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

Summary

The Protocol: The Story Behind Medical Care for Transgender Kids

Podcast: The Daily
Host/Author: The New York Times
Episode Title: The Protocol: The Story Behind Medical Care for Transgender Kids
Release Date: June 6, 2025
Duration: Approximately 45 minutes

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Introduction

In the inaugural episode of the six-part series The Protocol, hosted by Michael Barbaro, The Daily delves into the intricate and controversial world of medical care for transgender youth. This episode seeks to unravel the origins, developments, and current debates surrounding the treatment protocols for transgender children, particularly focusing on the use of puberty blockers and hormone therapies.

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Origins of Transgender Medical Care

The narrative begins with Azine Qureshi, a science and gender reporter, and her colleague Peggy Cohen Ketnes tracing the roots of transgender medical care back to the 1950s in the Netherlands. At that time, transgender individuals were largely misunderstood and often deemed mentally ill by the mainstream medical community. Peggy Cohen Ketnes highlights the shift in approach by pioneering doctors who began treating transgender patients with hormones and surgeries instead of solely relying on psychotherapy.

Notable Quote:

Peggy Cohen Ketnes (06:42): "These patients that were treated with psychotherapy languished, and that, quote, the majority were miserable, unhappy members of the community unless they committed suicide."

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The First Use of Puberty Blockers

A pivotal moment in transgender medical care emerged when Peggy collaborated with Henrietta Delamar Vandewall, an endocrinologist specializing in puberty issues. Together, they made a groundbreaking decision to administer puberty blockers to a 16-year-old patient, referred to as FG, marking the first known case of using such treatment for gender dysphoria in a minor.

FG's story is central to this episode. At twelve years old, FG expressed profound distress about his gender identity as puberty loomed. His family, particularly his mother, supported him after recognizing the signs of gender dysphoria.

Notable Quotes:

FG/Eric Kim (05:30): "I spent my whole life being, you know, covert and. And..."

FG/Eric Kim (26:19): "So puberty, that was. I mean, it literally saved my life."

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Developing the Dutch Protocol

Peggy Cohen Ketnes emphasizes the importance of creating a standardized process, which came to be known as the Dutch Protocol. This protocol was meticulously designed to assess which children would benefit most from medical interventions, ensuring that treatments like puberty blockers and hormone therapies were administered judiciously to minimize regrets and optimize psychological well-being.

Notable Quote:

Peggy Cohen Ketnes (43:27): "We cannot just start and do whatever we want, particularly in the beginning when you have no idea whether what you're doing is okay."

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Impact and Spread of the Protocol

The episode details how Peggy's work in Amsterdam in the early 2000s led to the establishment of the largest transgender medical program in the country. With a dedicated team, including mental health professionals like Anulu Devries, the protocol's success with FG encouraged its adoption worldwide. This expansion significantly influenced how transgender youth receive medical care today.

Notable Quote:

Azine Qureshi (44:41): "And what happened next would explain how this care that started almost by accident with this one kid would quickly spread around the world."

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FG’s Personal Journey

FG, now in his early fifties, shares his personal experiences, highlighting both the life-saving aspects and the enduring challenges he faces. His initial resistance to transitioning, driven by a desire to avoid vulnerability, underscores the complexities many transgender individuals navigate. FG discusses the physical pain of treatments, the psychological toll of maintaining secrecy, and the societal pressures that persist despite medical advancements.

Notable Quotes:

FG/Eric Kim (33:06): "I was like, put my foot down."

FG/Eric Kim (36:35): "I don't feel like ex. Why do I even have to have these thought processes?"

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Changing Perspectives and Current Debates

The discussion shifts to the evolving landscape of gender identity, contrasting FG's structured medical journey with contemporary movements that challenge traditional gender binaries. FG expresses concern that current trends may dilute the focused medical approach he experienced, turning gender identity into a broader cultural phenomenon rather than a medical necessity for those in genuine distress.

Notable Quote:

FG/Eric Kim (38:23): "I find that it's gone. It's like, gone a bit extreme to the other side. So it makes a laughing stock of what it's really about."

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Conclusions and Future Implications

Peggy Cohen Ketnes reflects on the enduring impact of FG's case, emphasizing the need for careful, individualized assessments in transgender medical care. The episode suggests that while the protocol laid a foundation for compassionate and effective treatment, ongoing debates and cultural shifts continue to shape its implementation and acceptance.

Notable Quote:

Peggy Cohen Ketnes (43:40): "Because exactly what you have to do with what kid, that's the challenge."

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Closing Remarks

The episode concludes with a teaser for the next installment in the series, promising to delve deeper into the continuing evolution of transgender medical care and the stories of those affected by these protocols.

Host’s Note:

Michael Barbaro (45:25): "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."

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Supporting Voices and Perspectives

Throughout the episode, interviews with key individuals like Peggy Cohen Ketnes and FG provide firsthand insights into the personal and professional challenges of pioneering transgender medical care. The inclusion of historical context and personal anecdotes enriches the narrative, offering listeners a comprehensive understanding of the subject.

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Key Takeaways

1. Historical Context: Transgender medical care has evolved significantly since the 1950s, shifting from a purely psychological approach to incorporating medical interventions.
2. Pioneering Efforts: The Dutch Protocol emerged as a structured method for treating transgender youth, primarily through the pioneering work of Peggy Cohen Ketnes and Henrietta Delamar Vandewall.
3. Personal Impact: FG’s story illustrates both the life-saving potential of medical interventions and the ongoing societal and personal challenges faced by transgender individuals.
4. Contemporary Debates: Current movements advocating for broader definitions of gender identity raise questions about the future and focus of transgender medical care.
5. Continued Evolution: The medical community continues to refine protocols to balance compassionate care with cautious, evidence-based practices.

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Conclusion

The Protocol: The Story Behind Medical Care for Transgender Kids offers a nuanced exploration of a deeply personal and socially significant topic. By intertwining historical developments with individual narratives, The Daily provides listeners with a thorough understanding of how medical protocols for transgender youth came to be and the ongoing debates that shape their future.

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For full access to this and other podcasts, subscribe at nytimes.com/podcasts, Apple Podcasts, or Spotify. To listen on the go, download the New York Times Audio app at nytimes.com/audioapp.

Transcript

[Eric Kim]

Hi, this is Eric Kim with New York Times Cooking. As a recipe developer, I spend a lot of my time trying to come up with dishes that are quick, easy, but also very special. For me, that means dishes like gochugaru salmon. It's a crispy salmon filet with a salty, sweet glaze that bubbles up in candies. I love cooking this because it only takes 20 minutes. You can get this recipe and so many more ideas on New York times cooking. Visit nytcooking.com to get inspired.

[Michael Balbaro]

From the New York Times, I'm Michael Balbaro. Today, the first episode of our new series, the Protocol.

[Donald Trump]

With a stroke of my pen on day one, we're going to stop the transgender lunacy.

[Eric Kim]

I am so hated for just existing.

[FG]

And being who I am.

[Donald Trump]

It will henceforth be the official policy of the United States government that there are only two genders, male and female.

[Eric Kim]

How has this impacted us? Well, it was already not a safe place, but now we feel like asylum seekers in our own country.

[Donald Trump]

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.

[FG]

Being able to transition absolutely saved my life.

[Azine Qureshi]

It's only been about two decades since trans and gender nonconforming kids in the US 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.

[FG]

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?

[Eric Kim]

You do not have the right to abuse your kids.

[Azine Qureshi]

This is cutting off their system. I am scared for myself, for my own health care. There's not enough evidence to put our children out on a huge experiment.

[Eric Kim]

If they cannot get treatment, children will die.

[Azine Qureshi]

These treatments do much more harm than good. Trans kids are under attack.

[FG]

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 transhuman, and we will never be eradicated. So are you going to be able to bring that inside?

[Azine Qureshi]

No, I don't think so.

[FG]

No.

[Azine Qureshi]

I'm going to leave it out here. This is a story of how we got here.

[FG]

I wonder if they're going to even let our phones in.

[Azine Qureshi]

It's a story I've Been reporting with my colleague Azine Gi, a science and gender reporter for nearly two years.

[FG]

See what they say. Okay.

[Eric Kim]

For now.

[Azine Qureshi]

And it's a story she's been reporting for much longer.

[FG]

We have so much ground to cover with her.

[Azine Qureshi]

And from the beginning, she's been telling me this is not just a story.

[FG]

About politics into the history.

[Azine Qureshi]

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 Azine Qureshi. Part one, the beginning. Okay, so where does this story start, then, in your mind?

[FG]

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.

[Azine Qureshi]

And those professionals would be trying to kind of convince these people that they.

[FG]

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 trans medicine that talks about this.

[Eric Kim]

One second.

[FG]

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.

[Peggy Cohen Ketnes]

Yeah, well, it started very long ago.

[FG]

And so by the 1980s, as these treatments were becoming a little less fringe.

[Peggy Cohen Ketnes]

I just had my Ph.D. and I.

[FG]

A clinical psychologist named Peggy Cohen Ketnes, started to research how these patients were.

[Peggy Cohen Ketnes]

Actually doing first follow up study in the Netherlands.

[FG]

This is for adults.

[Peggy Cohen Ketnes]

For adults, yeah.

[Eric Kim]

Yeah.

[Peggy Cohen Ketnes]

Because children were. No way that anyone would do something with children.

[FG]

And she found that, you know, while they were still struggling, 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. So I became involved, and at the same time that Peggy was doing this.

[Peggy Cohen Ketnes]

Research, but I was also a psychotherapist.

[FG]

She also had a clinical practice.

[Peggy Cohen Ketnes]

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.

[FG]

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 Pat, that they had felt they were in the wrong body for as long as they could remember.

[Peggy Cohen Ketnes]

These kids already had a lot of mental health care. They're functioning quite well, but because they.

[FG]

Weren'T 18, they couldn't get treatment right.

[Peggy Cohen Ketnes]

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.

[FG]

And, you know, 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.

[Peggy Cohen Ketnes]

Couldn't we do something about that age limit? And he said, okay, we can start it a little bit earlier.

[FG]

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 promising 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 natal 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.

[Azine Qureshi]

Right. A turning point.

[FG]

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.

[Peggy Cohen Ketnes]

Year olds and then an occasional 12.

[FG]

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.

[Peggy Cohen Ketnes]

But we said we don't, don't give.

[FG]

And just as Peggy was starting to recognize the significance of this moment for her patients.

[Peggy Cohen Ketnes]

And then I came across fg.

[FG]

That's when a kid walked into her office and offered an unexpected solution.

[Azine Qureshi]

I don't know exactly how will refer to him. In 1990, a 16 year old kid showed up at Peggy's office.

[FG]

In like our early emails, we had talked about what his comfort level was with his voice even appearing in this.

[Azine Qureshi]

His voice. He knows I'm recording, right?

[FG]

He knows you're recording.

[Azine Qureshi]

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 career has been closely protected. But he did agree to tell us.

[FG]

His story, so we're coming up on his number.

[Azine Qureshi]

And that's how we found ourselves on a quiet street in a European city we've agreed not to name.

[FG]

Hello.

[Eric Kim]

Hi. Perfect.

[FG]

Hi.

[Eric Kim]

Hi.

[FG]

Nice to meet you.

[Azine Qureshi]

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.

[FG]

I know, it's beautiful. The light is so nice.

[Azine Qureshi]

The walls were covered in bookshelves. The floor was covered in dog toys. And there were cats too. Somewhere we'd been told.

[Eric Kim]

Can I get you coffee or tea or something?

[FG]

Coffee, if you're gonna have something.

[Azine Qureshi]

He brought out some coffee, some pastries, and gestured to us to sit at the dining room table.

[FG]

And. And what is your comfort level with your name? We. FG is what we're sticking with. Yeah. Okay.

[Azine Qureshi]

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.

[Eric Kim]

And I spent my whole life being, you know, covert and. And.

[FG]

Right. So, yeah. What is your. Like, do you share with people in your professional space in your.

[Eric Kim]

No, I don't. I'm the best man in the world. I try to get away with a murder. I literally don't tell people that knew me when I was. Before my transition. No.

[FG]

So they don't know that you played this. Like, do you feel like you played a seminal role?

[Eric Kim]

I did, yeah. You did, yeah. That's one of my bragging rights. Right. I was the first person, so I was like the guinea pig.

[FG]

So some people do know that, like people close to me.

[Eric Kim]

No, no, the people that 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, you know, it's something that. There's so much that's happened and it explains so much of your. Of your. Of your personality, your character and 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]

Right.

[Azine Qureshi]

Because FG asked that we protect many of the identifying details of his life today.

[Eric Kim]

And if you do mention my profession, then kind of make it a medical.

[FG]

Profession rather than very vague.

[Azine Qureshi]

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.

[Eric Kim]

And I think that was just to show that I'd managed to achieve some kind of level of profession, which is not completely stupid.

[FG]

No, but there is this coded, like, well, did. Did he turn out okay? Like, did he succeed in life?

[Eric Kim]

If I was some loser, then that would be another thing. They could hitch to the bandwagon.

[FG]

Right?

[Eric Kim]

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. More than I think. No, no, sorry.

[FG]

So we have to do it. Maybe. To start, tell me a little bit about just your life growing up, like, early childhood.

[Eric Kim]

My mother. Is it. Well, it 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 more or less. I had a pretty happy childhood, but I was very. I was very aware of. Of my frustrations, which at the time, I didn't see as frustrations. I just didn't understand. Must assume that would sort itself out.

[FG]

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?

[Eric Kim]

Well, in the sense that being a boy or a girl.

[Azine Qureshi]

In the first case report, Peggy noted that fg, who was born female, quote, wished to be a boy from early on.

[Eric Kim]

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. I wanted to be like Knickerbockers and.

[FG]

Oh, so you put it like you to connect in the.

[Eric Kim]

Yeah, yeah, yeah, yeah, exactly. I was like, why am I wearing. Why am I wearing a dress?

[FG]

That's very innovative.

[Eric Kim]

Yeah, that's quite smart. Then I was. Now 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.

[FG]

Wow.

[Eric Kim]

And so I think my parents 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 cliche. I did. I played football, blah, 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 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. And that was my protection. But I was not unhappy when I was little.

[FG]

You weren't unhappy, but it was. Was it an expression of frustration or was it more just an. An assertion?

[Eric Kim]

Up until about nine or ten, it was an assertion. 11. Up until then I thought, oh, it'll still work out, it'll still. One day I'll wake up, it'll be fine. And then as I hit 12, 13 and puberty started to set in, I started to get really worried because then I was also aware of the. Hm, this is probably not going to work out how I want it to be.

[FG]

It's not going to just disappear.

[Eric Kim]

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, like even more difficult and demanding and opinionated and axes to grind. And then.

[FG]

Were you angry?

[Eric Kim]

Yeah, I was angry. But like I said, that made me, you know, at school I talked with my fists also talking my mouth, because it's also very argumentative, but I wouldn't tolerate anything. And if anyone said anything to me that I didn't like that, I smack them. But I would always smack people that were bigger than me, which wasn't very hunched down. No, exactly. Which wasn't very difficult because I was small anyway. But no, I was. I was quite. I was quite explosive. Which.

[FG]

And your friends, were they. You said they were mostly boys.

[Eric Kim]

Yeah.

[FG]

And was. Do you have any memory of it, of anything about your gender coming up with them, or did they just accept you as you were?

[Eric Kim]

And it did. Well, it came up. But probably. And I don't know what happened behind my back. I don't care. But, you know, there was a. I met 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. With this person, and I felt such resistance. It felt wrong. I said, I'm not doing this. I'm not doing it. She said, no, I don't want to do it either. And. And then I. And so I went to the. I said, I want gym on the other side. And I went, okay. And ever since then, I always did gym 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. 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? You know, what are they? Yeah, yeah.

[FG]

But it is interesting thinking about that time and. And what you were saying about your anxiety increasing. That. That is when the. 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?

[Eric Kim]

I was really worried about what was happening, what was going to happen, because I could see it around me, and I was.

[FG]

Puberty.

[Eric Kim]

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 that. Hoping that they read them. And then. So my mom found one of these really pathetic poems and. Which clearly I'd left there. And then she addressed it and she.

[FG]

Do you remember kind of like what the poem said?

[Eric Kim]

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 it was. I think I blocked it from my memory.

[FG]

Yeah.

[Eric Kim]

Except that was the general sense of it. Like it was feeling hopeless and. And. And desperate and blah, blah, blah, blah.

[Azine Qureshi]

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.

[FG]

Did your mom react in the way that you wanted?

[Eric Kim]

Which is to get. 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 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.

[FG]

And so you were 12, so that would have been 86.

[Eric Kim]

Yeah.

[FG]

Was your body changing?

[Eric Kim]

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 onto de Lamar, who sadly has passed away.

[Azine Qureshi]

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 Delamar Vandewall. 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 7 or 8 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.

[Eric Kim]

So I went to see her, didn't have a clue who she was, and she listened to my case. I think Louis Horace 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, yeah.

[FG]

Came up with like, basically was a pioneer worldwide for adult care.

[Eric Kim]

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. On blockers.

[FG]

Had they. Did they come up with the idea in response to meeting you? Is that your sense?

[Eric Kim]

Yes, that is my sense. Only because I was the first and because I was so convincing.

[FG]

Yeah.

[Eric Kim]

And I'm not sure if the conversation had come up that. Well, normally what we do is you put. When you're 16 or 7. Because I think that was when they started putting the youngest age you could put your hormones. And I said, no, I'm not doing it. Why can't we just. I think I probably said that. Why can't we just pause it now? 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 I. 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. So they took me seriously. And I think they said, well, this is such a bloody convincing case, great idea to experiment, this child. My parents were behind it.

[FG]

They were, yeah. So, I mean, you used the word guinea pig earlier. Were they aware? Aware?

[Eric Kim]

I think so.

[FG]

You don't think they were aware? It was the first. You were the first?

[Eric Kim]

Yes. No, I don't think I was aware. That was the first.

[FG]

Really? Oh, wow. Okay.

[Eric Kim]

But, I mean, it wasn't completely new because these hormones, blockers, were being given to kids that were entering, like, 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. Right?

[FG]

Or at least clinical experience.

[Eric Kim]

Exactly. So that's.

[Azine Qureshi]

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 Delamar 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 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.

[FG]

Do you think that would have scared you out of it?

[Eric Kim]

No, because there was an alternative.

[FG]

It was sort of irrelevant.

[Eric Kim]

Yeah. It's like, otherwise, I'm leaving. Leaving this world, which I wasn't. But it was that kind of. That feeling was there. It was like, there's no choice, you know, that we have to do something. This is not okay. I'm not doing this.

[FG]

Yeah.

[Eric Kim]

I was like, put my foot down.

[FG]

Yeah.

[Eric Kim]

No, I could be very pigheaded. Yeah. So, no, I'm not doing it. No, no, no, no, no. So puberty, that was. I mean, it literally saved my life. So I feel ind.

[FG]

Foreign. This podcast is supported by Strawberry Me Unlike any class, book, or podcast, Strawberry Me career coaching gives you something truly unique. A professional partner who's 100% focused on your success. It's not just advice. It's like therapy for your career. Your coach will ask the right questions, helping you uncover hidden strengths, break through obstacles, and move forward with confidence. If you're ready to unlock your full potential, visit Strawberry Methedaily to claim your $50 credit. That's Strawberry Methedaily.

[Azine Qureshi]

My name is Dan Powell.

[FG]

I'm Marian Lozano.

[Azine Qureshi]

We are composers at the New York.

[FG]

Times, and we write a lot of music for the Daily.

[Azine Qureshi]

I'm currently working on a piece called Geometry. It's a musical moment of reflection to help the listener digest the story.

[FG]

This piece is for a space episode. I want to put the listener right into the deep darkness of space for this cue.

[Azine Qureshi]

The producers wanted us to write something that would evoke the late 70s.

[FG]

I started with a bass line, and then I added some drums to it.

[Azine Qureshi]

He said, can you, like, add 20 or 30% more funk to this?

[FG]

We write music to highlight a moment, to draw you into the story without telling you how to feel.

[Azine Qureshi]

Yeah, it's always the puzzle to solve.

[FG]

So if you love the Daily and you want us to keep making reflective, cosmic, sometimes groovy, but always subtle music for the show, support us by subscribing to the New York Times. So sorry. So you started the blockers at 12?

[Eric Kim]

Yeah, 12 or 13.

[FG]

Do you remember, like, the first time getting it?

[Eric Kim]

And I just. Yeah, I do. And it hurt because you injected it into a muscle. And because I was also so. So body critical, I didn't want them to inject into my bum, which is the much better option. So I had it done in my leg the first time, and that hurt like a motherfucker.

[FG]

And had you met Peggy?

[Eric Kim]

No. Yeah, no, no, I met her. I think I got into conversations with her when I was about 16.

[Azine Qureshi]

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.

[Eric Kim]

So, yeah, I had to do a lot of psychometric and psychological testing anyway at various points in time. And I remember doing with Peggy, I filled in a lot of paperwork, a lot of questionnaires.

[Azine Qureshi]

And 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.

[Eric Kim]

And then I decided I didn't want to go to them until I finished school.

[FG]

Okay.

[Eric Kim]

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 was go on male hormones. I just didn't want to have to explain it to people.

[FG]

Right.

[Eric Kim]

Because again, it would make me vulnerable and 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, 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.

[FG]

Yeah.

[Eric Kim]

And maybe that's my own little hang up, but that's just pretty much how I went through life. Yeah.

[Azine Qureshi]

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 shameful. So rather than go through this transition in front of his classmates, FG decided to stay on the blockers an extra two years, meaning his body essentially remained frozen in his 13 year old state until he was 18. Then after high school, he took a year off to begin hormone treatments and go through male puberty as privately as he could.

[Eric Kim]

I think that, that, yeah, was a bit stressful, to be fair, because, you know, you have this like kind of underlying stress, 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's always a. That was. Stressed me out. Especially when I. As your voice started to change, it just became difficult because, well. Well, how are they addressing you now? So you're always thinking about those things, plus toilets.

[Azine Qureshi]

But even going to the clinic to get his hormone treatments was a stressful experience.

[Eric Kim]

And 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. I just didn't want to be seen.

[Azine Qureshi]

After a year on testosterone, he was ready to start university as a man.

[Eric Kim]

But there is still that transition of old life, new life. Who am I gonna run into? What do I have to say? Even at university, I ran into people that were from my school.

[FG]

Yeah.

[Eric Kim]

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. And my voice is lower. And I went by 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 even though 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 that. That. You know, 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, you know, 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 we people still do, you know, it's still used as a weakness. 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. Oh, that.

[Azine Qureshi]

Right. Then one of FG's cats fell off a window ledge.

[Eric Kim]

No. So I knew. So, so I, you know, I have a lot to say about. But then I'm like, off. I don't feel like ex. 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. Off. That hasn't actually happened. But I'm just, just to give you an idea of how my mind works.

[FG]

What you went through as an adolescent is still with you.

[Eric Kim]

Oh, absolutely. And that's what's formed me and that's how. That's why I said I never see myself as a victim. But I do feel that I should get some credit for something which. 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. No, it's like, oh, you know, be the martyr. My first year at university, I had three operations. Nobody knew about it.

[FG]

Wow.

[Eric Kim]

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, 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 can pee anymore.

[FG]

Oh my God.

[Eric Kim]

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.

[FG]

Yeah.

[Eric Kim]

But I can't say that. Do you know what I mean?

[FG]

I guess just the, 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. And I don't know, what do you make of that and what, what do you make of what that means for getting the medical treatment that you pioneered? I mean, you know.

[Eric Kim]

Yeah, 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 being. Coming from that particular narrative and being narrow minded. My conclusion now is that I find that it's gone. It's like, 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 punkah, you know, in the 80s, you were a punk or two. We always have to. We have to. We 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 have an opinion against the. The. The given society, because that's our rite of passage. And it feels like this has become a. Another forum for that. That it's just taken over that role and for the group that is as pure, like proper transsexuals. This flirting with pronouns and gender identity. It's 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. 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. Intellectually, I have to think about that.

[FG]

Right.

[Eric Kim]

But I don't take a lot of these people that seriously because it does seem to be a bit of a fashion statement.

[FG]

It's just interesting to me because you were once an adolescent who adults chose to take seriously.

[Eric Kim]

Yeah.

[Azine Qureshi]

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 six years after he'd begun hormones and had his first surgery. Peggy wrote that FG quote 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.

[Peggy Cohen Ketnes]

Because of him, we thought maybe we should do this more often, Giving the.

[Azine Qureshi]

Blocking hormones 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 treatment to more kids, Peggy felt they needed a process.

[Peggy Cohen Ketnes]

We cannot just start and do whatever we want, particularly in the beginning when you have no idea whether what you're doing is okay.

[Azine Qureshi]

She began to codify a protocol, what would come to be known as the Dutch protocol.

[FG]

How would you define the Dutch protocol?

[Peggy Cohen Ketnes]

Well, I think as very careful way to figure out who should have what kind of treatment to feel like they want to feel.

[Azine Qureshi]

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.

[Peggy Cohen Ketnes]

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 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 the challenge.

[Azine Qureshi]

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 Anulu Devries.

[FG]

My name is Azine Ghreshi.

[Azine Qureshi]

And what happened next would explain how this care that started almost by accident with this one kid would quickly spread around the world.

[FG]

Hello. It's good to see you.

[Eric Kim]

Hi. Hello.

[Azine Qureshi]

I'm Austin.

[FG]

I'm monolu.

[Eric Kim]

Hello.

[FG]

Hello.

[Azine Qureshi]

That's next time in part two. Special thanks for this episode to Emily Bazelon and Alex Bakker.

[Michael Balbaro]

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. 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.

[Donald Trump]

Look, Elon Musk and I had a great relationship. I don't know who it will anymore. I was surprised because during a news.

[Michael Balbaro]

Conference in the Oval Office, Trump acknowledged the rupture.

[Donald Trump]

And I'll tell you, it's not. 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.

[Michael Balbaro]

And Trump suggested that since Musk had stepped away from his administration, he had turned anti Trump because he missed the limelight.

[Donald Trump]

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.

[Michael Balbaro]

That's it for the Daily. I'm Michael Balbaro. See you on Monday.