Thoughts on "The Protocol"

One PITT reader's reflections on how this NYT podcast might sway public opinion

The New York Times has yet again waded into the turbulent waters of gender, this time with a six-part podcast called The Protocol. Per The Times, the podcast explores the story of medical treatment for transgender young people — how the care began, the lives it changed, and the legal and political fights that could end it in the United States.

They’re off to a good start at least, in that they didn’t refer to it as “gender affirming care”, which is a clear tip off on where anyone stands on this issue.

Reviews of the podcast are mixed. In her Substack “gender:hacked” and on the Informed Dissent podcast here and here, Eliza Mondegreen refers to it as a failure. On the other hand, Benjamin Ryan on X writes, “It’s good stuff and will make it very hard for all the haters to land punches.” So far the series itself has only 75 comments. Perhaps listeners aren’t used to leaving comments on a podcast. They run the gamut from listeners claiming the coverage is “harmful” to others thanking the Times for elevating so many different voices on the topic.

Following, one PITT reader gives reflections of the Podcast…

The first episode profiles a female they refer to as “FG”, who was the first patient to be put on puberty blockers and participate in what would come to be known as the Dutch Protocol. FG didn’t want anyone to know about her transition. But, if it was such a stellar experience, why would she be worried or care what others thought? Will podcast listeners hear the underlying pain or the shame of not being completely comfortable with the transition and, as a result, not wanting anyone to know about it?

FG had written a poem that seemed to have an undertone about suicide, but claims it wasn’t about suicide at all. This poem convinced FG’s mother to go along with allowing puberty blockers, because it made her fearful that FG might die by suicide. FG’s parents were not aware that she was also the first patient, a self-described guinea pig.

FG says, “I find that it’s gone a bit extreme to the other side, so it makes a laughingstock of what it’s really about, or at least it seems to be a fashion statement nowadays. It’s like in the 70’s you were a punker, in the 80’s you’re a punker too. You always… we have to fight against something… we need to… we are 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. It’s just taken over that role. And, for the group that is a pure proper transexuals, its flirting with pronouns and gender identity is insulting, because, like I said, we spend all our time trying to just fit in or be able to live the life that we feel we should have had. It’s not great help when you have people shouting from the barricades and trying to give you a different position, or a third sex, or whatever, and then talk about things we don’t want to talk about so they can identify you…I don’t take a lot of these people seriously because it does seem to be a bit of a fashion statement”.

Referring to FG, the Dutch Protocol founder Peggy Cohen-Kettenis explained, “Because of him, we thought maybe we should do this more often, giving the blocking hormones”. Viewing FG’s transformational treatment as a success, Cohen-Kettenis thought more kids could benefit from puberty blockers, claiming that the benefits were two-fold: they could prevent young bodies from growing in an undesired direction, and they could buy time for kids to consider if they wanted to proceed to the next step in gender reassignment. She believed in the idea that puberty blockers would give kids time to think, but, in order to expand the treatment to more kids, Cohen-Kettenis felt they needed a “process”. This process would come to be known as the Dutch Protocol. She said it was a “very careful way to figure out who should have what kind of treatment to feel like they want to feel”. And, she believed, the critical part of the protocol was the process of assessing the kids to figure out who should receive medical intervention, namely which kids would benefit from it and not come to regret it.

The third episode describes how Laura Edwards-Leeper, an American psychologist, traveled to Holland to learn more about the Dutch Protocol. She brought it back to Boston which had the only gender reassignment clinic in U.S. She now reflects that, “There were more kids identifying as non-binary. Aside from that, the big things were the later onset of gender dysphoria with no childhood gender confusion… much more complex mental health presentations…. It was a new group of patients who often, didn’t often, fit the profile that the Dutch studied”. She noticed that as more and more clinics were opening in the U.S. to meet the demands of this new group of patients, the thinking on how best to treat them was changing too. The new directive was to follow the kids’ lead and to be supportive and to affirm and help get the parents on board.

Edwards-Leeper said the U.S. was changing how to treat these kids. That treatment “needed to be child led and treat as quickly as possible”. She modified the Dutch Protocol and didn’t spend as much time as Dutch clinicians making sure they got the “real trans” kids. But after other providers pushed less gate keeping, Edward’s-Leeper became concerned and believed there would be a backlash if things did not slow down. She also saw the rise of detransitioners.

Pediatrician Johanna Olsen-Kennedy at Children’s Hospital Los Angeles opposes gate-keeping altogether. She thinks therapy and a long assessment do more harm than good. “What happens when you require someone to be in therapy for a year but have no interest in that? That doesn’t make sense”, she says in the podcast. She claims that the “Dutch Protocol was outdated; that children should be believed what their gender was”. She talks about this care in life-or-death terms. She asks parents, “Would you rather have a dead son than an alive daughter?” When asked if children are old enough at 12- or 13-years old to make the decision if they want biological children, she replied, “They make the decision to kill themselves at 12 or 13”. Olsen-Kennedy’s streamlined model of care became the new standard, and was now called “Gender Affirming Care”.

What the podcast fails to mention is that Johanna Olson-Kennedy is on record stating that there should be no minimum age for a double mastectomy. The podcast doesn’t tell about the video of Olsen-Kennedy replying to the question, What if a girl later regrets her mastectomy? by saying, “If you want breasts at a later point in your life, you can go and get them.” It leaves out the part where she compares the “gender affirming care” she provides to that for diabetes, telling The Atlantic, “I don’t send someone to a therapist when I’m going to start them on insulin”. And it somehow overlooks that Dr Olson-Kennedy suppressed the publication of a $10 million taxpayer-funded study she ran which did not find any improvement in the mental health of children treated with puberty blockers. She claimed the findings would be “weaponized” to gate-keep the treatment. What are podcast listeners going to think when they find out that Olsen-Kennedy’s clinic has been shut down?

In the fourth episode, listeners hear whistleblower Jamie Reed’s claims that children are being harmed by gender affirming care and what this means for parents. The podcast quotes Jamie Reed saying that parents who affirmed their child’s transition “will be the people that will hold onto this the longest. The belief that they made the right choice for their kids the longest. They wrapped their kids into something and they’re going to be the ones that will never let this go. There will never be a period where they will not personally probably hate every single individual who’s publicly stood in opposition to these interventions”. Although not mentioned in the podcast, this same sentiment is expressed by Helen Joyce in an interview with Peter Boghossian. Helen Joyce discusses how the parents of transgender children will never be able to face what they have done so they will never not support the affirmation model. This is why the affirming mother in the Podcast is upset with Jamie Reed, because she can never admit she harmed her child.

In the fifth episode, Dr. Hilary Cass, one of England’s top pediatricians and author of the famous Cass Review, says, “It doesn’t really make sense to have such a dramatic increase in numbers that has been really exponentially… that has happened in a really narrow time frame across the world. Social exception doesn’t happen in that way so dramatically.” Dr. Cass explains how hard growing up is today, with social media, pornography and being online possibly contributing to children’s distress around their bodies. She says, “A girl in early puberty who is maybe struggling with sexual identity, who may have been anxious about…early access to pornography, doesn’t fit in socially, doesn’t feel they’re meeting the social media stereotypes expected of girls and puberty, feels hideous. Then someone stops the puberty. You may feel a huge sense of relief and a temporary improvement in your mental health just because you’ve taken that away, but is that necessarily the right pathway for addressing those things or are there other ways? We need to know what it is that you’re treating, and whether we are treating the normal anxieties of puberty in some of these young people. Yes, you can put someone on a medical pathway, but if at the end of it they can’t get out of their bedroom, they don’t have relationships, they are not in school or in work, you have not done the right thing by them”.

Dr. Marci Bowers, a trans-identified American gynecologist who specializes in gender-affirming surgeries, who is also the current president of WPATH, tries to push back on Dr. Cass in this episode. Bowers states, “How does she use an end point like ‘getting a job’ in a world that is discriminatory? How do you measure ‘get out of the house’ and call that the kind of scientific end point that we should be looking at? What about self reporting? This is what she won’t listen to.”

The podcast opens with this: “It’s only been about two decades since trans and gender non-conforming 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”. Justice Kavanaugh is quoted as saying, “If the treatment is 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 the court’s to choose which group”.

The last episode of the podcast closes with audio clips of affirming parents and happily transitioned kids, even though studies indicate regret does not kick in on average until 10.8 years after transitioning. The Times had requested audio clips from ALL impacted parties. Many parents sent in testimonials explaining how gender affirming care has been a nightmare for their children and their families; that their children are the subject of a massive medical experiment and that gender transition is the medical scandal of our lifetime.

None of these were aired.