Podcast Summary: The Protocol – Episode: The Gender Kids

Release Date: June 5, 2025
Host/Author: The New York Times

Introduction

In this compelling episode of The Protocol, The New York Times delves into the intricate history and impact of medical treatments for transgender youth, focusing on the Dutch protocol's origins, its global influence, and the ensuing legal and political battles in the United States. Titled "The Gender Kids," the episode intricately weaves personal narratives with expert insights to present a nuanced exploration of transgender healthcare.

Origins of the Dutch Protocol

The story begins in the early 2000s at an Amsterdam clinic where Peggy, a pioneering clinician, collaborates with Dr. Anelu de Frise to develop a structured approach to treating gender dysphoria in young people.

Peggy:
[00:01] "I mean, when I started working here, Peggy just moved from Utrecht."

Dr. Anelu de Frise:
[00:06] "Dr. Anelu de Frise was one of the first people to join Peggy's new team at the Amsterdam clinic. At the time, Peggy was still developing her set of rules for providing this new medical intervention to young people. What came to be known as the Dutch protocol, puberty blockers. When puberty started, usually around 12, hormones as early as 16, and surgeries in AD. And critically, the mental health assessments that were designed to help figure out which kids should get medical intervention."

The Dutch protocol introduced a phased approach:

1. Puberty Blockers: Initiated around age 12 to delay puberty.
2. Hormones: Administered around age 16.
3. Surgery: Considered in adulthood.
4. Comprehensive Mental Health Assessments: To ensure appropriate treatment pathways.

Peggy:
[00:40] "That assessment was several sessions over a longer period of time and actually really get to know the family, get to know the kids."

The team emphasized thorough evaluations, often spanning at least six months, to understand each child’s unique situation fully.

Establishing the Protocol's Efficacy

By 2011, Dr. Anelu de Frise had embarked on a pivotal study involving 70 patients, marking the first substantial evidence supporting the Dutch protocol.

Peggy:
[02:18] "That's the 2011 study, the famous. Yeah, well, that was the first one that did some evaluation of really the medical intervention."

The study aimed to assess the psychological well-being of participants before and after receiving puberty blockers, followed by hormones and surgeries. The findings were groundbreaking, essentially launching the field of youth gender medicine.

Dr. Anelu de Frise:
[02:33] "The idea was to see how the kids were doing psychologically before they started puberty blockers and follow up with them over time to see how the blockers and then hormones and surgeries impacted their well-being and whether the kids they thought would benefit from the treatment actually were doing better."

Personal Narratives: Manon's Journey

A significant portion of the episode centers around Manon, one of the first children treated under the Dutch protocol. At 30, Manon reflects on her experiences, providing a deeply personal perspective on the protocol’s long-term effects.

Peggy:
[04:00] "This is Manon."

Manon's early life revealed a persistent discomfort with her assigned gender, leading her parents to seek medical intervention. The protocol's structured approach allowed for flexibility, ensuring that medical treatments were not rushed and that each step was carefully considered.

Austin Mitchell (Manon at age 30):
[08:23] "Always walking in my mom's clothes, wearing towels as skirts or long hair. I wanted to play with girl stuff... I always knew that it was temporary. I always knew that till the next phase were the hormones. I could stop every moment."

Manon’s narrative highlights both the benefits and complexities of the protocol:

• Benefits:

  • Emotional Stability: Improved psychological well-being post-treatment.
  • Personal Satisfaction: No regret regarding the choice to transition.

• Challenges:

  • Fertility Concerns: Making irreversible decisions about future parenthood.
  • Social Vulnerability: Increased sensitivity to societal perceptions and potential discrimination.

Manon:
[23:00] "That is such a nuanced thing that you're describing, is both saying, I don't regret it. I, I know I made the right choice, but also that there can be a part of it that, you know, is difficult for you."

Clinical Insights and Study Outcomes

Dr. Anelu de Frise’s studies provided empirical support for the protocol, showing significant improvements in the psychological well-being of participants. After an average of two years on puberty blockers, the children exhibited decreased behavioral and emotional problems, and their general functioning improved notably.

Dr. Anelu de Frise:
[28:27] "She found that after an average of two years on the blockers, the psychological well-being of the participants was improved, writing that their quote, behavioral and emotional problems and depressive symptoms decreased while general functioning improved significantly."

However, the study also acknowledged limitations, such as a small sample size and potential selection bias, underscoring the need for more comprehensive research.

Dr. Anelu de Frise:
[30:18] "She wrote that her study sample was small and came from one clinic. And she noted that because of the number of participants who had fallen out between the blockers paper and the follow-up paper, there was the possibility of selection bias."

Global Influence and Diverging Approaches

The Dutch protocol gained international attention, influencing transgender healthcare standards worldwide, notably being incorporated into the WPATH Standards of Care. However, as the protocol spread, variations emerged, particularly in the United States, leading to a divergence between the rigorous Dutch assessments and the more affirmative American approach.

Manon:
[33:04] "And to them, they were, like, very interested because there was this new thing to help."

Peggy:
[33:11] "Yeah, yeah, yeah. I don't want to pinpoint to colleagues that they are sort of the source of the things that the criticism that that's happening now. It's only quite recently that I've really been convinced that, yeah, maybe especially in the United States, there is approaches that are different from the approach that we are doing."

This divergence sparked debates over the protocol's integrity, with critics arguing that some adaptations were too lenient, potentially undermining the protocol's original efficacy.

Azine Ghreshi:
[34:31] "I would try to remind people that actually, you know, what I'm doing is so much less than what the Dutch do... So the fact that you're wanting to do, like, significantly less, less than my already pared down Dutch protocol is a little crazy."

Conclusion and Reflections

The Gender Kids episode concludes by reflecting on the enduring impact of the Dutch protocol through personal stories like Manon's and the ongoing debates surrounding transgender healthcare. It underscores the balance between medical rigor and compassionate care, highlighting the protocol's role in shaping the lives of transgender youth while acknowledging the complexities and controversies it continues to navigate.

Manon:
[26:57] "Yeah, a nightmare I cannot even imagine... I can live my life now, how I live it. A normal job. I have a good background... I just enjoy life."

This episode of The Protocol offers a comprehensive and empathetic exploration of transgender youth medical care, illustrating both the profound benefits and the intricate challenges of the Dutch protocol as it adapts to diverse cultural and medical landscapes.

Notable Quotes:

• Peggy (00:40): "That assessment was several sessions over a longer period of time and actually really get to know the family, get to know the kids."

• Austin Mitchell (Manon at 30) (19:22): "But I was so happy with it because I was very aware that I did not want anything to do with male puberty... it felt like a gift."

• Dr. Anelu de Frise (28:27): "Behavioral and emotional problems and depressive symptoms decreased while general functioning improved significantly."

• Manon (33:50): "There is a fear that the Dutch approach has been this rigorous... and the American affirmative approach... has somehow endangered everything."

Final Thoughts

The Gender Kids serves as a crucial narrative in understanding the evolution and current state of transgender healthcare for youth. By intertwining personal experiences with clinical research, the episode provides a balanced perspective that informs, engages, and challenges listeners to consider the multifaceted nature of transgender medical interventions.