The Now

Summary

Podcast Summary: The Protocol – Episode: The Now

Title: The Protocol
Host/Author: The New York Times
Episode: The Now
Release Date: June 5, 2025

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Overview

The Protocol is a six-part podcast series by The New York Times that delves into the complex and contentious landscape of medical treatment for transgender youth in the United States. Episode six, titled "The Now," focuses on the culmination of legal and political efforts to ban gender-affirming care for minors, the impact of these bans on patients and their families, and the broader societal implications. Through interviews with key stakeholders, including Dr. Scott Leibowitz, parents, transgender advocates, and political figures, the episode paints a vivid picture of the ongoing struggle between medical professionals and lawmakers over transgender healthcare.

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1. The Rise of Opposition and Legislative Action

The episode begins by introducing Dr. Scott Leibowitz, who ran a pediatric gender clinic in Ohio. Dr. Leibowitz reflects on the unprecedented legislative push to ban gender-affirming care, expressing disbelief at the scale and speed of these efforts.

"[00:00] Dr. Scott Leibowitz: I mean, of course, we're all looking at each other and thinking, you know, this couldn't possibly pass. Like this is such an overreach. It's just so not in the realm of reality that something."

In 2021, Ohio's Republican-led state legislature introduced the Save Adolescents from Experimentation (SAFE) Act, aiming to prohibit medical treatments for transgender minors. The Act sparked over a dozen hearings, where proponents vehemently supported the ban.

"[01:23] Scott Leibowitz: In 2021, Republicans in the state legislature introduced the Save Adolescents from Experimentation act, the SAFE Act."

During these hearings, testimonies from individuals like Laura Edwards Leeper and transgender advocates highlighted the perceived dangers of gender-affirming therapy, equating it to coercion and asserting that it erases transgender identities.

"[02:00] Dr. Scott Leibowitz: Gender affirmation therapy is a type of therapy that is supported by intimidation, fear, manipulation, and isolation rather than education, information."

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2. Impact on Clinical Operations and Patient Well-being

Dr. Leibowitz discusses the immediate repercussions of the legislative actions on his clinic. The hostile environment following each hearing led to an influx of distressed parents and increased clinical complexities, including heightened suicidal ideation and anxiety among patients.

"[03:21] Dr. Scott Leibowitz: It forces them to come out and put their own kids' privacy and safety at risk. So parents don't want to do that."

Families expressed a desire to share their positive experiences with gender-affirming care, but the hostile political climate deterred many from doing so. Dr. Leibowitz observed that testimonies supporting the bans often silenced the voices of those who benefited from the care.

"[03:45] Laura Edwards Leeper: My daughter is 14 and she's been in these rooms before... I did not feel safe having her in this room to watch them go to these hearings and beg."

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3. Legislative Rollout and Executive Actions

Despite initial resistance, the SAFE Act was signed into law by Governor Mike DeWine in December 2023. However, DeWine briefly blocked the ban after recognizing the nuanced care provided by Dr. Leibowitz's clinic.

"[04:23] Dr. Scott Leibowitz: It's horrible. It's awful to watch."

Nonetheless, in January 2024, the Ohio legislature overrode the governor's veto, making the ban effective by August 2024. The law included a grandfather clause, allowing existing patients to continue their treatments but prohibiting new prescriptions and referrals for gender-affirming care.

"[05:20] Scott Leibowitz: Not long after, DeWine became one of just two Republican governors to block their state's bans on gender affirming care for kids. But we all knew that that was not necessarily something that was going to last."

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4. Clinical Scenarios Under the Ban

Dr. Leibowitz categorizes the affected patients into three distinct groups:

1. Pre-Puberty Transgender Youth: These are children who have identified their gender from an early age and were awaiting puberty blockers. The ban created uncertainty about their eligibility for treatment.

   "[08:11] Scott Leibowitz: These were kids who had identified as another gender since early childhood..."

2. Youth on Puberty Blockers: This group faced immediate dilemmas as the ban prevented them from progressing to hormone therapy, leaving them in a state of limbo with limited options.

   "[09:18] Scott Leibowitz: Under the ban, even if a child was grandfathered in on one medication, they couldn't start a new medication..."

3. Decision-Making Age Youth: Adolescents who were in the process of deciding whether to pursue further treatment found themselves pressured into making hasty decisions without adequate support.

   "[11:37] Dr. Scott Leibowitz: These were patients who were less likely to fit the profile of the original Dutch cohort..."

The forced deadlines and restricted options led to increased feelings of hopelessness and exacerbated mental health issues among patients.

"[13:57] Azin Qureshi: So when did the ban actually go into effect?"

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5. The Broader Political Assault on Gender-Affirming Care

Following the ban's enactment, the Trump administration intensified efforts to dismantle gender-affirming care through executive orders and policy changes. This included restricting NIH funding for LGBTQ+ health research and directing the Department of Justice to prosecute providers offering such care.

"[25:00] Scott Leibowitz: President Trump took office and within hours issued his executive order declaring it the policy of the United States that, quote, sexes are not changeable..."

These actions were aimed at not only banning current services but also hindering future accessibility and research into transgender health.

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6. Personal Narratives: Families and Transgender Individuals

The episode weaves in powerful personal stories from families and transgender individuals affected by the bans:

• Laura Edwards Leeper: A parent struggling with her child’s transgender identity and the impact of the ban on her family’s safety and well-being.

  "[34:08] Laura Edwards Leeper: We have been really concerned about estranging our child, but we also have been, you know, really concerned about this as a better option. This experience has been pretty hellish."

• Transgender Advocate from Boston: A 26-year-old trans man narrates how gender-affirming care was life-saving, transforming his mental health and academic performance.

  "[35:08] Transgender Advocate: As a pediatric patient absolutely saved my life."

• Austin Mitchell: A parent recounts the emotional toll of moving states to protect his transgender child’s access to care, highlighting the personal sacrifices made.

  "[37:32] Austin Mitchell: ... we are moving to Barcelona, Spain in the next two weeks. I've personally gone dark digitally regarding anything to do with my child."

These narratives underscore the human cost of the legislative battles, illustrating the profound effects on families and individuals.

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7. Public Opinion and Political Polarization

A significant portion of the episode examines public opinion on gender-affirming care. A New York Times survey cited by Dr. Leibowitz reveals that 71% of Americans oppose doctors prescribing puberty blockers or hormones to minors, with stark differences across political affiliations.

"[45:14] Scott Leibowitz: ... 71% of respondents said no. That broke down to 90% of Republicans, 54% of Democrats, and 61% of independents."

Political figures like Governor Mike DeWine express pride in supporting gender-affirming care despite societal backlash, highlighting the deep polarization surrounding the issue.

"[47:21] Mike DeWine: ... I still feel very proud of what we built here, and I really feel like we should protect it as much as possible."

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8. The Supreme Court's Role and Future Implications

The episode touches on the impending Supreme Court ruling in U.S. v. Scremetti, which could have far-reaching implications for the legality of gender-affirming care and the constitutional protections for transgender individuals.

"[25:58] Scott Leibowitz: ... the Supreme Court's ruling in U.S. v. Scremetti will not only determine whether gender affirming care can be illegal... but... whether transgender people are entitled to specific protection under the Constitution's equal protection clause."

This case is portrayed as a pivotal moment that could redefine the landscape of gender and sex definitions in the United States.

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9. Concluding Reflections

The episode concludes with reflections on the irreversibility of the political assault on transgender healthcare and the bleak outlook for the future. Dr. Leibowitz expresses a sense of inevitability regarding the eradication of transgender care and rights, emphasizing the entrenched political motives driving these efforts.

"[22:47] Dr. Scott Leibowitz: ... there is such a laser focused mission that has a very well oiled financial machine behind it in politics on the right that is destined to eliminate trans care and basically trans rights and trans people from existence."

Transgender advocates voice their resilience and plea for understanding, highlighting that despite the backlash, the need for gender-affirming care remains critical.

"[43:10] Transgender Advocate: ... I know that regret and detransition are really issues that we need to be careful of. And banning that care doesn't solve that issue... To just let us live."

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Notable Quotes with Timestamps:

• "[00:00] Dr. Scott Leibowitz: ... this is such an overreach."
• "[02:09] Laura Edwards Leeper: ... This is not about erasing transgender children."
• "[05:20] Scott Leibowitz: ... the ban was scheduled to go into effect later that year."
• "[09:47] Scott Leibowitz: ... no reasonable option for them."
• "[17:24] Dr. Scott Leibowitz: ... there is very little reliable data on detransition."
• "[20:09] Scott Leibowitz: ... suicide and suicidality is far more complex than what is being talked about."
• "[25:02] Scott Leibowitz: ... create a society that has people with two sexes."
• "[35:11] Transgender Advocate: ... As a pediatric patient absolutely saved my life."
• "[45:14] Scott Leibowitz: ... 71% of respondents said no."

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Conclusion

"The Now" encapsulates a critical juncture in the ongoing debate over transgender healthcare in the United States. Through personal stories, expert insights, and an analysis of the political maneuvers undermining gender-affirming care, the episode highlights the profound and multifaceted impacts of legislative actions on young transgender individuals and their families. It underscores the urgent need for nuanced discussions and compassionate policies that balance medical ethics with the rights and well-being of transgender youth.

Transcript

[Dr. Scott Leibowitz]

I mean, of course, we're all looking at each other and thinking, you know, this couldn't possibly pass. Like this is such an overreach. It's just so not in the realm of reality that something.

[Scott Leibowitz]

Scott Leibowitz was running a pediatric gender clinic in Ohio when lawmakers in his state banned the care.

[Azin Qureshi]

Well, we have a million questions for you, so I'm ready.

[Scott Leibowitz]

Scott had trained with Laura Edwards Leeper at the first youth gender clinic in the US In Boston, before moving to Columbus to lead a program at a children's hospital there. It had become one of the most well known clinics to practice the assessment and therapy based model in the US With a process more closely resembling the Dutch. At one point, there were 10 full time mental health providers on the team. But things changed quickly.

[Azin Qureshi]

Yeah, when we talked the other day, a few days ago, you were like, you basically described last year as the worst year in your career. Can you sort of map out sort of what that year was like? Like, what was happening and how that was affecting you and your patients in the clinic?

[Dr. Scott Leibowitz]

Well, I think it actually starts before a year ago. Yeah, it started over three years ago.

[Scott Leibowitz]

In 2021, Republicans in the state legislature introduced the Save Adolescents from Experimentation act, the SAFE Act. Thank you, Chairwoman. I appreciate it.

[Chairwoman]

We have a quorum present and will.

[Laura Edwards Leeper]

Proceed as a full committee over the.

[Scott Leibowitz]

Next two legislative sessions. There were more than a dozen hearings, many where people testified in support of the ban on care.

[Laura Edwards Leeper]

This is not about erasing transgender children. Transing them is erasing them. If I had been transed, I wouldn't be here today as a woman and.

[Transgender Advocate]

A mother and a wife.

[Dr. Scott Leibowitz]

Gender affirmation therapy is a type of therapy that is supported by intimidation, fear, manipulation, and isolation rather than education, information.

[Laura Edwards Leeper]

And the adults have no problem walking.

[Mike DeWine]

The child from the building over here.

[Laura Edwards Leeper]

To the gas chamber over there.

[Mike DeWine]

Thank you for your time and support of this bill.

[Chairwoman]

Thank you so much for being here.

[Laura Edwards Leeper]

And for your testimony today.

[Dr. Scott Leibowitz]

So every time there's a hearing, you can imagine what our clinical inbox looked like the next day. Parents calling, stressed out, more emergencies, more urgencies, higher levels of suicidal thoughts, higher levels of anxiety, more depression. Just a higher level of clinical complexity to have to navigate in response to the external environment. And it just became a part of every single appointment of every day for two years.

[Scott Leibowitz]

And then Scott said the families he worked with wanted to tell their side of the story and talk about how different their experience was from what was being described.

[Dr. Scott Leibowitz]

They want to scream to the world, this is not true.

[Scott Leibowitz]

But the environment had grown so hostile, many didn't feel they could risk it.

[Dr. Scott Leibowitz]

It forces them to come out and put their own kids privacy and safety at risk. So parents don't want to do that. And I don't blame them and I don't urge them to and wouldn't urge them to. So you don't hear the stories of the people truly, truly impacted. And then for the parents who do, who really feel strongly about at least getting their voices out there.

[Laura Edwards Leeper]

My daughter is 14 and she's been in these rooms before. She asked to come here today. But after seeing how the other hearings went, I did not feel safe having.

[Dr. Scott Leibowitz]

Her in this room to watch them go to these hearings and beg.

[Laura Edwards Leeper]

And I'm asking you to support my freedom as a parent, to make these decisions with trained professionals to keep our children safe, to help me protect my.

[Dr. Scott Leibowitz]

Children, beg for their kids lives, sit there, look at a committee and plead with them not to do this.

[Laura Edwards Leeper]

I'm asking you to stop the hate and I'm asking you to stop this bill.

[Dr. Scott Leibowitz]

It's horrible. It's awful to watch.

[Scott Leibowitz]

When the ban finally passed in December 2023, it went on to the state's Republican governor, Mike DeWine, for a signature. And briefly, it looked like things might go differently in Ohio. DeWine had been on a listening tour and heard from people on all sides of the issue. Critics and detransitioners, as well as trans kids, their families and their doctors. He met with Scott, who impressed on him that his clinic looked nothing like what he might be hearing about.

[Dr. Scott Leibowitz]

That's not to say that other people approach the care, certainly in a different way than I do, but they're just not following the standard of care. So you don't create a law to ban the care for everybody just because some people are interpreting the standard of care in a way that's not appropriate.

[Scott Leibowitz]

Not long after, DeWine became one of just two Republican governors to block their state's bans on gender affirming care for kids.

[Dr. Scott Leibowitz]

But we all knew that that was not necessarily something that was going to last.

[Scott Leibowitz]

Just a few weeks later, in January 2024, the legislature overrode the governor's veto and the ban was scheduled to go into effect later that year. Under a grandfather clause, existing patients would be able to continue with the medications they were already taking. But for any new patients, it would now be illegal to prescribe puberty blockers or hormones to treat gender dysphoria. It would also be illegal to perform surgeries, illegal to refer any kids out of state for these treatments, even illegal, to give a child a diagnosis of gender dysphoria without the consent of a parent or guardian. And it all seemed to emphasize that the fight in the US Was no longer really about how the care was being provided to kids. It was about whether it should be provided at all. From the New York Times, I'm Austin Mitchell. This is the protocol with Azine Qureshi, Part six, the now.

[Azin Qureshi]

And so, as much as you can, getting into specifics without any, like, identifying patient details. Details. But just can you sort of walk us through specific scenarios, clinical scenarios that you were facing in those final months before the ban went into effect?

[Dr. Scott Leibowitz]

Okay. You had different clinical scenarios depending on where kids were at in their treatment or where they were at physically as well.

[Scott Leibowitz]

So Scott said the ban had put families at his clinic in all kinds of bad positions. And he talked about three groups of patients in particular.

[Dr. Scott Leibowitz]

I'll start with the young kids.

[Azin Qureshi]

Pre puberty.

[Dr. Scott Leibowitz]

Pre puberty, but, like, on the cusp of. And we're talking now, kids who know their gender for almost. Since they can talk.

[Scott Leibowitz]

The first group was kids who more closely fit the patient profile of the original Dutch cohort.

[Dr. Scott Leibowitz]

Like, more than half their life, they know themselves as a particular gender. They can't even imagine anything else. It's so clear.

[Scott Leibowitz]

These were kids who had identified as another gender since early childhood, were in ongoing assessment and therapy, and were just waiting for puberty to start in order to begin getting blockers.

[Dr. Scott Leibowitz]

And knowing that there's now this date that is coming, and they're not sure if their body will go into puberty by that point, that increases the stress level of those parents in ways that you would not want to know. So those families, what normally would be just a puberty check once in a while, are wanting to get checkups much more often because they're hopeful that their kid's body's sending some sense of, you know, like, it's changing. And then biologically, there's some sign of that, so that they can be eligible for the treatment before the ban goes into effect.

[Azin Qureshi]

But then, even for those kids, then, if they go on blockers, if they did start puberty and they initiated the puberty blocker before the ban went into effect, what would they do for the next step?

[Scott Leibowitz]

Like, under the ban, even if a child was grandfathered in on one medication, they couldn't start a new medication, meaning kids on blockers wouldn't be able to move on to hormones.

[Dr. Scott Leibowitz]

So then there was another group of kids, and this is probably the Most complex of all the groups are the kids that are on puberty blockers who are not appropriate or eligible for any treatment yet thereafter.

[Scott Leibowitz]

So the second group of patients were the ones on blockers who had been working with Scott and his team to decide whether or not to move on to hormones. Suddenly they were being rushed to make a decision that Scott wanted his patients to take time to consider.

[Dr. Scott Leibowitz]

Having a deadline by which a choice is removed, caused, lose, lose scenarios for all of us, like unethical situations.

[Scott Leibowitz]

Either one option was to go off the blockers and resume natal puberty, which.

[Dr. Scott Leibowitz]

Then goes against why they're on the puberty blockers in the first place.

[Scott Leibowitz]

Another option was to start on the hormones right away, before they'd had the time to fully explore that next step.

[Dr. Scott Leibowitz]

Challenge them, ask the questions that people are afraid to ask them.

[Scott Leibowitz]

Or they could stay on the puberty blockers until they could get treatment at an adult clinic when they were 18.

[Dr. Scott Leibowitz]

Which is medically incompatible with any form of healthy functioning. You need sex hormones.

[Scott Leibowitz]

But doctors don't recommend keeping kids on puberty blockers for this long because of the risk to bone health and emotional and cognitive development.

[Dr. Scott Leibowitz]

So these kids who were in treatment with puberty blockers had really no reasonable, and still have no reasonable option for them.

[Azin Qureshi]

What are they doing?

[Dr. Scott Leibowitz]

I wish I could tell you. I wish I could tell you. Crying, moving, feeling helpless, hopeless, and as though their lives are destroyed.

[Scott Leibowitz]

And then there was the third group.

[Dr. Scott Leibowitz]

So then there are the kids that are in decision making prime, right? There's an option for a treatment, but then it's kind of doing what we normally would do and be working through all the issues that we need to be working on.

[Scott Leibowitz]

These were patients who were less likely to fit the profile of the original Dutch cohort. They might have first started seeking treatment for gender dysphoria as teenagers and they might have had a more fluid or non binary sense of their gender, or they might have had serious psychiatric or other medical issues that needed to be addressed and a course of treatment had not yet been decided.

[Dr. Scott Leibowitz]

And that is a really challenging group to work with under the pretense of your choices being removed in a few months and that timeline getting closer and closer. And it puts us as doctors into the hot seat where if we disagree that a person should be going on to treatment because then it's like we're doing the worst thing to this person because we're worse in some ways than the legislator. Like, and so to.

[Azin Qureshi]

Because this, because basically the ban going into effect and you saying Actually, I don't think this is the right thing for you. Feels like you're standing in the way of them doing something for the next potentially like five years.

[Dr. Scott Leibowitz]

Yeah, right. Like knowing that, like my clinical judgment not being in agreement with what my patient feels creates an immense amount of struggle and tension in the clinical relationship. It exacerbates their already challenged mental health issues that they're going through. So they're coming to a psychiatry appointment and going home with a degree of hopelessness. I think when hopelessness enters the picture, which is what these bands do, hopelessness drives people to desperation and it drives people to experience the worst of whatever mental health they were previously predisposed to. It exacerbates and intensifies that. Right.

[Azin Qureshi]

So when did the ban actually go into effect?

[Dr. Scott Leibowitz]

So August 2024, HP68 began. It actually went into effect. I mean, it's so awkward how, you know, 10 o' clock that day, in the morning you're practicing and then at 12 o' clock you get the text that, oh, by the way, now it's illegal. You know, that's how it went.

[Azin Qureshi]

Wow.

[Dr. Scott Leibowitz]

Yep. Like, okay, this is now over. And we are now no longer here to help people make a choice or think through whether this choice is appropriate or not. We are here to help them navigate life with what they are allowed to do.

[Scott Leibowitz]

That's after the ban went into effect, Scott spent a few months working with kids in this new reality.

[Dr. Scott Leibowitz]

A lot of kids were just like, why do I have to come to this appointment? Oh, you know, if I can't have it, I can't have it. So what's the point?

[Scott Leibowitz]

And then at the end of the year, he left.

[Azin Qureshi]

Do you think this, like, could have gone differently or. I mean, I don't know how much hindsight you have right now, but, you know, something we've been talking about a lot was just where this started. And all that's changed in so little time in like two decades since Ana, Lou and Peggy first started doing this work. Do you think sort of part of the problem was how it played out in the US or do you think this was inevitable? It just so curious how you view this.

[Dr. Scott Leibowitz]

I definitely know that Dr. Edwards Leaper, Laura, has shared her feelings on this, and my feelings largely mirror hers.

[Scott Leibowitz]

Laura's fear had been that as clinics in the US started to move away from the assessment based model, at the same time that more patients and a more complex group of patients sought care, a growing number of young people would come to regret their decisions. And she worried that Those experiences would be weaponized by opponents of the care and cause a backlash. When she first started expressing those fears publicly back in 2018, advocates had said that focusing on detransition was alarmist and harmful. But by 2022, opponents of the care were effectively amplifying the voices of these young people to help push through the bans on care necessarily drop. That's when a small but outspoken group of mainly young women who had transitioned as adolescents and later regretted it became recurring figures on right wing media and in public testimonies in support of the bands. They talked about how they felt misled or neglected by their doctors. Some talked about feeling rejected by the trans community when they decided to detransition.

[Azin Qureshi]

I do think detransition has been like the central thing that these legislators have been able to point to, to say, yeah, that is real harm. And so as a clinician, how are you thinking about that outcome?

[Dr. Scott Leibowitz]

That's a really good question. Well, I approach the whole issue on detransition and regret in the same way I approach everything else that that community, which I am learning more about and actually very interested in serving and understanding.

[Scott Leibowitz]

In a field where the research is still growing, there is very little reliable data on detransition. Out of all the young people in the US who identify as trans, which the most recent data says is about 3% of high schoolers, only a small fraction medically transition and only a small fraction of those young people will detransition down the line. Advocates often say the rate is as low as 1 to 2%. But those rates are based on data that is decades old or data from a narrow subset of patients, like those who got surgeries or changed their legal gender status and later felt regret, which is not the case for many people who detransition. Almost all the data comes from people who transitioned as adults. More recent research suggests the figure could now be more like 5 to 10%.

[Dr. Scott Leibowitz]

And I am curious more about what the d trans community has to say about the way their care went and how they feel they approached that decision in the first place.

[Scott Leibowitz]

Scott said that as he's come to better understand the issue, it's reinforced for him the role of assessment. And increasingly, the field as a whole has been acknowledging that it is important to better understand these experiences. But many providers and advocates say that the potential harm of young people receiving care is still vastly outweighed by the harm of them not receiving care.

[Azin Qureshi]

Can I, can I ask a sensitive question? Just. I think we there often hear, you know, kids are going to die as a result of these bands. What do you think of that statement?

[Dr. Scott Leibowitz]

Ooh, that is a heavy question. Well, I do think that suicide and suicidality is far more complex than what is being talked about and how it's reduced down to that.

[Scott Leibowitz]

The data continues to show that transgender youth report much higher rates of suicidal thoughts and suicide attempts than the general population. A recent CDC survey of high schoolers found that about one in four transgender teenagers reported attempting suicide in the last year. More than twice the rate reported by cisgender girls and five times the rate reported by cisgender boys. And many trans people who have received gender affirming care say that it saved their lives, that they can't imagine what would have happened if they hadn't gotten the care. This is still one of the most powerful cases advocates make for why the care should be protected, that it's life saving. At the same time, the data doesn't clearly show that puberty blockers or hormones cause the risk of suicide to decrease in kids. What the data does show clearly is that having supportive families can help protect these kids.

[Dr. Scott Leibowitz]

So I do push back on using one really harmful potential outcome as a means of defending against a particular policy. That is one possibility, but it is not the possibility for everybody. And so to focus in on just the most extreme of possibilities, I think does a disservice to so many people because sitting around in agony and discomfort and just like being avoidant of the world, even if a kid doesn't end their life, like that is also happening. Like, what's wrong with protecting quality of life? What's wrong with saying banning this care is wrong because it negatively affects people's quality of life? Which is fully true.

[Azin Qureshi]

And so just this question of like, do you think things could have gone another way as someone who's, you know, now lived through a state where the politics have taken away this care? I mean you were, you were, from everything you're saying, you were, you were trying to like do this and in the way that you thought was the most ethical and briefly convinced the governor and that was not enough. Do you think that this could have gone another way?

[Dr. Scott Leibowitz]

Yeah, I mean, that's a hard, hard question to answer. I think originally felt very strongly that a lack of consensus on how to approach care was single handedly responsible for its demise at this moment. But over time I have really changed my tune internally to think that it really doesn't matter how the care is provided, that there is such a laser focused mission that has a very well oiled financial machine behind it in politics on the right that is destined to eliminate trans care and basically trans rights and trans people from existence. Right? They're just trying to create a society that they feel is ideal, and that's a society that has people with two sexes and that their gender is automatically what their sex is, and that the role of that gender is predefined. That is what that side wants and is in power and is able to get. And so because there's zero degree of nuance in today's culture or society, I feel like this was not preventable. And that's why I think this whole debate, this whole culture war, unfortunately, is hard to solve when people aren't on the fundamental same page about the existence of a trans identity and the fact that it is a valid identity. Like, we all have to agree on one thing before then we can start talking about the nuance.

[Scott Leibowitz]

Just weeks after Scott left his clinic.

[Transgender Advocate]

The new president has ordered the federal government to recognize only two genders, male and female.

[Scott Leibowitz]

President Trump took office and within hours issued his executive order declaring it the policy of the United States that, quote, sexes are not changeable and are grounded in fundamental and incontrovertible reality. The order called it a false claim that males can identify as and thus become women and vice versa. One week later, families and transgender advocates.

[Mike DeWine]

Concerned about a new executive order, Trump.

[Scott Leibowitz]

Issued his more targeted executive order entitled Protecting Children from Chemical and Surgical Mutilation.

[Azin Qureshi]

This order calls for the Secretary of Health and Human Services to, quote, take all appropriate actions to end the use of gender affirming care for young people.

[Scott Leibowitz]

And then, starting in March, the Trump administration has targeted hundreds of medical research grants funded through the National Institutes of Health. The Trump administration began to cut funding to hundreds of studies relating to LGBTQ health, including studies relating to gender identity. But the White House ordered the NIH to begin funding studies into regret and detransition. In April, the Attorney General, Pam Bondi, issued a memo saying that the Department of Justice would work with states to prosecute doctors who provide gender care to minors. And in June, the FBI put a call out on X, urging the public to report any hospitals, clinics, or providers offering the care. And in the coming weeks, the Supreme Court's ruling in U.S. v. Scremetti will not only determine whether gender affirming care can be illegal in the more than half the states in the country where it's currently fully or partially banned, but because it considers whether transgender people are entitled to specific protection under the Constitution's equal protection clause, it will likely have sweeping implications for how sex and gender are defined and protected more broadly in the United States. We started this reporting with Azine telling me that this wasn't just a political story, that it was a medical story. Over the past two years, as we reported on where this care came from, who it was meant to help, and how it came to be tangled up in the politics, and the politics have intensified beyond even what many of the people we talked to imagined. But what hasn't changed is that there are still kids who are asking for help and parents who are deciding what to do. Families who have a whole range of experiences and feelings about this care, but all of whom are caught between the medicine and the politics.

[Azin Qureshi]

Since I was like five, I felt.

[Chairwoman]

Like I was born in the wrong body. When we were in preschool we were.

[Azin Qureshi]

Asked make a full body like picture with crayons of what our dream job was.

[Chairwoman]

I said, a princess.

[Scott Leibowitz]

Our youngest born female announced at the age of five that they were a boy. He cut his hair, had lines, shaved in it, and hasn't worn anything but a jersey necktie or sweatpants since. Our daughter has always known who she is since the first moment she could really express herself. She'd drape a towel over her head to pretend that she had long hair. She'd even go to sleep that way. One day after preschool, she gathered up all her quote unquote boy clothes and threw them in the garbage and announced she wanted to start dancing because that's what girls do.

[Azin Qureshi]

When she was about eight years old.

[Scott Leibowitz]

She would ask me if she died, could she come back as a girl.

[Chairwoman]

I've been trans ever since I can.

[Scott Leibowitz]

Remember and I used to say that.

[Laura Edwards Leeper]

I would cut my boobs off with.

[Chairwoman]

A pair of scissors when they grew in.

[Azin Qureshi]

I am a mother to a 13.

[Laura Edwards Leeper]

Year old transgender son. It took us, her progressive parents, a long time to catch up with her.

[Azin Qureshi]

Longer than it should have.

[Laura Edwards Leeper]

At that time in her life. She had no history at all with gender confusion or other gender related matters. None.

[Chairwoman]

I was actually a real girly girl when I was a kid. Then as I got a little bit older and started to go through puberty, that changed a little bit for me. That made me very unhappy. I definitely felt like I didn't know what I was doing anymore.

[Transgender Advocate]

I am a 26 year old trans man from Boston. Obviously I am no longer a minor. I grew up with persistent gender dysphoria. I didn't know what it was at the time. My family and I all assumed that I was this extreme tomboy and I would grow out of it. As I got older, as puberty got closer, I began to fear that I might not grow out of it. I became severely depressed. When puberty did hit, I became practically catatonic. One day, someone at school called me trans as a joke. I went home, I googled it and suddenly discovered that there was a name, there was a term for this thing that had tormented me my whole life. And at first I was. I was crushed. I realized that this meant that I wasn't going to grow out of it. As I spent more time learning about the medical options, the feeling of being crushed started to shift into hope. I could imagine adulthood for the first time in my life. When I thought about growing up to be a man instead of an adult woman, I could imagine a future that didn't make me want to crawl out of my skin. I told my parents and my parents, finally, I think understanding the source of my discontent, were hesitant, you know, at first, and had lots of questions, but ultimately saw how much happier I was to have this hope in my life.

[Laura Edwards Leeper]

Our son came to us and said that he thought he was transgender, and it just didn't seem right. Our son had never once shown any discomfort with his sex. It seemed like more of a religion than anything. When I took him to the pediatrician, she ended up giving him all this information on the gender clinic, which I found very disturbing. I certainly never expected a pediatrician to support this idea. Our experience with pediatric gender affirming care.

[Azin Qureshi]

Was scary at first for mom and.

[Laura Edwards Leeper]

Dad, not for our son. We obviously did not enter into it lightly.

[Chairwoman]

We started going through a very long.

[Azin Qureshi]

Process, a great amount of counseling, many surveys.

[Transgender Advocate]

Our children have been required to be in therapy throughout the process.

[Scott Leibowitz]

We needed a referral from our pediatrician. We had a meet with a social worker from the hospital, and our daughter needed to attend talk therapy from a professional that dealt with trans kids. She seemed like she cares about kids. She didn't seem pushy, but she also was willing to prescribe puberty blocking medication after a one hour consultation without any outside counseling. I said, you know, isn't there supposed to be a period of counseling to determine whether the child really needs this? And she said, no, that's not the guideline anymore.

[Chairwoman]

I was fully immersed in this world of doctors are extremely transphobic. They're gonna try to test you to see if you're really trans. Doctors are there to gatekeep you, so what you need to do is you need to lie to them. So then in my mind, why am I gonna Go see this person just to lie to them.

[Azin Qureshi]

It was so heartwarming and relieving to.

[Chairwoman]

Know that there were people in the.

[Azin Qureshi]

Medical profession who understood what my son was going through. It was a long process, but not in a bad way. I felt like it was very thorough. It wasn't like they were pushing me to put him onto hormones.

[Laura Edwards Leeper]

We have been really concerned about estranging our child, but we also have been, you know, really concerned about this as a better option. This experience has been pretty hellish.

[Chairwoman]

When.

[Transgender Advocate]

I was 17, and after a year.

[Chairwoman]

Of careful deliberation, being examined to make sure I didn't have any other underlying.

[Transgender Advocate]

Conditions, my mom said, no, we're going to wait a little bit because we need to do other things to ensure that you will not regret this decision.

[Chairwoman]

Later on.

[Transgender Advocate]

I told her straightforward would you rather have a child on hormones or a dead child? And she made that decision pretty quickly.

[Chairwoman]

And finally gave me the authorization to start the hormones.

[Dr. Scott Leibowitz]

I can say that gender affirming care.

[Transgender Advocate]

As a pediatric patient absolutely saved my life.

[Chairwoman]

Knowing that there was a solution to the immense emotional pain he had been feeling for so much of his life was a welcomed relief.

[Azin Qureshi]

He went from not doing any schoolwork.

[Dr. Scott Leibowitz]

To getting straight A's in all honors classes.

[Laura Edwards Leeper]

She is more open, she is confident.

[Chairwoman]

She can look people in the eyes.

[Laura Edwards Leeper]

He used to not hug me, and now he hugs me. He's no longer depressed.

[Chairwoman]

It was this like, push and pull between I made this horrible mistake. I think I made a mistake and, well, you're committed for life. There is no going back. And I felt I didn't know what to do with my thoughts because I was still so involved in these online communities and my entire social circles would abandon me or would decide that I was a horrible person, which they did eventually. But in that world, detransition doesn't happen, or at the time it didn't happen. And if it does happen, it's because of transphobia. And that didn't describe my experience. So I didn't know what my place would be because I can't just walk away from it. My body will be trans forever in some ways. So I just had the hardest time even thinking about it because what was I going to do about it if I were to accept that I'd made a mistake? I was terrified to feel regret because what would that say about this medicine?

[Transgender Advocate]

My transition care prevented the irreversible changes that my body was going to go through naturally. And those were the changes that haunted me. And I was saved from that my voice never developed as an adult female. So my vocal cords responded well to testosterone, my hips didn't widen, and mentally that meant that I could finally just be a kid.

[Austin Mitchell]

I've got four kids and one of them, our 14 year old, is trans. My wife and I decided a few months ago that we needed to pack up and move to Connecticut. When I heard the times, when I heard your invitation, I was in the middle of packing. You know, how has this impacted us? Well, you know, beyond needing to move, we lost our gender affirming care for a bit. And then just the, you know, the lack of confidence that she would be able to continue to get the care she needs and deserves. And further executive orders that targeting teachers, administrators who use pronouns for kids, not the ones that they identify by. All this has made this not a safe place. It was already not a safe place, but now we actually feel like asylum seekers in our own country.

[Laura Edwards Leeper]

Families are talking about how to get affirmative hormones underground if needed. I've been dealing with an excellent endocrinologist. She has been giving us all sorts of insights into stockpiling testosterone. My child is afraid to pursue any hormonal therapy. He wants a deeper voice and a more masculine body, but he thinks it will be worse to experience that and then lose it. I worry that not only will gender clinics stop providing gender affirming care for minors soon, I also worry that my husband and I could be criminalized for allowing our son to receive care. Every parent of a trans kid who I know is either exploring options for emigration or is actively emigrating.

[Dr. Scott Leibowitz]

We already knew things were going to get better, so we had planned on leaving in July. However, when Trump came out with all of these anti trans executive orders, bills, all sorts of stuff we knew was.

[Scott Leibowitz]

Escalating more than we thought.

[Dr. Scott Leibowitz]

So I sold all our stuff, sold our beloved house. We loved everything about where we lived, but, you know, safety is most important.

[Laura Edwards Leeper]

We were freaking out trying to figure out where we were going to get him. Puberty blockers and testosterone. And did I need to fight to Mexico? Did we need to move to Canada? The actions of the government have impact us so much that we are moving to Barcelona, Spain in the next two weeks. I've personally gone dark digitally regarding anything to do with my child. My email, messaging app, digital documents, photo storage are all encrypted. I'm lining everything up so that everything looks as if he was born a male. I would do anything for my child. I will do anything to save him.

[Austin Mitchell]

Our hope is, is that in Connecticut, the powers that be will be able to protect us and that my daughter will be able to get the care she needs and be in a community that will celebrate her for who she is. We're leaving all her friends behind. We've been here for 13 years. All our family lives in the South. We'll be a thousand miles away. It's. I don't know. The whole thing is heartbreaking. My wife cried a bunch this morning because we're going to do a big farewell party this afternoon and do a little country boil and say our goodbyes.

[Chairwoman]

Okay. In terms of do I think it should be banned? No, I don't think it should be banned. I know people who it works for it, and I just wish that it could be seen as more complicated than it is right now. I understand very well why a lot of detransitioned people do support these bans. For people who detransition and are coming out of that in a lot of grief, often losing their whole communities, often losing their friends. You just have nowhere to go. Except there's a lot of Republicans who are happy to tell you that what you went through is so horrible and they want to make sure it never happens again. And will you participate in that? There are problems, but the problem is not trans identities. The problem is not social media. The problem is not that this medicine exists or that it's used to treat dysphoria. The problem is a bunch of smaller things that have a very. A very bad outcome when they connect with each other.

[Laura Edwards Leeper]

Feels like we've been caught up in a really political storm of like, either you're for this or against this.

[Azin Qureshi]

And we're very much in the gray.

[Transgender Advocate]

Now that I'm an adult, I. I realized that I was not only saved by this care, but I was also saved by time. I witnessed the attacks on medical care that allowed me to become the man I am today. And it makes my stomach churn to think that had I been born in a different state or even if I had been born 10 years later, that I could have been forced into a life that I don't even know how to conceptualize. And I know that this debate is complicated. I know that not all kids have the same unwavering sense in their gender identity. It doesn't always happen that way. And I know that regret and detransition are really issues that we need to be careful of. And, you know, the dealing with minors feels especially complicated for families, but banning that care doesn't solve that issue. When I first walked into the gender clinic you know, at 12 years old, I thought things were only going to get better for kids like me. And I certainly could not have imagined that 10, 15 years later, I would be witnessing that unraveling and that I would be making this recording and making this plea to anybody listening to. To just let us live.

[Scott Leibowitz]

Earlier this year, the New York Times commissioned a survey of Americans looking at attitudes on some of the big political and cultural issues that had driven the election, including immigration, the economy, presidential power. When asked whether doctors should be able to prescribe puberty blockers or hormones to minors, 71% of respondents said no. That broke down to 90% of Republicans, 54% of Democrats, and 61% of independents. And it reflected a far different landscape than the one that Peggy Cohen Ketnes and Ana Lou de Vries were operating in as they first began to develop this care in a small clinic in the Netherlands.

[Mike DeWine]

Yeah. Apparently, issues around sex and gender, and especially when it's about youth. Yeah. Sometimes I wonder why. Why everybody is at once concerned about it and why it's now such a big issue where there are many more problems in the world that I think affect many more people and are much more important to solve than, you know, this issue. That's only for a relatively small group, really important. And that's, in a way, a pity, because I think we have real challenges in transgender care, and we have a lot of uncertainties where we have to deal with, and we should be open to ask ourselves those questions. But if it's so politicized, it gives the feeling that you're pushed in a more extreme corner, where that room. To have that discussion and to have that debate become smaller.

[Azin Qureshi]

How do you. I mean, does that make you unsettled? Like, do you wake up in the middle of the night? What does Annalie Devries think about when she wakes up in the middle of the night?

[Mike DeWine]

Well, sometimes there's. I feel like there's a lot on my shoulders. Absolutely. Yeah. And how to best deal with it is absolutely a challenge. Yeah. But I think. Yeah. I still feel very proud of what we built here, and I really feel like we should protect it as much as possible. In that regard, I honor Peggy Cohen, Katniss. I honor Henriette de Lamar and Louis Goran, who was an endocrinologist here, and they started something, and especially because they started it together with research that I really want to be part of and make sure that we can continue with that work.

[Azin Qureshi]

I talked to. Sorry, this is the very last thing, but I did talk to the head of a gender clinic in the United States. Someone who, you know, who was basically said to me that his concern is this is going to be a thing that we did for, that we were able to do for a while that we no longer are able to do. Not just in the, you know, the states in the United States that have banned it, but just is that something you worry about?

[Mike DeWine]

So I don't think transgender individuals gender diversity will disappear and I hope that medical affirming treatment will remain available for all of them when they really feel the need for it. And under certain conditions I hope it will not disappear. But it definitely evokes very strong societal concerns and people who have no idea of how it is to be or to experience this seem to be very concerned about it and have strong opinions and yeah, that's politics.

[Scott Leibowitz]

The Protocol was researched, written and reported by Azin Ghreshi. It was produced by me, Austin Mitchell, Larissa Anderson and Luke Van der Pluke, with production help from Eli Cohen. It was edited by Lisa Tobin, Larissa Anderson and Paula Schumann. Fact checking was by Caitlin Love, Jane Ackerman and Sharmila Venkatasubin. Mixing and mastering was by Daniel Ramirez and Afim Shapiro. Our executive producers are Paula Schuman and Lisa Tobin. Special thanks to Sam Dolnick, Celia Duggar, Virginia Hughes, Jim Yardley, Roje Jaquette, Mike Abrams, Susan Wessling, Carolyn Ryan, Patrick Healy, Zachary Small, Megan Tuohy, Emily Bazelon, Adam Liptak, Amy Harmon, Benjamin Mueller, Julie Snyder, Lisa Chow, Alex Bakker, Kennan McKinnon and Valentine de Hing.

[Austin Mitchell]

Sa.