Podcast Summary: The Protocol – Episode: The Now

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

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.

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."

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."

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."

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?"

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.

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.

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."

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.

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."

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."

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.