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

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.

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."

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."

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."

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."

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?"

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."

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."

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."

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.

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.

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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