In June 2025, New York Times released The Protocol, about healthcare for gender diverse youth. The limited podcast series reflects the transphobic framing of other Times coverage by co-hosts Azeen Ghorayshi and Austin Mitchell.
Analysis
The flawed premise is that being transgender is a psychological disease rather than a trait. The podcast promotes psychologists and psychiatrists who believe they are treating a mental illness. Therefore, “psychological outcomes” are their measure of success.
Cisgender minors who receive similar gender-affirming care are not subjected to the same psychological gatekeeping. That’s because the only valid measures for the effectiveness of drugs and surgery that lead to somatic changes are physical function and cosmesis.
The podcast’s narrative is that transgender healthcare for minors used to have strict psychological and psychiatric gatekeeping. Ghorayshi and Mitchell imply that rejecting many trans people for care is worth it if that gatekeeping spares one young (read: cisgender) person from getting care they later regret. Ghorayshi and Mitchell believe that psychological gatekeeping in America has become too lax, and they want to see stricter controls or even bans on evolving models of care.
Journalists who have framed this as a public debate that should be decided by the lay public have allowed opponents of this care to use the media and government to restrict or ban this care, similar to how New York Times health journalist Jane Brody and Times contributors like Thomas Szasz helped get adult care shut down as “experimental” in 1979 after a decade of anti-trans reporting.
This podcast reflects a disgraceful unfolding chapter in American media that repeats the pattern from 50 years ago, and work like this will come to be seen in decades ahead for what it is: an assault on the rights and dignity of trans and gender diverse youth, spearheaded by ideologically-motivated cisgender journalists.
Production
According to the Times:
“The Protocol” was researched, written and reported by Azeen Ghorayshi. It was produced by Austin Mitchell, Larissa Anderson and Luke Vander Ploeg, with production help from Eli Cohen. It was edited by Lisa Tobin, Larissa Anderson and Paula Szuchman. Fact-checking by Caitlin Love, Jane Ackermann and Sharmila Venkatasubban. Mixing and mastering by Daniel Ramirez and Efim Shapiro. Our executive producers are Paula Szuchman and Lisa Tobin.
Part 1: The Beginning
The first section profiles “FG,” a conservative Dutch trans man who was the first documented patient to receive puberty blockers in a clinical setting in that country.
“FG” is a transmedicalist and transsexual separatist. In the interview, “FG” complains about how “insulting” the current trans community is to “pure, proper transsexuals”:
“It’s gone a bit extreme to the other side, so it makes a laughingstock of what it’s really about. It seems to be a fashion statement nowadays. It’s like when in the 70s you were a punker. We have to fight against something. We’re forging our identities as young people. We need to stand out, we need to have an opinion against a given society, because that’s our rite of passage. It feels like this has become another forum for that. It’s taken over that role. And for the group that is pure, proper transsexuals, this flirting with pronouns and gender identity is insulting. We spend all our time trying to just fit in, or be able to live the life 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 of a third sex or whatever, and then talk about things we don’t need to talk about so that we can then 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 would break it open. That’s not how I feel, but intellectually I have to think about that. 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 also profiles Peggy Cohen-Kettenis, the Dutch psychologist who allowed “FG” to get puberty blockers.
New York Times suggested background reading for the episode:
- NYT: “Alex Bakker’s book “The Dutch Approach” chronicles the doctors who helped develop the field of transgender medicine for adults, and later for a select group of children, in the Netherlands.”
- on this site:
- Alex Bakker
- NYT: “Peggy Cohen-Kettenis’s case report on “FG” detailed the first known case of a child with gender dysphoria treated with puberty blockers. Dr. Cohen-Kettenis and colleagues published a follow-up 22 years later on how he was doing.”
Part 2: The Gender Kids
This episode focuses on Dutch psychiatrist Annelou de Vries and the development of what became known as the Dutch Protocol. As one would expect from a psychiatrist, de Vries strongly promotes disease models of gender diversity and considers psychiatric counseling critical. de Vries also believes the measure of “effectiveness” is directly linked to psychological outcomes. de Vries would screen out about 30% of prospective clients, whom de Vries considered to be gay, or had “psychological issues that needed to be dealt with first,” or comprised the 10% of young people whom de Vries diagnosed with “autism spectrum disorder.”
Ghorayshi and Mitchell then interview Manon, one of the 70 participants in de Vries’ 2011 study, featured in the book Gender Kids by Sarah Wong. de Vries had several criteria: early history of “gender identity disorder,” supportive parents, and a kind of “watchful waiting” because “most” kids would grow out of it, but they felt for “most” kids, the stress would dissipate until puberty. After a year, which included questions to Manon and seminal parent about sexual abuse.
de Vries described puberty blockers as “reversible,” but there were risks like “bone density and possibly brain development.” Mitchell says, “This is what the Dutch thought of as one of the radical innovation of the blockers: that it was just a pause that could be undone, and meanwhile Manon could think about what came next.” Manon took puberty blockers from age 12 to 16, then signed consent forms acknowledging loss of reproductive capacity.
Mitchell points out the central role of psychiatric gatekeeping in the protocol: “and critically, the mental health assessments that were designed to help figure out which kids should get medical intervention.” According to de Vries, assessment “takes at least half a year, but as we say, we take the time we need.”
de Vries found improvement in psychological function, but did not help with gender identity disorder. In a follow-up report on 55 of the 70 subjects, “were generally satisfied with their physical appearance, and none regretted treatment.” Their gender dysphoria had resolved, and their psychological functioning had continued to improve over time, with rate of clinical problems were now “indistinguishable from general population samples.” deVries cautioned about the small sample size and selection bias, and that a randomized clinical trial would have been preferable, but noting the ethical problems of withholding treatment from patients as a control.
Mitchell says, “Her final words sound now like a bit of a warning: ‘Clinicians should realize that it was not just the early medical intervention that led to the success of this study.”
deVries says, “It’s not only the medical approach, but it’s the whole approach. So it’s psychological assessment but also psychological counseling if necessary, really addressing psychiatric problems, family difficulties, family challenges…”
The guidelines were adopted by WPATH, and clinicians began visiting the clinic to learn more. Mitchell says in foreshadowing of their thesis: “And as they brought the care back to their countries, not everyone was following the protocol.”
Ghorayshi then reiterates the podcast thesis: “There is this fear that the Dutch approach has been this rigorous… There’s a process for evaluation, assessment is central, and the American affirmative approach and how it has played out in our fractured healthcare system, has somehow endangered everything. That it broke, maybe, something that you started.”
de Vries concludes: “It’s only recently that I’ve been convinced that yeah, maybe, especially in the United States, there is approaches that are different than the approach we are doing here.”
New York Times suggested background reading for the episode:
- NYT: “In 2006, the Dutch team published the criteria for a new approach to treating children with gender dysphoria, what came to be known as the Dutch protocol. In later years, they published additional papers on the Dutch approach.”
- NYT: “In 2011 and 2014, the Dutch team published the first data on the protocol, from a study that followed a group of young patients after they received the treatments. The landmark study would establish the field of medical care for transgender youth worldwide.”
- NYT: “The 2011 book titled “Gender Kids” in Dutch featured portraits of Manon and other transgender children in the Netherlands.”
- on this site:
- Sarah Wong
Part 3: The American Approach
Focuses on conservative American psychologist Laura Edwards-Leeper, who was hired as the therapist for the first American youth gender clinic, founded by Norman Spack. Edwards-Leeper visited de Vries for a week in 2007 and said, “They were following a very, very strict protocol, and that’s really what helped me figure out what to do when I got back to the US.”
New York Times suggested background reading for the episode:
- NYT: With a cover featuring the actress Laverne Cox, Time magazine declared 2014 the ‘transgender tipping point,’ a milestone in visibility for trans people in the United States.”
- on this site:
- TIME Magazine
- Laverne Cox
- NYT: “In 2015, the National Institutes of Health announced a multimillion-dollar grant to a team led by Dr. Johanna Olson-Kennedy for the first U.S. study of long-term health outcomes for transgender youth.”
- on this site:
- Johanna Olson-Kennedy
- Stephen Rosenthal
- Robert Garofalo
- Norman Spack
- NYT: “In a 2018 article by Jesse Singal in The Atlantic, Laura Edwards-Leeper expressed concern about what she saw as a shift away from an assessment-based approach to gender care. The magazine later published several critiques of the piece.”
- on this site:
- The Atlantic (publication)
- Jesse Singal (author)
- Critics of Jesse Singal’s transgender coverage
- When a Child Says She’s Trans (article)
- Jeffrey Goldberg (editor)
- Tey Meadow (critical response)
- Evan Urquhart (critical response)
- Thomas Page McBee (critical response)
- Robyn Kanner (critical response)
- NYT: “In 2021, Dr. Edwards-Leeper co-wrote an op-ed for The Washington Post urging providers to prioritize psychological assessment for transgender youth seeking medical interventions.”
- on this site:
- Laura Edwards-Leeper
- Erica E. Anderson
- Washington Post
Part 4: The Whistleblower
[in progress]
Focuses on anti-trans extremist Jamie Reed.
New York Times suggested background reading for the episode:
- NYT: “In early 2023, Jamie Reed, a former case manager at the youth gender clinic at Washington University in St. Louis, filed a whistleblower complaint alleging that the center had hastily prescribed hormones to patients.”
- on this site:
- Jamie Reed
- Azeen Ghorayshi (who previously centered Reed in a 2023 profile as a cisgender person under siege)
- Jesse Singal (who worked with Reed to publish additional information from children’s medical records)
- NYT: “In response to Ms. Reed’s claims, Washington University conducted an internal review. It concluded that “allegations of substandard care causing adverse outcomes for patients” at the gender center were “unsubstantiated.””
- NYT: “Citing Ms. Reed’s affidavit, Missouri lawmakers passed S.B. 49, a ban on gender-affirming care for minors, in May 2023.”
Part 5: The Review
[in progress]
Focuses on British anti-trans pediatrician Hilary Cass and the Cass Review.
New York Times suggested background reading for the episode:
- NYT: “The Cass Review was commissioned by the National Health Service in England and was published in 2024 alongside several systematic reviews of the evidence.”
- on this site:
- Hilary Cass
- Cass Review
- NYT: “Several critiques of the Cass Review have since been published.”
- on this site:
- Meredithe McNamara
- Kellan Baker
- Kara Connelly
- Aron Janssen
- Johanna Olson-Kennedy
- Ken C. Pang
- Ayden Scheim
- Jack Turban
- Anne Alstott
- Chris Noone
- Alex Southgate
- Alex Ashman
- Éle Quinn
- David Comer
- Duncan Shrewsbury
- Florence Ashley
- Jo Hartland
- Joanna Paschedag
- John Gilmore
- Natacha Kennedy
- Thomas E. Woolley
- Rachel Heath
- Ryan Goulding
- Victoria Simpson
- Ed Kiely
- Sibéal Coll
- Margaret White
- D. M. Grijseels
- Maxence Ouafik
- Quinnehtukqut McLamore
- NYT: “In 1979, Johns Hopkins shuttered its pioneering program for gender-affirming surgery for adults, which had been opposed by the university’s chief of psychiatry, Dr. Paul McHugh.”
- NYT: “In May 2025, Dr. Johanna Olson-Kennedy posted a preliminary version of her paper on psychological outcomes for adolescents after puberty blockers.”
- on this site:
- Johanna Olson-Kennedy
- Ramon Durazo-Arvizu
- Liyuan Wang
- Carolyn F. Wong
- Diane Chen
- Diane Ehrensaft
- Marco A. Hidalgo
- Yee-Ming Chan
- Robert Garofalo
- Asa E. Radix
- Stephen M. Rosenthal
Part 6: The Now
[in progress]
New York Times suggested background reading for the episode:
- NYT: “Ohio’s H.B. 68, enacted in 2024, banned the provision of puberty blockers, hormones or surgeries as gender-affirming care for minors in the state.”
- on this site:
- Carey Callahan
- Scott Leibowitz
- NYT: “In a 2023 national survey of high school students conducted by the Centers for Disease Control and Prevention, more than 3 percent of students identified as transgender, and one in four transgender students reported attempting suicide in the past year.”
- on this site:
- Centers for Disease Control and Prevention
- NYT: “Detransition researchers have argued that detransition needs “further understanding, not controversy.””
- on this site:
- Kinnon Ross MacKinnon
- Pablo Expósito-Campos
- Wren Ariel Gould
- NYT: “New York Times polling in January 2025 found that 71 percent of Americans felt that minors should not be prescribed puberty blockers or hormones.”
References
Urquhart, Evan (June 13, 2025). New York Times podcast on youth trans care leaves out the patients. The Objective https://objectivejournalism.org/2025/06/new-york-times-podcast-on-youth-trans-care-leaves-out-the-patients/
Molloy, Parker (June 4, 2025). The Quote That Reveals What’s Really Behind Anti-Trans “Concerns.” The Present Age https://www.readtpa.com/p/the-quote-that-reveals-whats-really
Reed, Erin (June 6, 2025). NYT Anti-Trans Podcast Finds Earliest Puberty Blocker Patient: Is Just Some Normal Happy Dude Now. Erin In The Morning https://www.erininthemorning.com/p/nyt-anti-trans-podcast-finds-earliest
Urquhart, Evan (June 5, 2025). Mom of trans child accuses New York Times’ ‘The Protocol’ podcast of exploitation. The Objective https://objectivejournalism.org/2025/06/mom-of-trans-child-accuses-new-york-times-podcast-the-protocol-of-exploitation/
Urquhart, Evan (June 5, 2025). ‘Who can I talk to that has a human heart?’: New York Times doubles down on harming trans people. The Objective https://objectivejournalism.org/2025/06/new-york-times-podcast-doubles-down-on-harming-trans-people/
Hollar, Julie; Riggio, Olivia (June 5, 2025). Activists Await NYT Podcast on Trans Care With Justifiable Dread. FAIR https://fair.org/home/activists-await-nyt-podcast-on-trans-care-with-justifiable-dread/
Molloy, Parker (June 4, 2025). The New York Times Is About to Do More Damage to Trans People. The Present Age https://www.readtpa.com/p/the-new-york-times-is-about-to-do
Caraballo, Alexandra (June 3, 2025). The New York Times’ War on Trans People. The Dissident https://www.thedissident.news/the-new-york-times-war-on-trans-people/
Anti-trans coverage
Singal, Jesse; Herzog, Katie (June 17, 2025). What We Thought Of “The Protocol.” Blocked & Reported https://www.blockedandreported.org/p/premium-what-we-thought-of-the-protocol
Hughes, Mia (June 15, 2025l). Beneath the Surface of The Protocol. Genspect https://genspect.org/beneath-the-surface-of-the-protocol/
Sapir, Leor (June 13, 2025). The New York Times’s Pediatric Gender Medicine Podcast Disappoints. City Journal https://www.city-journal.org/article/new-york-times-the-protocol-podcast-pediatric-gender-medicine-science
Davis, Lisa Selin (June 13, 2025). What “The Protocol” Got Wrong, Left Out, and Misrepresented. BROADview https://www.broadview.news/p/what-the-protocol-got-wrong-left
Davis, Lisa Selin (June 12, 2025). NYT trans podcast fails to grapple with detransitioners. UnHerd https://unherd.com/newsroom/nyt-trans-podcast-fails-to-grapple-with-detransitioners/
Lane, Bernard (June 9, 2025). Identity extremism. Gender Clinic News https://www.genderclinicnews.com/p/identity-extremism
Appel, Ben; Cohn, Cori; Davis, Lisa Selin; “Mondegreen, Eliza,” Reed, Jamie (June 8, 2025). Episode 28: Jamie Reed responds to the New York Times’s podcast, “The Protocol.” https://informeddissentpodcast.substack.com/p/episode-28-jamie-reed-responds-to
Appel, Ben; Cohn, Cori; Davis, Lisa Selin; “Mondegreen, Eliza,” Reed, Jamie (June 7, 2025). Episode 27: Dissecting “The Protocol.” Informed Dissent https://informeddissentpodcast.substack.com/p/episode-27-dissecting-the-protocol
Times coverage
Staff (June 6, 2025). Introducing ‘The Protocol,’ a New Podcast From The New York Times. New York Times https://www.nytco.com/press/introducing-the-protocol-a-new-podcast-from-the-new-york-times/
Ghorayshi, Azeen; Rudoren, Jodi (June 6, 2025). Our New Podcast: In “The Protocol,” we explore the controversial debate over health care for trans youth. New York Times https://www.nytimes.com/2025/06/06/briefing/the-protocol.html
Ghorayshi, Azeen; Mitchell, Austin (June 6, 2025). ‘The Protocol’: The story behind medical care for transgender kids. New York Times https://www.nytimes.com/2025/06/06/podcasts/the-daily/medical-care-transgender-kids.html
Staff (June 2, 2025). The Protocol. New York Times https://www.nytimes.com/2025/06/02/podcasts/trans-gender-care-protocol.html
Media
YouTube (youtube.com)
- New York Times Podcasts (NYTPodcasts)
- Introducing ‘The Protocol’ (May 30, 2025) https://www.youtube.com/watch?v=91h2W71XY_o
- Part 1: The Beginning (June 5, 2025) https://www.youtube.com/watch?v=G5UOm3BB8Rs
- Part 2: The Gender Kids (June 5, 2025) https://www.youtube.com/watch?v=k-2WTK7Q_o0
- Part 3: The American Approach (June 5, 2025) https://www.youtube.com/watch?v=KkpXBZcZ9ts
- Part 4: The Whistleblower (June 5, 2025) https://www.youtube.com/watch?v=U2eqQO_552s
- Part 5: The Review (June 5, 2025) https://www.youtube.com/watch?v=I4H-7C1MFQU
- Part 6: The Now (June 5, 2025) https://www.youtube.com/watch?v=NU1gBB9nDGk