‘The Protocol’: The Story Behind Medical Care for Transgender Kids

With the stroke of my pen on day one, we are going to stop the transgender lunacy.

[CROWD CHEERING]

I am so hated for just existing and being who I am.

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.

[CROWD CHEERING]

Being able to transition absolutely saved my life.

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?

Trans rights! Human rights!

You do not have the right to abuse your kids. This is cutting off their genitals!

I’m scared for myself, for my own health care.

There’s not enough evidence to put our children out on a huge experiment.

If they cannot get treatment, children will die.

These treatments do much more harm than good.

Trans kids are under attack! What do we do! Stand up, fight back!

We are not going to rest until every child is protected, until trans ideology is entirely erased from the Earth.

We are trans people! We are trans human, and we will never be eradicated!

So are you going to be able to bring that inside? No.

I don’t think so, no. We’re going to leave it out here.

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

Let’s see what they say —

OK.

— for now.

We have so much ground to cover with her.

Just getting into the history, and —

We are going to the outpatient —

It’s such a sensitive topic and —

Yeah. Well, it started very long ago.

I’d just had my PhD, and I became —

— first follow-up study in the Netherlands.

This is for adults.

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

I was also a psychotherapist.

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.

These kids already had a lot of mental health care. They’re functioning quite well.

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.

I said, can we do something about that age limit? And they said, OK, we can start it a little bit earlier.

It looked promising.

— 14 – and 15-year-olds, and then an occasional 12-year-old.

And then I came across FG.

— that’s when a kid walked into her office and offered an unexpected solution.

I don’t know exactly how we’ll refer to him.

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

His voice? He knows I’m recording, right?

He knows you’re recording.

So we’re coming up on his number.

Hi.

Hi. Perfect.

Hi.

Nice to meet you.

— to meet with the first person ever given puberty blockers to treat gender dysphoria. [DOG BARKING]

Do you mind if we keep the shoes on?

Yeah, oh, yeah.

Yeah?

I love these big windows.

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

Can I get you a coffee or tea or something?

Can I have coffee?

If you’re going to have something —

And what is your comfort level with your name? FG is what we’re sticking with. Yeah. OK.

And I spent my whole life being covert. And so —

Yeah. What is your — do you share with people in your professional space and your —

No, I don’t.

You’re just a man in the world.

I try to get away with murder. I literally don’t tell people that knew me when I was — before my transition. No.

So they don’t know that you played this — do you feel like you played a seminal role?

I did.

Yeah, you did.

Yeah. That’s one of my bragging rights, right?

Yeah.

I was the first person, so I was like the Guinea pig.

So some people do know that — people close to you —

No, the people that — no, the people that are close to me and the people that need to know or I’ve told —

Mm-hmm.

Oh, then I love to share, because it’s something that — there’s so much that’s happened, and it explains so much of your personality, your character, 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.

Right.

Because —

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

Very vague.

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

No, but there is this coded, like, well, did he turn out OK? Did he succeed in life?

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

Right.

I mean, I could be a loser anyway, regardless. I know many normal cis people that are complete losers, so. It’s actually more than —

Well, but — I think — no, no, sorry.

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

My mother is — well, was English, because she died. My father’s Italian. And they’re quite — well, I think my mother was more liberal than my father, because he came from a small village, and he’s Italian. You probably read that in the case report as well.

But I had, more or less — I had a pretty happy childhood. But I was very — I was very aware of my frustrations, which at the time I didn’t see as frustrations. I just didn’t understand.

Right.

And I just assumed that would sort itself out.

When you say “frustrations” and “sort itself out,” you mean the things that you were drawn to or the people you were drawn to? Like, what —

Well, in the sense that — being a boy or a girl. [CHUCKLES]

Right.

And I remember being five and coming down. And I had to wear a dress thing, and I put a safety pin in between, because I wanted to be like Knickerbockers and —

Oh, so you put two to connect to the front and back?

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

That’s very innovative.

Yeah, it’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.

Wow.

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 — the usual cliche. I did — I played football, blah, blah. I 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 — 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.

You weren’t unhappy, but it was — was it an expression of frustration, or was it more just an assertion of —

Up until about 9 or 10, it was an assertion — 11. Up until then, I thought, oh, it’ll still work out. It’ll still work. 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, hmm, this is probably not going to work out how I want it to be.

It’s not going to just disappear.

And my parents, up until then, had been pretty good, especially my mom. I was close to my mom, 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, even more difficult, and demanding, and opinionated, and axes to grind. And then —

Were you angry?

Yeah, I was angry. But like I said, that made me — at school, I talked with my fists. I also talked with my mouth, because I was also very argumentative, but I wouldn’t tolerate anything. And if anyone said anything to me that I didn’t like, I’d smack them. But I would always smack people that were bigger than me. [LAUGHS]

Never very punch down.

No, exactly, which wasn’t very difficult, because I was small anyway. But no, I was quite explosive, which —

And your friends, were they — you said they were mostly boys?

Yeah.

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 — well, it came up, but probably — and I don’t know what happened behind my back. I don’t care. I certainly didn’t care. But there was — 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 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 then I — and so I went to the — I said, I want gym on the other side. And they went, OK. 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.

Wow.

And I was convinced that she was the same. And she just turned out to be quite a butch lesbian.

Right.

What are they?

Yeah.

Yeah.

But it is interesting, thinking about that time and what you were saying about your anxiety increasing — that that is when the splitting starts to happen, both with puberty and with school and with sexuality and everything is — so was that all weighing on you at that time?

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

You mean puberty?

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, hoping that they read them. And then so my mom found one of these really pathetic poems and — which, clearly, I’d left there. And then she addressed it, and she —

Do you remember what the poem said?

It was along the lines of, 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 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.

Yeah.

So that was the general sense of it, that I was feeling hopeless and desperate and blah, blah, blah, blah.

Did your mom react in the way that you wanted, which was to get out —

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, and 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.

And so you were 12, so that would have been ‘86?

Yeah.

Was your body changing? Were you —

It was changing, but it was just, like it was prepubescent. And I can’t remember how long I was in conversation with this psychologist. But she put me on to Delemarre, who sadly has passed away.

So I went to see her. I didn’t have a clue who she was. And she listened to my case. I think Louis Gooren came into it as well, who’s also just died, and —

Who was also —

Yeah, he was the father of the whole gender team.

For adults, right?

Yeah, yeah.

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

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 blockers.

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

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

Yeah.

And I’m not sure if the conversation had come up that, well, normally, what we do is, when you’re 16 or 17 — because I think that was when they started putting — 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 I 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 just want to wake up, and I want to have 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, and it made me vulnerable. And my whole life, I was not about being vulnerable. So yeah, in a nutshell, that was — I just analyzed it. That’s probably what it was.

Yeah.

And so they — so they took me seriously, and I think they said, well, this is such a bloody convincing case.

Mm-hmm.

Great idea to experiment on this child. My parents were behind it.

They were?

Yeah.

So, I mean, you used the word “Guinea pig” earlier. Were they —

Aware?

— aware?

Don’t think so.

You don’t think they were aware it was the first — you were the first?

Yeah. No, I don’t think I was aware that I was the first.

Really? Oh, wow. OK.

But I mean, it wasn’t completely new, because these hormone blockers were being given to kids that were entering 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?

Or at least clinical experience.

Clinical — yeah, exactly.

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

No, because there was an alternative.

It was sort of irrelevant.

Yeah, I was like, otherwise, I’m leaving. I’m leaving this world — which I wasn’t, but it was that kind of — that was like —

That feeling was there.

It was like, there’s no choice. We have to do something. This is not OK. I’m not doing this.

Yeah.

I was like, putting my foot down.

Yeah.

No. I could be very pigheaded. [CHUCKLES]

Yeah.

Said, no, I’m not doing it. Nope, nope, nope, nope, nope. So, puberty, that was.

I mean, it literally saved my life. So I feel indebted.

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

Yeah. 12 or 13.

Uh-huh. Do you remember the first time getting it 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, so body-critical, I didn’t want them to inject it 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.

And had you met Peggy?

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

Yeah, I had to do a lot of psychometric and psychological testing anyway at various points in time, and I remember doing it with Peggy. I filled in a lot of paperwork.

Yeah, yeah.

A lot of questionnaires and —

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

OK.

Because —

Why —

Because I didn’t want to have to explain myself. Now, I just — I had 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.

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 what 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’d said, hello, well, this is what’s going to happen. Stand up in class and out yourself. I don’t want to do that. I never wanted to do that. So I chose not to.

Yeah.

And maybe that’s my own little hangup, but that’s just pretty much how I went through life.

Empowering there.

Yeah.

I mean, when you —

I think that year was a bit stressful, to be fair, because you have this kind of underlying stress and 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 a — 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 it was — you’re always thinking about those things, plus toilets. But —

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

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 — so I just didn’t want to be seen.

Right.

But there is still that transition of old life, new life. Who am I going to run into? What do I have to say? I’ve — even at university, I ran into people that were from my school.

Yeah.

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, blah, blah, blah, and my voice is lower. And I went, oh, by the way, 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.

Wow.

But there were a few dicey 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 even — I made it ridiculous, because I said, oh, what, you think I want to be a girl?

I just turned around, and these people were so confused that they dropped it. But that was pretty — 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 — that people start to look at you differently. And I’m like, no, that’s exactly what I don’t want people to do, or feel that they have a special bond with me because they know something about me, which, at the same time, it’s OK, 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 people still do. 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 for.

I’m responsible for how smart I am, what I’ve done with my life. So you’re the loser. But not about how I was born into a body that didn’t belong to my mindset. And the only thing I can do is deal with it and be successful at it.

[THUD]

That was —

No, so anyway, so I have a lot to say about — but the other thing — oh, fuck 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, no, I will not be treated in a different way or have the idea that you feel superior because, oh, poor you. Fuck off. That hasn’t actually happened. But I’m just — just to give you an idea of how my mind works.

Well, that — what you went through as an adolescent is still with you.

Oh, absolutely. And that’s what’s formed me. And that’s how — that’s why I said, I’d 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.

Right, right.

But it is a big deal. No, it’s like, oh, be the martyr. In my first year at university, I had three operations. Nobody knew about it.

Wow.

And I completed my first year with flying colors.

Wow.

And I didn’t think anything of it. And then, all the years to come, I had — I was in and out of hospital with operations, and even a complication, where I had to rush myself off to hospital because I couldn’t pee anymore.

Oh, my god.

But nobody had a clue. And then I had to make a story around that. And I thought, god damn it, I did all that.

Yeah.

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

Yeah. I guess just this idea of wanting, your whole life, to blend in and blending in — 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?

Yeah, 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 coming from that particular narrative and being narrow-minded.

Right.

My conclusion now is that I find that it’s gone — it’s 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. In the ‘80s, you were a punk, too. We always 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, where you 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 just pure, like, proper transsexuals, this flirting with pronouns and gender identity — it’s insulting.

Because like I said, we spend all our time trying to just fit in or be able to live the life that we feel we should have had. And it’s not a 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 talk about things that we don’t want you to talk about, so that they can identify you. But maybe that’s my own — I’m still stuck in my own paradigm.

And maybe that shouldn’t be a taboo. Maybe we should break it open, and I don’t know. That’s not how I feel, but I — intellectually, I have to think about that.

Right.

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

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

Yeah.

Because of him, we thought maybe we should do this more often, giving the blocking hormones.

Give them more space and time to think about the decisions.

But you cannot just start and do whatever you want, particularly in the beginning, when you have no idea whether what you are doing is OK.

How would you define the Dutch protocol?

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

Because 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. I mean, look at FG.

What’s your name?

My name is Azeen Ghorayshi.

Hello.

Hi, Annelou. It’s good to see you.

Good to see you. Hi, hello.

I’m Austin.

I’m Annelou. Hello. Hello.

Look, Elon and I had a great relationship. I don’t know well anymore. I was surprised because —

And I’ll tell you, it’s not — he’s not the first. People leave my administration, and they love us. And then at some point, they miss it so badly, and some of them embrace it, and some of them actually become hostile. I don’t know what it is. It’s sort of Trump derangement syndrome, I guess they call it, but —

We have it with others, too. They leave, and they wake up in the morning, and the glamor is gone, the whole world is different, and they become hostile. I don’t know what it is. Someday, you’ll write a book about it, and you’ll let us know.