a whistleblower emerged from a youth gender clinic in St. Louis: Jamie Reed. With her asymmetrical haircut, tattoos, and even a trans husband, Reed came with a lot of queer credibility. She had witnessed doctors caught between the two sides: the assessment-based American version of the protocol, and the affirmative model, which put children in the doctor’s lab coat. Reed, like many others around the world, saw the kind of patient seeking interventions—mastectomies, estrogens, blockers—change drastically. And she saw that they weren’t properly evaluated before getting them. She saw that she was participating in hurting children.

Eventually, Reed testified in favor of banning gender-affirming care for youth. The Times reporters make it seem not only that Reed was single-handedly responsible for the cascade of bills that would limit these medicines, but that she did so despite it hurting her own trans husband. That is, there’s a “third” side: the evil-doers banning gender-affirming care, punishing the many who need it to save the few who didn’t. Reed functions as a proxy for Republicans who pushed these bills, as if the reporters didn’t want to catch cooties by actually talking to any of them.

That Reed—with whom I do a podcast—is portrayed as the foil to Olson-Kennedy surprised and disappointed me, because it’s not happy trans kids versus evil Reed, angling to take their care away. It’s happy trans kids versus detransitioners, who went through these medical procedures and realized that they had been both emotionally and physically harmed. It’s happy trans kids versus desisters, who also feel harmed, and families that lost custody of kids or whose relationships were damaged by the insistence that a lack of affirmation equals harm.

We don’t hear a single word from any of those people. This is an egregious error. There are plenty of lawsuits by detransitioners out there, and a subreddit with thousands of them. They are easy to find, but, as usual, The New York Times didn’t give them a platform. Nor did they mention that Reed’s trans husband has now very publicly detransitioned, and supports her work on regulating youth gender medicine for kids.

Take that in for a minute. They took two years to do a podcast on the youth gender culture war, and didn’t feature a single young person hurt by it. They didn’t feature a single young person who lost body parts only to find out later that they were just gay, or autistic, or depressed. I’m sorry. I was willing to give this podcast a chance—grateful, even, that finally the Times-worshipping people in my neighborhood would understand the issue better. But they won’t.

In fact, they won’t learn what I think is the most important aspect of this culture war, because the podcast fails in the second part of its mission, to explain how we came to be fighting over it. It’s not because Jamie Reed testified against it. It’s because Democrats refused to regulate it. They refused to admit that there were problems, insisting that any objections—no matter the liberal credentials of those who raised them—were right-wing fear-mongering. Republicans filled a regulatory vacuum that we—liberals, the Left, Dems—created. We handed the issue to them on a silver platter.

Not only did they say thank you very much and take it up—and use it for massive political gain—but they invited the disaffected liberals, lefties, feminists, and gay people to join them. Many did.

Why are we fighting over youth gender medicine? Because Democrats, and the liberals who run institutions and advocacy groups, failed us. Unfortunately, you won’t learn that from the podcast. But fortunately, you’ll learn that from my forthcoming book.

For more on The Protocol, see our podcast on the youth gender culture war, Informed Dissent.