Beneath the Surface of The Protocol

Not everything is as it appears in the New York Times podcast by Azeen Ghorayshi and Austin Mitchell

Beneath the Surface of The Protocol

Appearances can be deceiving. Just as blocking puberty, administering wrong-sex hormones, and performing surgeries can create the illusion of a person living a thriving life as a member of the opposite sex, so too can a six-part podcast that tracks the puberty suppression experiment from its origins to the present day, that is bursting with firsthand accounts of key figures from both sides of the story, give the impression that this is a thorough, in-depth account of the entire medical adventure.

Yet, in both scenarios, all is not quite what it seems. To understand what’s really going on, with the young people who have been experimented on and within the scandal of pediatric gender medicine, you have to be willing to dig far deeper. Look way beneath the surface.

In its new podcast, The Protocol, The New York Times failed to do this—perhaps because its audience isn’t ready for such depth, or perhaps journalist Azeen Ghorayshi has somehow managed to spend years immersed in this scandal without ever fully understanding it. Or perhaps it’s because The New York Times played such a pivotal early role in promoting this medical treatment and the ideology that sustains it, making it impossible for the flagship outlet to face the truth head-on.

Whatever the reason, the sanitized themes are clear from the start. Minutes into the introduction, transgender identities are framed as natural and healthy, and psychotherapeutic attempts to help an adult reconcile body and mind are dismissed as “corrective.” The early pioneers—figures like John Money and Harry Benjamin—who abandoned talk therapy in favor of the impossibility of medical sex changes, are portrayed as compassionate and forward-thinking. And when it comes to adults, the practice of destroying functioning endocrine systems and cutting into healthy bodies is sound medical practice that is not up for debate.

The Dutch pioneers of the puberty suppression experiment are treated with the same unquestioning deference throughout the entire series. Their approach is presented as a careful and reasonable response to the terrible suffering experienced by a tiny number of young people who feel they are trapped in the wrong body. The series places much emphasis on the psychological assessments preceding treatment, which are presented as a way to detect the real “trans kids,” and therefore the whole scandal is blamed on the recklessness of US doctors who didn’t follow the protocol as it was intended.

Then, there are the fascinating, and revealing, interviews with FG—aka Patient Zero in the puberty suppression experiment—and Manon, one of its earliest participants. These cases are presented as success stories, but a closer listen reveals regret, emotional distress and foreclosed futures. Yet, instead of grappling with what was lost, the series frames their transitions as inevitable and necessary, treating lifelong medicalization as the only path to a fulfilling life. In doing so, it reinforces the very premise it ought to interrogate—was the Dutch model ever appropriate, safe, or justified?

Mistakes Were Made (but not by the Dutch)

What’s most striking about the interviews with Peggy Cohen-Kettenis and Annelou de Vries—two of the pioneers of the puberty suppression experiment—is the absence of remorse. Despite the growing scandal and evidence of harm, neither appears to question the consequences of what they set in motion. Both remain unwavering in their belief that their protocol was justified and continues to do good. They are still convinced that their assessment process could reliably identify the true trans kids, and show not a glimmer of doubt about whether adolescents can consent to life in permanently altered bodies with drastically narrowed possibilities. Their dubious metric of success—whether a young person “passes” as the opposite sex—remains firmly in place.

Also notably absent were the difficult questions from Ghorayshi and Mitchell. At no point do they put it to de Vries and Cohen-Kettenis that this was, and still is, medical experimentation on healthy children and adolescents. There is no serious challenge to their core assumption that if gender dysphoria persists or intensifies at puberty, it is likely to be permanent—an idea lacking in any empirical evidence. Nor is there any acknowledgment that even with thorough psychological assessments, it remains impossible to reliably determine which young people will persist in a cross-sex identity into adulthood and which will naturally desist.

There is also no recognition that subjecting minors to irreversible medical interventions contradicts everything we know about adolescent identity development and the neuroscience showing that the brain remains under construction well into the twenties. Crucially, the podcast never confronts the possibility that many of these young people—if given time and space to mature—would simply have grown up to be gay or lesbian.

Instead, Ghorayshi and Mitchell allow the pioneers to speak unchallenged, reinforcing a narrative that frames permanent medicalization as a compassionate solution—rather than exposing it for what it is: a deeply flawed, ideologically driven experiment on healthy, but vulnerable, youth.

According to the New York Times, mistakes have been made, but not by Cohen-Kettenis and de Vries. It’s the recklessness of some rogue players in the US field of gender medicine who ruined it for everyone.

The Spread of a Meme and the Power of Irrevocability

The fascinating stories of FG and Manon appear intended to show how important early medical intervention is for gender-distressed young people, yet each account contains clear evidence of how deeply misguided these interventions really are.

First up is FG—Patient Zero in the puberty suppression experiment. Now in her early 50s, she is jovial as she explains her decision to keep her identity hidden and laughs that she deserves “bragging rights” for her role in this historic event. It’s a dark and distasteful moment, given the devastation that flowed from the experiment she and her doctors embarked upon.

FG walks listeners through the familiar arc of childhood gender nonconformity, including a telling anecdote: in high school, she befriended a fellow tomboy, and together they joined the boys in gym class and decided they were boys. “I was convinced that she was the same [as me], and she just turned out to be quite a butch lesbian,” FG recalls. A short, simple line that captures the enormous power of ideas to shape lives.

Around this time, FG wrote a poem full of adolescent angst, with “an undertone of suicide.” By chance, her aunt had just read a “book about transsexuality” and suggested to FG’s worried mother that it might explain her tomboy daughter’s distress.

That twist of fate led to a cascade of events: a psychologist visit, a referral to Henriette Delamarre-van de Waal—a Dutch endocrinologist already using puberty blockers for precocious puberty—and then on to Peggy Cohen-Kettenis, who recommended cross-sex hormones. This team of eager doctors, swept up in the excitement of the moment, saw in FG the perfect candidate: a test case for their bold new idea.

This illustrates the cultural power of the belief that some people are born in the wrong body and that medicine can fix it. In an earlier era, a girl like FG would have muddled through adolescence, come to accept her sexuality, and grown into a masculine lesbian adult. But by the time she wrote that poem, the concept of being “transgender” had already entered the public imagination. When her aunt introduced that idea into the family, FG’s distress was interpreted through this fashionable new lens.

Such is the way culture-bound syndromes spread—starting in small pockets, then leaping from mind to mind until large swathes of the population begin to explain their suffering using the framework the syndrome provides.

As the New York Times put it: “[FG] wasn’t the first kid to feel that way, but through some combination of his conviction, the place in time, and the doctors who took him seriously, he was the first kid to get this revolutionary medical intervention.” But the podcast never acknowledges how narrowly FG missed living a full life as a butch lesbian like her friend. Ghorayshi doesn’t ask, and it’s unclear if FG has ever allowed herself to consider it. Through no fault of her own, she was swept into an experiment that offered only one path. She is not to blame for being made the guinea pig in a medical misadventure she was far too young to understand.

Then there is Manon. Perhaps some will listen and hear an inspiring success story, but it’s difficult to see how. Now 30, Manon is living with the irreversible consequences of medical decisions made when he was still a child. He vividly describes a moment at age 16 when he was asked whether he wanted children—a question he could not possibly answer. Faced with the distressing alternative of pausing puberty suppression and banking sperm, he chose to sign away his fertility. Today, surrounded by peers who are becoming parents, he acknowledges the lasting impact of that choice.

Though he insists he has no regrets, his reflections are filled with loss, longing, and the emotional walls built in childhood that he still carries. He speaks of having "put life on pause" through adolescence, only to discover that pressing play again wasn’t so simple. The disconnect between his stated certainty and the pain he describes suggests a powerful self-deception—an understandable response to the sunk cost of irreversible treatment. His story reveals a young adult who senses all that was taken from him, who knows he was too young to understand the weight of his decisions, but who cannot allow himself to regret them—because regret would mean facing the full cost of what was sacrificed. Like FG, when his story is over, one is left wondering what his life could have been.

From Amsterdam to America: Scaling Without Safeguards

Midway through the series, the podcast finally begins to confront the harms and dangers of pediatric gender medicine. It documents the sudden surge in patient numbers and the emergence of a new demographic—adolescent girls—arriving in unprecedented waves. This shift coincided with the total collapse of medical safeguards, driven by activist clinicians like Johanna Olson-Kennedy. Whistleblower Jamie Reed delivers a compelling and disturbing account of the chaos that followed, laying bare the damage inflicted by a system built on ideological zeal and blind affirmation.

But without ever questioning the foundational premise of the puberty suppression experiment itself, these episodes fall short. It’s like producing a documentary near the end of the lobotomy scandal that casts Egas Moniz’s original procedure as sound and careful, and blames the catastrophe solely on Walter Freeman’s reckless, drive-thru prefrontal lobotomies—without ever acknowledging that the entire practice was a medical atrocity from the start.

Hopkins 2.0

For anyone who’s been watching the WPATH ship take on water and wondering what the atmosphere is like below deck, Episode 5 delivers a glimpse into the chaos.

It opens with the calm reassuring tones of Dr. Hilary Cass, who speaks with the confidence of a respected professional who has the evidence on her side. She patiently explains the findings of her four-year, thorough investigation into England’s youth gender service, and just how weak the evidence base is for pediatric medical transition.

This stands in stark contrast to the interview that follows, with former WPATH president Marci Bowers. Gone is the cool composure of the celebrity gender surgeon who appeared in the reality TV show I Am Jazz—this version of Bowers sounds at the end of his tether, and the wild statements come thick and fast.

“Gender-affirming care…it is like the Holocaust,” says Bowers. “There are not two sides to this story.” He accuses Cass of lacking authority on the issue because she “has never worked with a trans person.”

“She’s had a long career in pediatrics, but not obviously with kids with gender issues, but—Well, there you go, full stop. There you go.”

Journalists don’t always need to ask hard questions or challenge absurdities head-on. Sometimes just letting people speak is the most revealing strategy of all. This is one of those moments. Contrasting Bowers with Cass speaks for itself. Whether deliberate or not, this episode paints the clearest picture of the two sides of this scandal: measured, evidence-based professionalism grounded in caution on one side, and the ideological incoherence that leads to so much medical harm on the other.

Obviously Bowers fails to grasp that what makes Cass such a trusted authority is precisely the fact that she does not inhabit the world of gender-affirming medicine—an alternate universe where children are considered to be wise all-knowing sages capable of discerning their true authentic selves and it is ethical medical care to amputate the healthy breasts of a distressed 16-year-old lesbian. Cass is an authority because she inhabits reality—where evidence matters, where medicine is cautious, and where the Hippocratic Oath still means something.

An agitated Bowers also points to “the thousands of members of the AMA, Endocrine Society, the American Academy of Pediatrics, and the APA, all with extensive experience treating this population.”

“Why are they somehow biased, and she is not?”

This stunning display of wilful ignorance would be comical if it weren’t for the ruined lives, the destroyed families, and the tsunami of pain and suffering that the capture of all these major medical associations has led to. Then comes a clownish outburst aimed this time at distinguished psychiatrist Dr. Paul McHugh, who, in his role as psychiatrist-in-chief at Johns Hopkins in the 1970s, famously shut down John Money’s gender clinic.

Despite writing about another era, when the transgender craze was still in its infancy, McHugh’s words are as relevant today as they were when he penned them. He once wrote that when providers give in to “the folly of transgenderism,” they “abandon the role of protecting patients from their symptoms and become little more than technicians working on behalf of a cultural force.”

For Bowers, the reason there’s no good quality research in the entire field of gender medicine is because of the actions of McHugh. Bowers overlooks the fact that in the years since the political tide has shifted into a more favourable direction for his field, not one single randomized controlled trial has been conducted, or has any evidence that could be considered high quality materialised.

“The truth really doesn’t lie. The research and the data, it’s certainly coming,” Bowers insists—perfectly capturing a recurring theme in gender medicine: that the evidence is always just over the horizon. No need to worry about the discarded healthy organs, the disfigured genitals, the lost fertility, or the shattered prospects for future intimacy—the scientific justification is on its way. Any day now.

Amidst all the ideological bluster, Bowers does stumble onto a truth. He calls the Cass moment “Hopkins 2.0”—intended as a jab—but the comparison holds. In John Money’s era, gender medicine was steeped in the fashions and ideals of the sexual revolution—infused with its libertine spirit, its zest for boundary-breaking, and its disdain for traditional norms. It was wacky fringe medicine dressed up as progressive innovation. Then along came McHugh, who prioritized evidence over ideology and placed the Hippocratic Oath above political fashions. The closure of Johns Hopkins’ gender clinic marked a moment when science reasserted itself over ideological zeal.

Today, with Cass’s findings, the European retreat, the HHS report, and a cascade of international reversals, history is repeating. Once again, science is making a comeback; evidence is being scrutinized and found wanting—and medical professionals are emerging from the ideological fog of trans activism and remembering their first duty: do no harm.

The Protocol rightly frames the current debate in the U.S. as no longer being about how youth gender care is delivered, but whether it should be provided at all—yet this is a question the New York Times treats as unthinkable, when in fact it’s the only one that actually matters.

Reverence, not reckoning

The podcast ends with reverence for the architects of this failed experiment. Annelou de Vries expresses unshaken pride in her role in the scandal: “I still feel very proud of what we built here… and I really feel like we should protect it as much as possible.”

She honors her fellow pioneers—Peggy Cohen-Kettenis, Henriette Delamarre-van de Waal, and Louis Gooren—for launching an experiment that altered the bodies and futures of healthy children, many of whom would otherwise have grown up to be gay or lesbian.

And, astonishingly, she deploys the familiar trans activist deflection: Why do people suddenly care so much?

Of course, the better question is: why doesn’t she care? Why doesn’t it haunt her that children with no clear diagnosis have been steered into treatments that impede their development, drastically reduce or destroy their fertility, impair their sexual function, remove their healthy organs, and severely limit their futures—long before they are old enough to comprehend what that means?

Like Walter Freeman who went to his grave still believing in his prefrontal lobotomies, de Vries cannot—or will not—see the damage she has done. She appears to be caught in what journalist Megan McArdle calls the Oedipus Trap: when the cost of facing a terrible mistake is so high, it is easier to blind yourself than to look upon it.

As a production of The New York Times—a flagship outlet, known for its standards of journalistic rigor—this podcast appears thorough, meticulous, and balanced. But as stated at the outset, that appearance is deceiving. It misses the central truths, avoids the hard questions, and fails to grapple with the heart of the scandal. In doing so, it risks misleading listeners who lack deeper knowledge of the subject, leaving them with the false impression that they’ve heard the full story, when they’ve only been offered a shallow, sanitized glimpse of a far darker reality.

By honouring those who designed and unleashed one of the most reckless medical experiments in history, the podcast not only dishonors the victims, but also dismisses the anguish of families enduring the consequences. The New York Times had a chance to tell the truth; instead, it chose to revere those responsible for the harm.

Mia Hughes is the Director of Genspect Canada and the author of The WPATH Files.