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.

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.

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.

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.

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).

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.

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).

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).

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.

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.