The Beginning

Summary

The Protocol: The Beginning – Detailed Summary

Released on June 5, 2025, "The Beginning" is the inaugural episode of The New York Times' six-part podcast series, "The Protocol." This episode delves into the origins of medical treatments for transgender youth, tracing how such care emerged, the lives it transformed, and the ensuing legal and political battles in the United States. Through interviews and firsthand accounts, the episode provides a comprehensive exploration of this pivotal moment in transgender healthcare.

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1. Setting the Stage: A Polarized Landscape

The episode opens amidst a highly polarized socio-political climate concerning transgender rights. A political figure vehemently opposes transgender policies, declaring, “We’re going to stop the transgender lunacy. I am so hated for just existing” (00:02). This rhetoric underscores the tension between transgender activists and political adversaries.

An activist counters, emphasizing the personal significance of transition: “Being able to transition absolutely saved my life” (00:52). The journalist narrates the current state: “It’s only been about two decades since trans and gender non-conforming 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” (00:58). This sets the premise for the episode’s exploration of the origins of transgender youth treatment.

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2. Historical Context: The Netherlands Pioneers

The conversation shifts to the historical backdrop of transgender medical care, highlighting the Netherlands as a forerunner. An activist recounts, “back in the 1950s, they were among the few countries in the world that were actually treating trans patients” (04:16). During this era, transgender individuals faced significant stigma, with the medical community often dismissing them as “mentally disturbed” or “psychotic” (04:45).

However, a small group of progressive doctors began to challenge these misconceptions. An activist explains how these doctors shifted their approach from trying to “correct” transgender identities to affirming them through medical interventions like hormone treatments and surgeries (05:21). This marked a fundamental change in how transgender individuals were treated within the medical system.

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3. Peggy Cohen Ketnes: A Shift in Paradigm

In the 1980s, clinical psychologist Peggy Cohen Ketnes played a pivotal role in advancing transgender healthcare. A researcher details her initial focus: “A clinical psychologist named Peggy Cohen Ketnes started to research how these patients were” (06:56). Peggy observed that while transgender adults remained distressed, those who underwent medical transitions reported significantly improved well-being.

Peggy’s research highlighted that hormone treatments not only alleviated psychological distress but also facilitated smoother social integration by preventing undesired physical changes during puberty (09:25). This insight underscored the critical window of adolescence as a transformative period for transgender youth.

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4. The First Case: FG’s Transformative Journey

The heart of the episode centers on FG, the first individual to receive puberty blockers for gender dysphoria. Setting the stage, the journalist describes FG's initial interactions: “He was the first kid to get this revolutionary medical intervention” (12:00). FG’s story is deeply personal, detailing his childhood struggles with gender identity and the increasing anxiety as puberty approached (16:44).

FG recounts his determination: “I just wanted to wake up and that's what I said. I used to. I just want to wake up and I want to” (24:30). His resolve led him to Dr. Henrietta Delamar Vandewall, an endocrinologist specializing in precocious puberty. Together with Dr. Louis Horns, they decided to lower the age for hormone treatments from 18 to 16, thereby pioneering a new approach (24:14).

The first administration of puberty blockers was a painful yet life-saving procedure for FG: “And it hurt because there's a. You injected it into a muscle… it hurt like a motherfucker” (28:05). Despite the pain, FG recognized the necessity of the treatment, stating, “Puberty, that was... it literally saved my life” (27:32).

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5. Developing the Dutch Protocol: Systematizing Care

Peggy Cohen Ketnes realized the potential of puberty blockers beyond isolated cases and sought to create a standardized approach. She began codifying a protocol to assess and treat transgender youth carefully, ensuring that medical interventions were beneficial and minimized the risk of future regret (40:35).

This protocol, later known as the Dutch Protocol, emphasized thorough psychological evaluations and a stepwise approach to medical treatment. The journalist notes, “The critical part of that protocol was a process for assessing the kids to figure out who should receive medical intervention” (40:49). This structured methodology allowed for broader application, ensuring that each case was handled with the necessary care and attention.

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6. FG’s Later Reflections and Current Perspectives

Now in his early 50s, FG reflects on his experience and the evolution of transgender movements. He expresses a nuanced view, recognizing both the significance of his own treatment and the complexities of current gender discourse. FG states, “I find that it's gone, it's like gone a bit extreme to the other side” (36:03), critiquing what he perceives as the politicization and commercialization of gender identity.

He contrasts his personal journey with the broader movements, suggesting that the current trend may overshadow the foundational work that aimed to support genuine transgender identities: “We spend all our time trying to just fit in... 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” (36:14).

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7. Legacy and Global Impact

Peggy's initial success with FG laid the groundwork for transgender youth healthcare worldwide. As the podcast concludes, it hints at the rapid spread of these protocols, transforming transgender healthcare from a nascent field into a globally recognized medical practice. The collaborative efforts of mental health providers like Anelu Defries further solidified the framework necessary to support transgender youth (42:00).

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8. Concluding Insights

"The Beginning" intricately weaves personal narratives with historical and medical developments, highlighting the profound impact of early medical interventions on transgender youth. By chronicling FG’s journey and Peggy Cohen Ketnes’ pioneering work, the episode underscores the delicate balance between medical innovation and socio-political dynamics.

Notable Quotes:

• Political Figure: “With a stroke of my pen on day one. We're going to stop the transgender lunacy. I am so hated for just existing” (00:02).

• Activist: “Being able to transition absolutely saved my life” (00:52).

• FG: “Puberty, that was... it literally saved my life” (27:32).

• Journalist (Austin Mitchell): “This is a story I've been reporting with my colleague Azine Gi, a science and gender reporter, for nearly two years” (02:33).

Speaker Attribution:

• Political Figure: Represents opponents of transgender policies.

• Activist: Advocates for transgender rights and personal experiences.

• Journalist (Austin Mitchell): Narrates and interviews key figures.

• FG (referred to as Political Figure for anonymity): The first recipient of puberty blockers, sharing his personal journey.

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Final Thoughts

"The Beginning" serves as a foundational narrative within "The Protocol" series, offering listeners a deep dive into the inception of transgender youth medical care. Through meticulous storytelling and emotional testimonies, the episode provides an essential understanding of the challenges and triumphs that have shaped transgender healthcare as it stands today.

Transcript

[Political Figure]

With a stroke of my pen on day one. We're going to stop the transgender lunacy. I am so hated for just existing.

[Activist]

And being who I am.

[Political Figure]

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.

[Activist]

Being able to transition absolutely saved my life.

[Journalist]

It's only been about two decades since trans and gender non conforming 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.

[Activist]

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?

[Political Figure]

You do not have the right to abuse your kids.

[Journalist]

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

[Political Figure]

If they cannot get treatment, children will die.

[Journalist]

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

[Activist]

What do we do? We are not gonna 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 eradic. So are you going to be able to bring that inside?

[Journalist]

No, I don't think so.

[Activist]

No.

[Journalist]

This is a story of how we got here.

[Activist]

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

[Journalist]

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

[Political Figure]

See what they say. Okay. For now.

[Journalist]

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

[Activist]

We have so much ground to cover with her.

[Journalist]

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

[Activist]

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.

[Journalist]

Mm.

[Activist]

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.

[Journalist]

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

[Activist]

Kind of talked 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 one.

[Political Figure]

Second.

[Activist]

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.

[Researcher]

Yeah, well, it started very long ago.

[Activist]

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

[Researcher]

I just had my Ph.D. and I.

[Activist]

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

[Researcher]

Actually doing first follow up study in the Netherlands.

[Activist]

This is for adults.

[Researcher]

For adults, yeah, yeah. Because children were no way that anyone would do something with children.

[Activist]

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.

[Researcher]

So I became involved.

[Activist]

And at the same time that Peggy was doing this research, I was also a psychotherapist. She also had a clinical practice.

[Researcher]

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.

[Activist]

And she started getting a few referrals for younger patients who are, you know, 16, 17, and who are 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.

[Researcher]

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

[Activist]

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

[Researcher]

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.

[Activist]

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 endocrinologists overseeing hormone treatments for trans adults in the Netherlands.

[Researcher]

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

[Activist]

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.

[Journalist]

Right, A turning point.

[Activist]

Yeah. And their development, I mean they're, they're going through these, you know, irreversible changes that will be much harder to undo further down the line.

[Researcher]

Breast and beard and low voice.

[Activist]

And this was becoming even more clear to her as she started to see younger kids, the first 14 or 15.

[Researcher]

Year olds and then an occasional 12.

[Activist]

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.

[Researcher]

Said we don't, don't give.

[Activist]

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

[Researcher]

And then I came across fd.

[Activist]

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

[Journalist]

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

[Activist]

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

[Journalist]

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

[Activist]

He knows you're recording.

[Journalist]

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 at the next street. But he did agree to tell us.

[Activist]

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

[Journalist]

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

[Political Figure]

Hi. Hello. Hi. Perfect.

[Activist]

Hi.

[Political Figure]

Hi, nice to meet you.

[Journalist]

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.

[Activist]

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

[Journalist]

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

[Political Figure]

Can I get you coffee or tea or something?

[Activist]

Coffee, if you're going to have something.

[Journalist]

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

[Activist]

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

[Journalist]

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.

[Political Figure]

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

[Activist]

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

[Political Figure]

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

[Activist]

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

[Political Figure]

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.

[Activist]

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

[Political Figure]

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.

[Activist]

Right.

[Journalist]

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

[Political Figure]

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

[Activist]

Profession rather than very vague.

[Journalist]

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.

[Political Figure]

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

[Activist]

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

[Political Figure]

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

[Activist]

Right.

[Political Figure]

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. Well, but I don't. No, no. Sorry.

[Activist]

Maybe to start, tell me a little bit about just your Life growing up, like, early childhood.

[Political Figure]

My mother, is it. Well, it was English because she died. My father's Italian and they're quite. Well, I think my. My mother was more liberal than my father because he came from a small village and he's Italian. You probably read that in country, 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. I just assumed that would sort itself out.

[Activist]

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?

[Political Figure]

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

[Journalist]

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

[Political Figure]

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. I wanted to be like Knickerbockers and.

[Activist]

Oh, so you put like, dude connected the photo.

[Political Figure]

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

[Activist]

That's very innovative.

[Political Figure]

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.

[Activist]

Wow.

[Political Figure]

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.

[Activist]

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

[Political Figure]

Up until about nine or ten, it was an assertion. 11. Up until then I thought, oh, it'll still work out. 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 them. This is probably not going to work out how I want it to be. And my parents up until then have been pretty good, especially my mum. I was very close to my mum and. 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.

[Activist]

Were you angry?

[Political Figure]

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, I'd. I'd 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.

[Activist]

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

[Political Figure]

Yeah.

[Activist]

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? And it did.

[Political Figure]

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.

[Activist]

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?

[Political Figure]

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

[Activist]

Puberty.

[Political Figure]

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 mum found one of these really pathetic poems and which clearly I'd left there. And then she addressed it and she.

[Activist]

Do you remember kind of like what the poem said?

[Political Figure]

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.

[Activist]

Yeah.

[Political Figure]

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

[Journalist]

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.

[Activist]

Did your mom react in the way that you wanted? Which is to.

[Political Figure]

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 others. 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.

[Activist]

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

[Political Figure]

Yeah.

[Activist]

Was your body changing?

[Political Figure]

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.

[Journalist]

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.

[Political Figure]

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

[Activist]

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

[Political Figure]

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.

[Activist]

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

[Political Figure]

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

[Activist]

Yeah.

[Political Figure]

And I'm not sure if the conversation had come up that well. Normally what we do is you. You're. When you're 16 or 7. Because I think that was when they started putting you at the youngest age you could put your hormones. And I was like, no, I'm not doing it. Why can't we just. I think 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 used to. 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 with this child. My parents were behind it.

[Activist]

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

[Political Figure]

I think so.

[Activist]

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

[Political Figure]

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

[Activist]

Oh, wow. Okay.

[Political Figure]

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 Bloc countries for gymnasts, but we don't talk about that. So there is some kind of data there. Right?

[Activist]

Or at least clinical experience.

[Political Figure]

Exactly. So that's.

[Journalist]

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.

[Activist]

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

[Political Figure]

No, because there was an alternative.

[Activist]

It was sort of irrelevant.

[Political Figure]

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.

[Activist]

Yeah.

[Political Figure]

I was like, put my foot down.

[Activist]

Yeah.

[Political Figure]

No, I could be very pigheaded.

[Activist]

Yeah.

[Political Figure]

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.

[Activist]

So, so sorry. So you. So you started the blockers at 12?

[Political Figure]

Yeah, 12 or 13.

[Activist]

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

[Political Figure]

And I just. Yeah, I do. And it hurt because there's a. You injected it into a muscle. And because I was also so sort of 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.

[Activist]

And had you met Peggy?

[Political Figure]

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

[Journalist]

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 DEs 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.

[Political Figure]

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.

[Journalist]

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.

[Political Figure]

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

[Activist]

Okay.

[Political Figure]

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.

[Activist]

Right.

[Political Figure]

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'd 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.

[Activist]

Yeah.

[Political Figure]

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

[Journalist]

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.

[Political Figure]

I think that, yeah, was a bit stressful to be fair because you know, you have this like kind of 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's always, that always stressed me out. Especially when I. 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.

[Journalist]

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

[Political Figure]

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.

[Journalist]

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

[Political Figure]

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.

[Activist]

Yeah.

[Political Figure]

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, my voice is lower. And, and I went by one, 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, you know, 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, you know, 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. 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 do. Deal with it and be successful in it. Oh, that.

[Journalist]

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

[Political Figure]

No. So anyway, so. So I, you know, I have a lot to say about. But then I'm like, off. I don't feel like, why do I even have to have these thought processes? I've already got my defense ready if it ever came up, because I know I will not be treated in a different way or have the idea that you feel superior because, oh, poor you, you off. That hasn't actually happened. But I'm just. Just to give you an idea of how my mind works.

[Activist]

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

[Political Figure]

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. 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. I was in. In and out of hospital with, with operations and, you know, even a complication, I had to rush myself off to hospital because I can pee anymore. And. But nobody had a clue. And then I had to make a story around that. I thought, damn it, I did all that.

[Activist]

Yeah.

[Political Figure]

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

[Activist]

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. And 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 mean, you know.

[Political Figure]

Yeah, I think it's a different. 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 punker, you know, in the 80s you were a punker too. 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 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 a pure, like proper transsexuals, this flirting with pronouns and, 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, that's my own, I'm still stuck in my, my own paradigm. And maybe that shouldn't be a taboo. Maybe we should break it open. And. I don't know, I. That's not how I feel, but I can intellectually, I have to think about that.

[Activist]

Right.

[Political Figure]

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

[Activist]

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

[Political Figure]

Yeah.

[Journalist]

So this is how it all started with a kid. 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.

[Researcher]

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

[Journalist]

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.

[Researcher]

More space and time to think about the decisions.

[Journalist]

She felt the blockers would give kids time to think. But to give this treatment to more kids, Peggy felt they needed a process.

[Researcher]

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

[Journalist]

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

[Activist]

How would you define the Dutch protocol?

[Researcher]

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

[Journalist]

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.

[Researcher]

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.

[Journalist]

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

[Activist]

Hello. It's good to see you. Hi.

[Political Figure]

Hello.

[Journalist]

I'm Austin.

[Activist]

I'm Monalu.

[Journalist]

Hello.

[Activist]

Hello.

[Journalist]

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