The Daily - ‘The Protocol’: The Story Behind Medical Care for Transgender Kids

Episode Date: June 6, 2025

This episode contains strong language.Since 2021, nearly half the states in the U.S. have passed bans on medical treatments for transgender minors. The Trump administration is now targeting the care, and in the coming weeks, the Supreme Court is expected to weigh in.Against that backdrop, “The Daily” is running the first episode of a six-part series from NYT Audio about the story of youth gender medicine — where it came from, whom it was meant to help, and what may come next in the legal and political fights over its future.It starts in the Netherlands, with a clinical psychologist and a 16 year-old who was determined to go through life as the gender he had long felt he was.Guests: Azeen Ghorayshi is a reporter for The New York Times covering the intersection of sex, gender and science. Austin Mitchell is a supervising audio producer for The New York Times.You can find all six episodes of “The Protocol,” along with additional reading material, at nytimes.com/theprotocol.For more information on today’s episode, visit nytimes.com/thedaily. Transcripts of each episode will be made available by the next workday. Unlock full access to New York Times podcasts and explore everything from politics to pop culture. Subscribe today at nytimes.com/podcasts or on Apple Podcasts and Spotify.

From the New York Times, I'm Michael Balbaro. Today, the first episode of our new series, The Protocol. 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. How has this impacted us? Well, it was already not a safe place. But now we feel like

asylum seekers in our own country. 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? have the right to abuse your kids. This is cutting off their dignity. 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 human! And we will never be eradicated! Um, so are you going to be able to bring that inside? No. I don't think so. No. We're going to leave it out here.

This is a story of how we got here. That's why I wonder if they're going to even let our phones in. 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. We have so much ground to cover with her. And from the beginning, she's been telling me this is not just a story about politics.

Just getting into the history and... It's a story about medicine, about a new kind of treatment for a small group of kids. We are going to the outpatient... 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 you know, when these kids are actually beginning to interact with the medical community, there's actually a really clear beginning. 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. So at the time, the mainstream medical establishment

really viewed trans people with a lot of suspicion. You know, 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, you know, being mentally disturbed or sexually deviant or even psychotic. And so if they got any healthcare 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... 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 transmedicine that talks about this one second. It says that 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. characteristics and they also perform surgeries. And so by the 1980s, as these treatments were becoming a little less fringe, a clinical

psychologist named Peggy Cohen-Ketness 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. 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. And at the same time that Peggy was doing this research, she also had a clinical practice.

So when people heard that I knew something about transgender people, I got referrals for adults mainly, but occasionally there was also an older adolescent among them. 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. These kids already had a lot of mental health care. They're functioning quite well. But because they weren't 18, they couldn't get treatment.

Right. And I thought, that is a bit silly. For years and years, they very well know what they want. But because they don't have the right age, they have to wait. And 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. 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. So she went to the lead endocrinologist overseeing hormone treatments for trans adults in the Netherlands. Couldn't we do something about that age limit? And he said, OK, we can start it a little bit earlier. 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. 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 needle puberty before it had fully set in.

And so what Peggy was realizing was that puberty was this incredibly critical period in these patients' lives. Mm-hmm. Right. A turning point. Yeah. And their development, I mean, they're going through these 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. The first 14 or 15-year-olds, and then an occasional 12-year-old. 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 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. 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. And just as Peggy was starting to recognize the significance of this moment for her patients, And then I came across FG. That's when a kid walked into her office and offered an unexpected solution. In 1990, a 16-year-old kid showed up at Peggy's office.

In like our early emails we had talked about what his comfort level was with his voice even appearing in this. His voice. He knows I'm recording, right? He knows you're recording. 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. And that's how we found ourselves on a quiet street in a European city we've agreed not to name Hello! Hi! Perfect! Hi! Nice to meet you. to meet with the first person ever given puberty blockers to treat gender dysphoria. Do you mind if I put shoes on? Yeah, oh yeah, yeah. 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. 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. 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. I spent my whole life being covert and... Right, yeah.

What is your... Like, do you share with people in your professional space and your... No, I don't. You're just a man in the world. I try to get away with the murder. I literally don't tell people that knew me before my transition. So they don't know that you played this... Seminal role. Do you feel like you played a

seminal role? I did. Yeah, you did. Yeah, 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, like people close to you know. 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 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. 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. I think that was just to show that I'd managed to achieve some kind of level of profession, which is not completely stupid.

No, but there is this coded, like, well, did he turn out okay? Like, did he succeed in life? If I was some loser, then that would be another thing they could hitch to the bandwagon. I mean, I could be a loser anyway, regardless. I know many normal, like, cis people that are complete losers. So it's actually more than...

But I don't... No, no, sorry. Maybe to start, tell me a little bit about just your life growing up like early childhood. My mother was English because she died. My father's Italian and they're quite, well, I think my mother was more liberal than my father because he came from a small village and he's Italian. You probably read that in the case report as well. But you know, I had

a more or less, I had a pretty happy childhood, but I was very, I was very aware of my frustrations, which at the time I didn't see as frustrations, I just didn't understand. I just assumed that would sort itself out. When you say frustrations and sort itself out, you mean sort of the things that you were drawn to or the people you were drawn to, like what? Well, in the sense that being a boy or a girl. 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, I had to wear like a like a dress thing and I put a safety pin in between because I wanted to they wanted to be like knickerbockers and Yeah, yeah, exactly, that's why am I wearing why am I wearing a dress Yeah, that's quite smart then I was no, I'm not but and When I had a choice in the matter, I had my hair cut short. I've never had it long again.

Wow. And so I think my friends just thought I was a tomboy. I was pretty rough and ready and rambunctious. And I tussled, I fought. All my friends were boys. You know, the usual cliché. I did, I played football, blah,ah blah did judo all these things, but I was quite aggressive because I was very

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 as I 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 girl. 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? Up until about nine or ten, it was an assertion. Eleven. Up until then I thought, there was an assertion, eleven. Up until then I thought, oh, I'll still work out, I'll still work out, one day I'll wake up, it'll be fine. And then as I hit twelve, thirteen and puberty started to set in, I started to get really worried because then I was so aware of that, hmm, this is probably not going to work out how I want it to be.

And it's not going to just disappear. Yeah. And my parents up until then had been pretty good, especially my mum. I was very close to my mum, which put a little strain on the relationship with my dad because he was also quite jealous and I think he didn't really understand. So then we would often sit around the table and have massive arguments, which is also quite Italian, so it's very emotional. And it wasn't until I was 11 or 12 and then I started to become

really anxious, which just I think translated to being even more aggressive, even more difficult and demanding and opinionated and axes to grind. And then... Were you angry? Yeah, I was angry. But like I said, that made me you know, at school, I talked with my fists. I also talked with my mouth because it was so very argumentative. But I wouldn't tolerate anything. And if anyone said anything to me that I didn't like, I'd

smack them. But I would always smack people that were bigger than me. Which wasn't very down. Exactly. Which wasn't very difficult because I was small anyway. But no, I was quite I was quite explosive, which wasn't very difficult because I was small anyway, but no, I was quite explosive. And your friends, you said they were mostly boys? Yeah. And do you have any memory of anything about your gender coming up with them or did they just accept you as you were? It did, well it came up, and I don't know what happened behind my back, I don't care. I certainly didn't hear that. But you know, there was a point, when I was 12, I met a girl.

She was in my class. And she was also a bit of a tomboy. And we became very close very quickly. And it was at that time that the gym lessons were separated to boys and girls. So the very first gym lesson where we had to do it, I was there with this person. And I felt such resistance, it felt wrong. I said, I'm not doing this, I'm not doing this. She said, no, I don't want to do it either. And so I went to the,

I said, I want Jim on the other side. And they went, okay. And ever since then I always did Jim with the boys, but so did she. And at the time we both decided that we were boys. And I was convinced that she was the same. And she just turned out to be quite a butch lesbian. But we didn't think anything of it. We didn't feel foolish about doing that. And so it became, I think half of the people were just confused at that point. They're like, what is this?

What are they? But it is interesting thinking about that time and what you were saying about your anxiety increasing, that 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? Yeah. 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 read them. And then so my mum found one of these really pathetic poems and 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...

Something like, 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? 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 mum and in a couple of hours she goes, don't you think that this might be what is the case? And I guess my mum 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 De La Mar, who sadly has passed away. In that first report, Peggy explained the events that led up to FG showing up at her office. He had been to see a prominent endocrinologist named Henrietta De La Mar van de Waal.

She specialized in kids with issues relating to puberty. Some of these kids had what's called precocious puberty, where it started too early, like seven or eight years old. And the treatment that Henrietta would give these kids was a monthly injection of a drug that would stop that from happening by blocking the release of the hormones that trigger puberty. A puberty blocker.

And when she eventually stopped giving the drug to these kids, puberty would proceed as normal. So I went to see her, didn't have a clue who she was. And she listened to my case, I think Louis Hordens came into it as well, who's also just died. And yeah, yeah, he was the father of the whole gender team. For adults, right? Yeah, yeah, he was the father of the whole gender team for adults, right? Yeah, yeah, yeah, I like basically was a pioneer worldwide for adult care. Exactly. Exactly So they evaluated me and then they decided

That I would be a good candidate No, they well, I was the first to put on blockers. Did they come up with the idea in response to meeting you? Is that your sense? Yes, that is my sense. Only because I was the first and because I was so convincing. And I'm not sure if the conversation had come up that, well, normally what we do is you put your, when you're 16 or seven,

because I think that was when they started putting you at the youngest age, you could put your hormones in. And I was like, no, I'm not doing it. Why can't we just, but I think I probably said that, why can't we just pause it now and just let me be? So yeah, I just wanted to wake up and that's what I said.

I just want to wake up and I want to, it had been that I was born a boy, full stop, so that my history was congruent with that narrative. I didn't want to have to explain myself because that made me feel weak in hindsight. It made me vulnerable. And my whole life I was not about being vulnerable. So yeah, in a nutshell, that was probably, I just analyzed it. That's probably what it was.

And so they said they took me seriously and I think they said, well, this is such a bloody convincing case. Great idea to experiment with this child. My parents were behind it. They were? Yeah. So I mean you used the word guinea pig earlier. Were they aware? Don't think so. You don't think they were aware it was the first? Yeah. You were the first? Yeah. No I don't think I was aware that was the first. Really? Oh wow. Okay. But. But it wasn't completely new because these tormos blockers were being given to kids that were

entering precocious puberty and in the East block countries for gymnasts, but we don't talk about that. So there is some kind of data there. Or at least clinical experience. Exactly. Peggy's report was matter of fact in talking about the significance of this moment. She simply wrote that the case is the first we know of in which a young person struggling with their gender had been given this drug.

The report doesn't note the unexpected way in which it had come about. With a doctor who hadn't even been working with trans kids. Henrietta De La Mar Vandewaal died in 2014, but her husband told us that he doesn't think she saw this as some revolutionary act. This was a drug she was already using with her other patients, she understood the side effects, she saw a kid who was really hurting, and after consulting her patients, she understood the side effects. She saw a kid who was really hurting, and after consulting her colleagues, she decided that this might help. He doesn't think that she had any idea really how transformational this would turn out to be, to use this drug

in this whole new way with FG. Do you think that would have scared you out of it? No, because there was no alternative. It was sort of irrelevant. Yeah, otherwise I'm leaving this world, which I wasn't, but it was that kind of... That feeling was there. It was like there's no choice. We have to do something.

This is not okay. I'm not doing this. I was like, put my foot down. No, I could be very pigheaded. So not okay I'm not doing this. I just put my foot down. No, I could be very pig-headed. So no I'm not doing it. No, no, no, no. So puberty that was. I mean it literally saved my life. So I feel indebted. So, sorry, so you started the blockers at 12? Yeah, 12 or 13. Do you remember like the first time getting it? Yeah, I do. It hurt.

Because you injected it into a muscle. And because I was also so body critical, I didn't want to inject it into my bum, which is the much better option. So I had it done in my leg the first time and it hurt like a motherfucker. And had you met Peggy? No, yeah, no. I met her, I think I got into conversations with her when I was about 16. When he was 16, FG was referred to Peggy's office. He had been on blockers for several years and during that time he had remained certain about his desire to transition, to live as a boy. So the next step would be to go off the blockers and onto hormones, in his case testosterone,

a step that was only available because Peggy and Louis had lowered the age from 18 to 16. But the report noted that his parents were, quote, not happy with the idea of sex reassignment, and that for FG, the prospect of being forced to resume female puberty was creating so much distress that ultimately his general practitioner sent his family to Peggy. Yeah, I had to do a lot of psychometric and psychological testing anyway at various points to Peggy. Once he started seeing Peggy, he underwent several assessments. Peggy talked in her report about the results of his IQ test, his personality tests, a Rorschach test.

She mentioned he went through several therapy sessions and so did his family, and he also attended group therapy sessions with peers. When she concluded that there were no psychological issues that might interfere with his decision, she recommended he begin hormone treatment. And then I decided I didn't want to go onto them until I finished school. Okay. Because I didn't want to have to explain myself. Now I just, I'd frozen time. And if I went onto hormones, which is very paradoxical because on the one hand, all I wanted to do is go into male hormones. I just didn't want to have to explain it to people.

Right. Because again, it would make me vulnerable. Why do I have to explain myself to you? You mean nothing to me. Well, they did, but you know what I mean. It just puts you in a very vulnerable position. I'll never know how it would have been if I said, hello, well, this is what's going to happen.

Stand up in class like out yourself. I don't want to do that. I never wanted to do that. So I chose not to. And maybe that's my own little hangup, but that's just pretty much so I chose not to. And maybe that's my own little hang up, but that's just pretty much how I went through life. For FG, the pain he was feeling was similar to what Peggy had seen with her adult patients. It wasn't just that he felt he was in the wrong body, it was also that

the world saw him as something he felt he wasn't. Peggy noted this in her report. She said that the idea that people around him would see him as someone who used to be a girl but was now a boy was, quote, shameful. So rather than go through this transition in front of his classmates, F.G. decided to stay on the blockers in extra two years, meaning his body essentially remained frozen in his thirteen-year-old state until he was eighteen. Then, after high school, he took a year off to begin hormone treatments and go through male puberty as privately as he could.

I think that was a bit stressful to be fair because you have this underlying stress, stress with phones because you'd answer and you didn't want to be considered a fair because you have this underlying stress, I stress with phones, because you'd answer and you didn't want to be considered a woman because you had a high voice, but at the same time, so that always stressed me out, especially as your voice started to change, it just became difficult because, well, how are they addressing you now?

So you're always thinking about those things plus toilets. Even going to the clinic to get his hormone treatments was a stressful experience. I spent my whole time just sneaking in. I felt I didn't want people to point me out as, oh, that's somebody that's going to this. I just didn't want to be seen. After a year on testosterone, he was ready to start university as a man. But there is still that transition of old life, new life, who am I going to run into, what do I have to say? Even at university, I ran into people that were from my school.

And I remember the one thing I said, I met this guy and he was a year below me. And of course he knew who I was. And he goes, oh blah blah blah. And my voice is lower and I went, oh by the way, one thing, don't say she to me. And that was the only thing I said to him and that was it. We never talked about it again. But there were a few dice situations with somebody else

that was, it's amazing how small the world is that some things got back to other people and they confronted me with it and I just laughed it off and pretended that I, even though I made it ridiculous, It's amazing how small the world is, that some things got back to other people and they confronted me with it and I just laughed it off and pretended that I made it ridiculous because I said, oh, what, you think I want to be a girl? I just turned around, these people were so confused that they dropped it. But that was pretty, you're always in the back of your mind, you're always worried about these things,

especially then, because why do I want people to view me differently? That's my whole thing. Then people start to look at you differently. I'm like, no, that's exactly what I don't want people to do. Or feel that they have a special bond with, because they know something about me, which at the same time, it's okay, but at the same time, by saying that, you're saying it's a weakness. That's what you're saying,

and they can use it against you whenever they like, even though it's like faulting me for being small, which people still do. It's still used as a weakness. Like, it's not my fault, I'm small. What do you want me to do about it? It's not something that me for being small, which people still do. You know, it's still used as a weakness. Like, it's not my fault. I'm small. What do you want me to do about it? It's not something that I'm responsible. I'm responsible. But how smart I am, what I've done with my life. So you're the loser.

But but but not about how how I was born into a body that didn't belong to my mindset. And the only thing I can do is deal with it and be successful in it. Right then, one of FG's cats fell off a window ledge. No, so anyway, I have a lot to say about it, but then I'm saying, fuck off, I don't feel like it. Why do I even have to have these thought processes? I've already got my defense ready if it ever came up because no, I will not be treated in a different way or have the idea that you feel superior because, oh, poor you.

Fuck off. That hasn't actually happened, but just to give you an idea of how my mind works. What you went through as an adolescent is still with you. Oh, absolutely. And that's what's formed me. And that's why I said I never see myself as a victim, but I do feel that I should get some credit for something, but obviously I can't because then I'd have see myself as a victim, but I do feel that I should get some credit for something, but obviously I can't because then I'd have to put myself out as a victim.

But you know, it is a big deal. It's like, oh, you know, be the martyr. You know, my first year at university, I had three operations, nobody knew about it. And I completed my first year with flying colors. And I didn't think anything of it. And then, you know, all the years to come, I had to, I was't think anything of it and then you know all the years to come I had I was in and out of hospital with with operations and you know even a complication where I had to rush myself off to hospital because I couldn't pee anymore and but nobody had a clue and then

I had to make a story around that and I thought god damn it I did all that yeah but I can't say that. Do you know what I mean? 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. 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 think it's a difficult question because I do know I have a very strong opinion on that, but that's my opinion because it's also fed by my own story. And I try to make the distinction between coming from that particular narrative and being narrow-minded. My conclusion now is that I find that it's gone a bit extreme to the other side. So it makes a laughing stock of what it's really about, or at least it seems to be a fashion statement nowadays. And it's like when you were in the 70s, you were a punker, you know, in the 80s you were a punker too. We always have to fight against something,

we need to, we're forging our identities as young people, so we need to stand out, we need to fight against something. We need to, we're forging our identities as young people. So we need to stand out. We need to have an opinion against the given society because that's our rite of passage. And it feels like this has become another forum for that, that it's just taken over that role. And for the group that is pure, like, proper transsexuals, this flirting with pronouns and gender identity is insulting. Because

like I said, we spend all our time trying to just fit in or, you know, or be able to live the life that we feel we should have had. And it's not great help when you've got people shouting from the barricades and trying to give you a different position, a third sex or whatever, and then talk about things that we don't want you to talk about so that they can identify you. But maybe that's my own, I'm still stuck in my own paradigm. And maybe that shouldn't be a taboo. Maybe we should break it open. And I don't know. That's not how I feel. But I can intellectually, I have to think about that.

Right. But I don't take a lot of these people that seriously, because it does seem to be a bit of a fashion statement. It's just interesting to me because you were once an adolescent who adults chose to take seriously. Yeah. who adults chose to take seriously. Yeah. So this is how it all started.

With a kid who only ever wanted to wake up and have it be that he was born a boy, and to never have to explain himself to anyone. He wasn't the first kid to feel that way, but through some combination of his conviction, the place and time, and the doctors who took him seriously, he was the first kid to get this revolutionary medical intervention. FG was 24 years old when Peggy published her first case report on him. It was 11 years after he'd started blockers and 6 years after he'd begun hormones and had his first surgery. Peggy wrote that F.G.

reported no gender dysphoria at all. He said that he had found the adjustment to the male role to be very easy and expressed no doubts on the adequacy of his masculine behavior. He never felt any regrets about his decision and had never contemplated to live as a girl again. In conclusion, Peggy said, for certain selected cases with a lifelong, consistent and extreme gender identity disorder, delaying puberty may be a physical and psychological beneficial way to intervene.

Because of FG, Peggy thought that more kids could benefit from what had clearly been a transformational treatment for him. And she thought that the benefits of puberty blockers were twofold. They could prevent young bodies from growing in an undesired direction. They also made it possible for kids to consider, without that stress, whether they wanted to go on to the next steps, which would be irreversible. She felt the blockers would give kids time to think. But to give this time to think. But to give this treatment to more kids, Peggy felt they needed a process.

She began to codify a protocol, what would come to be known as the Dutch protocol. How would you define the Dutch protocol? Well, I think as a very careful way to figure out who should have what kind of treatment to feel like they want to feel. And the critical part of that protocol was a process for assessing the kids to figure out who should receive medical intervention. Which kids would benefit from it and not come to regret it. Because we didn't want to have all kinds of disasters right from the beginning.

But in much of these decisions, knowing the kids was very helpful. You just see what's happening. Look at FG. If you see how well they are doing, you know, it could not be completely wrong. It's just that exactly what you have to do with what kid, that's exactly what you have to do with what kid.

That's the challenge. In the early 2000s, Peggy moved her work to Amsterdam, to the biggest transgender medical program in the country. And she started to put together a team of mental health providers to assess and treat the kids coming into the clinic, including a psychiatrist named Analu De Vries. And what happened next would explain how this care that started almost by accident with

this one kid would quickly spread around the world. That's next time in part two. Special thanks for this episode to Emily Bazelon and Alex Bakker. The Protocol is a six-part series from the Times. That was part one. You can hear the rest of the series right now. Go to wherever you listen to podcasts and search for The Protocol. We'll be right back with the headlines. Here's what else you need to know today.

The political partnership between President Trump and Elon Musk appeared to implode in real time on Thursday, as the two men traded a series of increasingly acrimonious insults and threats. What had started as a spat over Trump's big domestic policy bill, which Musk opposes as too expensive, mushroomed into squabbles about which man deserves credit for Trump's election victory, and recriminations over Trump's decision last week to drop his support for a Musk ally who had been nominated to run NASA. Then came the threats.

Trump questioned whether the federal government should cut billions of dollars in contracts to Musk's companies, and Musk seemed to approve of calls that Trump be impeached. Look, Elon and I had a great relationship. I don't know if we're well anymore. I was surprised because... During a news conference in the Oval Office, Trump acknowledged the rupture. And I'll tell you, he's not the first.

People leave my administration and they love us. And then at some point, they miss it so badly and some of them embrace it and some of them actually become hostile. I don't know what it is it's sort of Trump derangement syndrome I guess they call it but... And Trump suggested that since Musk had stepped away from his administration he had turned anti Trump because he missed the limelight. We have it with others too. They leave and they wake up in the morning and the glamour's gone, the whole world is different and they become hostile. I don't know what it is.

Someday you'll write a book about it and you'll understand. That's it for The Daily. I'm Michael Boborio. See you on Monday.