I wanted to say more about the two suicides. These two suicide deaths were mentioned in a presentation by Anna van der Miesen at EPATH in April 2023. Unless I misunderstood (possible!), these patients were drawn from the "original" cohort (and the follow-up time was about right for that to be the case), but it's possible these 30 "trans-autistic" patients were drawn from or constitute a separate long-term follow-up cohort of patients seen at the Amsterdam clinic. In any case, there were two suicides among 30 patients.
Breakdown:
17/30 eligible patients participated in the follow-up study. 13 were not included, including four who declined and two who "passed away." The reasons the others were not included were not named but presumably they didn't respond to outreach or could not be tracked, though the latter seems unlikely. Later in the presentation, the presenter clarified that the two who passed away had in fact died as a result of suicide. It wasn't clear when these deaths happened or at what stage of transition, but the (surviving) young people were in their early to mid-thirties at the time of the follow-up study, so we're talking about young adults.
Conference abstract:
"New Research Findings of the Amsterdam Adolescent
Transgender Cohort: A Long-Term Follow-up of Autistic
Transgender Children and Adolescents into Young
Adulthood
Authors
Anna van der Miesen - Center of Expertise on Gender Dysphoria, Department of
Child and Adolescent Psychiatry, VU University Medical Center, Amsterdam
Isa van Wieringen - Center of Expertise on Gender Dysphoria, Amsterdam UMC,
Location VUmc
John Strang - Children's National Medical Center
Annelou de Vries - Center of Expertise on Gender Dysphoria, Amsterdam UMC,
Location VUmc
Abstract
Background: Multiple international studies have identified a significant over-
representation of autism spectrum disorder (ASD) among transgender children
and adolescents. Estimates suggest that up to 22.5% of transgender adolescents are autistic and there is an over-representation of transgender identities among
autistic children and adolescents. However, no outcome studies exist that
investigated gender identity development over time, mental health outcomes,
and health care experiences of autistic youth previously seen in a specialized
gender identity service.
Method: In this long-term follow-up study, a mixed-methods study consisting of
a quantitative and a qualitative interview component will be used. This
quantitative component, partly informed by a community-based participatory
research approach, aligns with self-advocates’ calls for research partnerships
with the autistic and transgender communities. In the first part of the study, a
comprehensive gender and autism questionnaire was developed through a
Delphi procedure with autistic transgender self-advocates. The questionnaire,
the qualitative interview, and additional quantitative questionnaires will be
administered to 30 adults who were previously seen in a specialized gender
identity service as children and adolescents.
Results: Preliminary findings from this long-term follow-up study of the autistic
individuals will be discussed, both based on quantitative measures (comparison
of mental health challenges between baseline and follow-up) as well as on the
qualitative findings with the topics of gender identity development over time
and the discussion of life experiences of autistophobia and transphobia.
Conclusions: This first study of a well-characterized cohort of children and
adolescents previously seen in a specialized gender identity service will provide
initial insight in how to improve and personalize care for this population."
van der miesen AIR., van Wieringen IM, Strang JF, et al. A Long-Term Follow-up of Autistic Transgender Children and Adolescents into Young Adulthood. Conference Proceedings of the European Professional Association for Transgender Health Symposium. April 26–28, 2023; Killarney, Ireland."
This study included questions about current gender identification (including nonsense like "elf," "fairy," and "friendly non-intimidating woman").
Presenter mentioned two patients had detransitioned (both male) and that one male patient had expressed serious regret about undergoing vaginoplasty but still identified as trans.
76.5% had received GAMT
52.9% desire further GAMT
Six patients were described as moving from clinical-level mental health challenges to subclinical.
Autism was experienced by patients as a "barrier" to accessing "gender-affirming care."
Presenter: “Each referral followed their own unique path with regard to their gender identity and mental health trajectory.”
Zero patients thought autism and GD were related — “completely different”
2 suicides mentioned (initially described as “passed away”). Doesn't dwell on this at all. Presenter says "no crystal ball" for how transition will go.
I would very, very much like to get to the bottom of whether these were part of the Original Cohort, or whether these were kids just coincidentally being seen at the same clinic at the same time.
If you throw in the poor kid who died a gruesome death from surgical complications, that would make this group of 70 one of the most heartbreaking experimental results I’ve ever heard of.
If these data were coming from 70 patients at a “pray the gay away” camp and there were two suicides and a kid died during an “exorcism”, we would be calling for someone to be put in jail.
Yeah, I really wish they would publish this research because it's extremely important and also confirm where this cohort comes from. It's grim no matter what. I know the Amsterdam clinic did a retrospective study of patients seen in the first 20 years of the Dutch protocol (https://pubmed.ncbi.nlm.nih.gov/36763938/). Possible these 30 patients were drawn from this much larger data set... but then why would there only be 30 "trans-autistic" patients (out of 1766 total) and not a much larger sample of autistic patients, since clinic estimated ~20% of their gender patients to be autistic.
I must admit I stopped giving them the benefit of the doubt a long time ago, but I suspect that they intentionally buried the desistance rate by pooling the Dutch Protocol cohort with other patients.
It sounds like the Dutch clinicians may have obscured the fact of these two suicides(?!) for years. Talk about a potential smoking gun! I hope there is some mechanism (legal/regulatory) to force them to clarify the relationship between these two dead patients and “The Protocol.” Lifesaving indeed.
I don’t know about other listeners, but I feel a sort of proprietary interest toward the five of you. I am so grateful that you are out there, braving the slings and arrows, and brilliantly articulating from five extremely different and valuable POVs why the whole transitioning of children is so entirely problematic, that I feel proud on behalf of all that you do. I hope you feel that pride. The extent of knowledge and dedication and downright goodness with which you critique all of the insane BS of The Protocol is a gift. YOUR podcast is a necessity in the world right now, and you are brilliantly meeting the need. Don’t underestimate your positive impact.
I am very much looking forward to listening to all of you discuss the rest of The Protocol. One thing that really made my blood boil is how Laura Edwards Leeper is presented. She is presented like a blameless saint in all of this — that she went and learned from the best of the best and then because of understaffing and the ideology running amok all around her, her purity in understanding and assessing so-called trans kids was threatened. First of all, they do not mention the flaws in the Dutch study, including the switching of the scales at the end and the very dubious idea that anyone including patient zero actually fares better in the long run from these interventions, much less whether there were/are less invasive, more holistic ways to help by maybe just allowing for homosexuality and gender nonconformity. And second of all, they don’t challenge Leeper’s claim that she really knows how to identify (as Jaime later says in the series, but actually has changed her mind on now) the one kid out of 15 who is “true trans.”
I also noticed the failure to mention the switching of the scales, which is an obvious methodological error. This could easily have been rectified by including a contemporary critic of the Dutch model at this moment in the podcast. Instead critics — Hillary Cass and Jamie — were presented as part of a chronological narrative that avoided a deep dive into the validity of The Protocol.
Excellent analysis, y’all! Really appreciate all of the points you made, and I acknowledge the emotional toll that listening to this podcast may be taking on some of you. Know that the sacrifices you all are making by putting yourselves out there will lead to many people being saved from the harm that my family has experienced.
Lisa, great, concise summary of the basic thesis of the podcast. I totally agree. And Sarah, I agree with your frustration that this is going to leave people with the idea that this “care” is still appropriate for a lot of kids.
Cori, I really appreciated your comment about “imposter syndrome.” That is what I sense from my trans son. Seven years into hormones, he’s just not comfortable in his own skin, even though he was so sure that estrogen would magically do that for him. I wish more people considering this treatment could hear your story.
And Jamie, yes! Please do an episode I can send to my normie friends and link to in comments on social media. Break it down in terms my educated, liberal, well-intentioned NYT-reading family can understand. Their four biggest misconceptions are:
1. That there is such a thing as a trans kid, born in the wrong body, and, like being gay or left-handed, it’s innate and we shouldn’t try to change it.
2. That the gender-affirming “care” process is cautious and data-driven. I thought this, too, until we went to the Duke gender clinic and realized their job was to scare me into putting my son on estrogen as soon as possible by threatening suicide and estrangement.
3. That this “care” helps people and improves their outcomes.
4. That almost no one regrets it.
Thank you all. Looking forward to hearing your thoughts on the other four episodes.
Thank you for listing the four biggest misconceptions!
The first one I think is huge. I've been meaning to ask our hosts if they would consider doing an episode just on that.
The belief that being trans is innate, like being gay, is the biggest obstacle I've found in trying to talk to people about this. They always ask with incredulity, "Don't you believe there are actual trans people???"
Your point in the Dissenting the Protocol podcast about a female who had puberty blocked at age 12 sounding like an adolescent really struck me. This is because puberty blockers induce a condition I was born with, called secondary hypogonadism (or hypogonadal hypogonadism). In the 1980s, I was treated for this at the University of San Francisco, now a gender clinic, because I couldn’t go through puberty naturally. My treatment involved a medically induced puberty with androgens, the appropriate sex-based hormones for my male biology.
When puberty blockers are given to a 12-year-old without reintroducing the correct sex-based hormones, physical and mental development halts at that age. Without those hormones, the individual remains in a state akin to a “eunuch” from ancient Greece—adolescent, docile, and easily manipulated. This effect is evident in boys and, as you noted, likely in girls too. Cross-sex hormones don’t resolve this because they’re not suited to the child’s biological sex, leading to permanent issues like underdeveloped genitals and loss of sexual function.
I was fortunate to receive proper treatment, which fully reversed my condition, allowing me to physically and mentally mature. The claim that puberty blockers are “fully reversible” comes from cases like mine, where appropriate hormones are used. However, even with proper treatment, men like me often struggle with a form of gender dysphoria into adulthood due to the distress of disrupted puberty, despite being mentally and physically mature.
The current protocol of blockers followed by cross-sex hormones guarantees untreated hypogonadal hypogonadism, with all its physical and mental effects, effectively creating modern-day eunuchs with added complications from cross-sex hormones. I’ll discuss this further at my presentation during the Genspect conference in Albuquerque, New Mexico, this year. Thank you for highlighting this critical issue.
I think I’m your normie NY Times reader. Maybe. Liberal academic, friends with trans-identifying kids, a few trans-identified students and colleagues. I appreciate all your critiques of The Protocol. But to answer your question, Yes, listening to this will make normies think more critically. IDK I might have crossed over the normie line but I was who you are talking about maybe less than a year ago.
I’m so relieved to hear this and I hope you are representative! The whole time I was listening my blood pressure was going up and up every time they made some vague claim or inference that went unchallenged: “oh we wanted to help young people transition because adults who weren’t allowed to transition (because doctors were mean and gatekeepey and acted like they were mentally ill) committed suicide” and nobody fact checked it to say “well actually the largest Swedish study showed the suicide rate was 19x higher for medically transitioned adults than controls!” And I was getting really upset thinking hey I know that but no one else does! People listening are going to think oh this really is lifesaving care!
People complain about Joe Rogan letting bullshit go unchallenged on his podcast but this is THE NEW YORK TIMES!
I listened to the whole series yesterday and they never once challenged the suicide narrative, never mentioned that multiple children in the U Wash puberty blocker study DID commit suicide, never mentioned that the UK debunked the suicide myth, never mentioned Brigg’s paper on it…
did mention the stupid study with I thought about 27 kids who identified as trans, where 13 said they had thought seriously about suicide...
"One frequently-cited study from “The Time” found that nearly half of the young trans people surveyed had seriously considered dying by suicide. About a quarter of them said they had actually tried to."
Also that study about kids who were accepted or rejected for treatment (I think the ones who were rejected didn't meet the dutch criteria)...maybe you say later but the point I got from it, if it is the same study I am thinking of, Smith et al.? , is that almost all those who were rejected...no longer wanted medical transition a few years later. They grew out of it.
In response to Sarah's comment about how Protocol is taking the Laura Edwards Leeper line: that there are true "trans" kids and we just need to pull back a bit and do more evaluation. This is been Jesse Singal's line for a long time--let's just be more careful! And trans some kids. (Although he may be moving away from that, slowly.)
Yes, I agree, it's a phony baloney line, and it could sustain the carnage a bit longer.
But! Speaking as someone who used to believe that line (let's just slow down a bit and find the true trans), learning *anything* more unravels that belief. It may be a way station, in other words, on the journey towards understanding there is no true trans.
By critiquing the affirming model and calling for moderation, perhaps Protocol might inadvertently lead some observers to realize there is no moderation in harming children. Maybe?
I thought the whistleblower episode did quite a hit job on Jamie. They concentrated a lot on some woman who said Jamie had ruined her life (or some such hyperbole), yet no one would know of her if she'd not come forward to dispute the email about legal action etc.
The whole series had the feel of a propaganda piece, not an attemp to educate or explain. They had an agenda, it seemed to me.
One thing I'm interested in learning is about a comment Sarah made that taking wrong sex hormones does not actually result in wrong sex puberty. I suppose the reason is that puberty is about more than just the hormone but I've never seen that explained.
The way I think about the "wrong sex puberty" notion is to consider the definition of puberty: the maturation a child into an adult capable of reproduction. So there can be only one puberty - the maturation of the reproductive system you were born with. In both sexes that involves growth and maturation of the reproductive organs including sperm and ova maturation so they are capable of fertilisation - a boy can't have a girl's puberty because he does not have a girl's reproductive organs and vice versa. Taking supraphysiological doses of cross sex hormones produces some of the secondary sex characteristics of the opposite sex, but that's not puberty.
Exactly--at the end of puberty you have someone who can reproduce (a female who can get pregnant, a male who can make someone pregnant). Outside of disorders.
These young people are having their puberty interrupted and their development modified. They get some of the physical changes the opposite sex gets with puberty but they don't go through "puberty" of the opposite sex.
There are also a lot of brain changes that occur and the whole point of Sallie Baxendale's paper was that they have no idea how these blockers interfere with that--she also gave a talk at the SEGM 2023 NYC conference which is on youtube: https://www.youtube.com/watch?v=z5ZnRKqqByg
The paper is more formal, the talk is about 20 min. It seemed very understandable to me, she is a good speaker.
It is not clear if the clinicians pushing this understand these medically treatd young people are not going through the "other puberty." One endocrinologist who co-authored the Endocrine Society guidelines said, when other endocrinologists pointed out these chemical imbalances looked very dangerous: (https://academic.oup.com/jcem/article/104/11/5102/5482265)
" In no case does the guideline recommend “high-dose cross-sex hormones”; rather, it offers protocols designed to achieve hormone levels in the physiological range associated with the individual’s affirmed gender identity. "
This is simply false. These are high dose cross sex hormones. Females are given testosterone to reach male levels, which are high doses for females, and analogously for males and estrogen.
Maybe I'm asking the wrong question. The genderists are accepting that they won't mature sexually , but that's kind of the point of the treatment. My interest is in what else puberty brings, such as maturation of the brain, growth spurts, other non sexual changes and whether the wrong sex hormones trigger those changes. If they do, then in a way it doesn't matter if they've lost the chance of sexual maturity (from their distorted perspective).
One thing I read this afternoon was that the growth spurt does still occur as long as the growth plates in the bones haven't fused, which normally happens towards the end of normal puberty at 15 or so (so how is that affected by this fake puberty?). And that makes me wonder about FG who had testosterone at 18; is he child sized as a result?
The doctors and therapists doing this should have realized there was something wrong when they were medicalizing gender nonconformity and proto-gay kids, but they didn't. They *really* should have started questioning what they were doing when they got on board with transitioning and medicalizing straight, gender conforming, highly sensitive and emotionally dysregulated teenage girls with no history of gender distress or confusion and a sudden onset of a trans identity, but that also didn't cause them to seriously question what they were doing. Why? Of course, there are the issues of politics and fears of being called transphobic or being anti-human rights, but I think there's another very important reason that may be less obvious in the gender non-conforming proto-gay kids but is very obvious in the teen girls: most doctors and therapists do t have the training, skills, or personal distress tolerance to sit with and actually help support and build coping and resilience skills with these kids with big intense emotions. We so frequently like to compare this to the lobotomy scandal because of the surgical aspect, but there's another parallel. Doctors and families who adopted lobotomies as a viable treatment option because they didn't have any other skills or options for treating these difficult cases. One of the reasons lobotomies fell out of style was the development of antipsychotic meds. Doctors and families had other options. Ben and Cori rightly talk about teaching resilience. It's also about creating a culture where resilience and distress tolerance are valued and therapists are trained in properly working with these highly distressed and dysregulated youth.
This is what some of the Tavistock whistleblowers have said. And some such as Marcus Evans have noted that some of the clinicians themselves seemed to be in a rush, like the kids, not willing to actually, themselves, take "time to think."
I decided to watch the video version of this, and Lisa, when you introduced yourself as incredibly grumpy, I thought the caption was going to read, “Lisa Sullen Davis.”
Yes, please please, do an episode just of Jamie and the Protocol podcast. Do it soon, so that people who google Jamie have something that directly addresses these issues.
I am torturing myself by listening a second time through because the first time I just couldn’t stop yelling out questions into the void that I wish had been asked and refuting ridiculous, irresponsible statements that were made. And, Jaime, I just cannot abide how you were treated. You are the only one they challenged. They pandered to everyone else and nodded along, only slightly challenging Laura Edwards Leeper. So in summary, they only challenge anyone who questions any of this. Which makes all the activist vitriol against “Protocol” very uninformed because unfortunately, I think it just advances the affirmative model. I honestly don’t know how you kept your cool with the two of them (especially during that moment when he tried to play therapist with you in a thinly veiled gotcha moment sharing his pseudo psychological insight that your feeling like you were not allowed to be your true self in your job is just like how trans people feel. Therefore, how dare you not allow them to be their true selves by interfering with their life saving/affirming care… ) or with that unhinged mother yelling “me, me, me.” How telling was that? You perfectly and calmly made Helen Joyce’s point that in the face of liver damage and all the rest, these parents have to cling to having done the right thing. I am so glad you all are doing an extra episode.
I am thankful to all of you for listening to "The Protocol." I have not done so, because my shock that anyone, then or now, could believe in, make excuses for, or try to sculpt a "middle ground" out of this merda, is everpresent.
I do understand Ben's initial shot of joy that perhaps maybe the social-contagion contingent of straight young girls might soon be spared. We are talking about tens, maybe hundreds of thousands of precious young women!! ANY reduction in this insanity is crucial--and reasons why it is monstrous perpetrated against one set of people are also reasons it is monstrous against another set of people. It doesn't mean we abandon the fight to pull the monsters off the bodies of the proto-gays.
It looks as if they are trying to take the middle-leave the teen girls alone, but throw the rest under the bus (younger kids, boys) with assessments which still, after 20 years, have not been shown to determine who will be better off with these interventions than without them.
I'm sure there were assessments for all sorts of other harmful treatments, just because they've been doing them for a while doesn't mean they distinguish anything useful, such as who would be better off than not with these interventions--which they keep saying here--thank goodness!!
Let the record show that NO ONE is better off with these "interventions."
Nobody would be having this conversation if the intervention was gouging someone's eyes out, because they're uncomfortable looking at their body. Or slicing someone's ears from their head, because they didn't like the pitch of their voice. And yet, and yet! Chopping someone's healthy dick up/off with a knife: there are people who think there COULD be a circumstance in which that would make him better off?! Wrecking someone's clit, destroying her healthy breasts: there are creatures walking around so insensate that they could even connect "better off" with these acts?!
Let all of our conversations, podcasts and writings serve to pull away the euphemisms. We need to intercept the flow of lies to well-meaning normies.
My response to The Protocol is that it is more propaganda than journalism. It reminds me of what Nixon proposed during the Watergate scandal, a limited hangout. Admit that there are problems, as a means for avoiding the more serious issues.
The most glaring indication for me was the failure to address a fundamental problem with the Dutch study, that it reversed the questionnaire for males and females after the blockers had been administered. This is such a glaring methodological problem that it calls into question the integrity of the entire research project. It is practically inconceivable that professional journalists, who took two years to report this series, could have missed this failing.
How could this be? Well, the other tell is that they failed to interview any critics of the protocol who could have alerted them to this problem, though they did report the sampling problems that the author admitted and which were later noted by the Cass Review. There was obviously a lack of journalistic will to get to the truth.
Instead, interviews were presented in a series, which presented the conflict between evaluation, and what is essentially affirmation on demand. But even with this severely self-limited remit, they failed. The final episode (which I assume you will be discussing in a future episode), provides no essential summary or draws any conclusions about this conflict. It just leaves the listener with a vague understanding that, as Reagan said during the Iran-Contra scandal, ¨Mistakes were made."
Rather than reckoning with these mistakes, we are presented with a series of first-person accounts that reiterate the recurring theme of the podcast: there are children who were suffering, and something needed -- and continues to need -- to be done. But now, those mean old Republicans--aided by whistleblower Jamie, who is all but accused of being insensitive to their plight--want to ban this essential care for so many suffering children. It all but shouts a cliche made famous by the Clinton sex scandal: "Dear God, won't somebody please think of the children?
So what we have is not journalism, but scandal management that, to paraphrase the Simpsons, tugs at the heart while it clouds the mind.
Tobin’s rationale of The Protocol is helping people ‘to better understand’ the bases of GAC prior to Skrmetti release? Well, they sure failed there. No depth. All-affirming journalism. Complete lack of knowledge about what undergirds medical science and practice. And there’s only 1 whistleblower in the world, Jamie Reed? I’d think they were incompetent if it didn’t seem apparent that they’ve brainwashed themselves into Affirmation Uber Alles.
Commenting for a second time because I've just gotten to the episode where they interview Jamie. Oh my god. I don't think I've ever heard a worse interview conducted by such an interviewer at such a prestigious publication. Why is Azeen trying to debate Jamie? Why are she and Austin being so condescending? It literally sounds like they've called Jamie into the principal's office to lecture her about something she's in trouble for. They are so charitable to every other interview subject except her. That sounds like it must have been such an uncomfortable room to be in. Also, why the obsession with the feelings of the parents? It feels like they're trying to placate their audience of parents who have transitioned their children that "no, no, don't worry, you did the right thing" without actually being able to back that up.
Agree! "you're a person of extremes" and "you have an anarchist tattoo!" Jamie is the only person who's credibility is undermined -- and in such a personal way (subtext: you really are unstable). Kudos to you Jamie for your commitment to integrity and ability to maintain your composure. Thank you for your courage.
Jamie, the way you point out how FG is still stuck pre-puberty is an amazing and so true realization. That’s such an insight about the whole movement. How can people grow in themselves and the world if they embrace a counter-factual as their identity and are told my others they are entitled to require that be affirmed by others? Wow. This explains so much of the odd personality traits that this group seems to exhibit in common.
I wanted to say more about the two suicides. These two suicide deaths were mentioned in a presentation by Anna van der Miesen at EPATH in April 2023. Unless I misunderstood (possible!), these patients were drawn from the "original" cohort (and the follow-up time was about right for that to be the case), but it's possible these 30 "trans-autistic" patients were drawn from or constitute a separate long-term follow-up cohort of patients seen at the Amsterdam clinic. In any case, there were two suicides among 30 patients.
Breakdown:
17/30 eligible patients participated in the follow-up study. 13 were not included, including four who declined and two who "passed away." The reasons the others were not included were not named but presumably they didn't respond to outreach or could not be tracked, though the latter seems unlikely. Later in the presentation, the presenter clarified that the two who passed away had in fact died as a result of suicide. It wasn't clear when these deaths happened or at what stage of transition, but the (surviving) young people were in their early to mid-thirties at the time of the follow-up study, so we're talking about young adults.
Conference abstract:
"New Research Findings of the Amsterdam Adolescent
Transgender Cohort: A Long-Term Follow-up of Autistic
Transgender Children and Adolescents into Young
Adulthood
Authors
Anna van der Miesen - Center of Expertise on Gender Dysphoria, Department of
Child and Adolescent Psychiatry, VU University Medical Center, Amsterdam
Isa van Wieringen - Center of Expertise on Gender Dysphoria, Amsterdam UMC,
Location VUmc
John Strang - Children's National Medical Center
Annelou de Vries - Center of Expertise on Gender Dysphoria, Amsterdam UMC,
Location VUmc
Abstract
Background: Multiple international studies have identified a significant over-
representation of autism spectrum disorder (ASD) among transgender children
and adolescents. Estimates suggest that up to 22.5% of transgender adolescents are autistic and there is an over-representation of transgender identities among
autistic children and adolescents. However, no outcome studies exist that
investigated gender identity development over time, mental health outcomes,
and health care experiences of autistic youth previously seen in a specialized
gender identity service.
Method: In this long-term follow-up study, a mixed-methods study consisting of
a quantitative and a qualitative interview component will be used. This
quantitative component, partly informed by a community-based participatory
research approach, aligns with self-advocates’ calls for research partnerships
with the autistic and transgender communities. In the first part of the study, a
comprehensive gender and autism questionnaire was developed through a
Delphi procedure with autistic transgender self-advocates. The questionnaire,
the qualitative interview, and additional quantitative questionnaires will be
administered to 30 adults who were previously seen in a specialized gender
identity service as children and adolescents.
Results: Preliminary findings from this long-term follow-up study of the autistic
individuals will be discussed, both based on quantitative measures (comparison
of mental health challenges between baseline and follow-up) as well as on the
qualitative findings with the topics of gender identity development over time
and the discussion of life experiences of autistophobia and transphobia.
Conclusions: This first study of a well-characterized cohort of children and
adolescents previously seen in a specialized gender identity service will provide
initial insight in how to improve and personalize care for this population."
van der miesen AIR., van Wieringen IM, Strang JF, et al. A Long-Term Follow-up of Autistic Transgender Children and Adolescents into Young Adulthood. Conference Proceedings of the European Professional Association for Transgender Health Symposium. April 26–28, 2023; Killarney, Ireland."
This study included questions about current gender identification (including nonsense like "elf," "fairy," and "friendly non-intimidating woman").
Presenter mentioned two patients had detransitioned (both male) and that one male patient had expressed serious regret about undergoing vaginoplasty but still identified as trans.
76.5% had received GAMT
52.9% desire further GAMT
Six patients were described as moving from clinical-level mental health challenges to subclinical.
Autism was experienced by patients as a "barrier" to accessing "gender-affirming care."
Presenter: “Each referral followed their own unique path with regard to their gender identity and mental health trajectory.”
Zero patients thought autism and GD were related — “completely different”
2 suicides mentioned (initially described as “passed away”). Doesn't dwell on this at all. Presenter says "no crystal ball" for how transition will go.
So, 30 patients
- 13 lost to follow up, including four who declined and two who were dead as a result of suicide. So that's two deaths and 11 question marks.
Among the 17 who did participate in the follow-up study:
- two detransitioners
- one case of serious regret about genital surgery
I would very, very much like to get to the bottom of whether these were part of the Original Cohort, or whether these were kids just coincidentally being seen at the same clinic at the same time.
If you throw in the poor kid who died a gruesome death from surgical complications, that would make this group of 70 one of the most heartbreaking experimental results I’ve ever heard of.
If these data were coming from 70 patients at a “pray the gay away” camp and there were two suicides and a kid died during an “exorcism”, we would be calling for someone to be put in jail.
Yeah, I really wish they would publish this research because it's extremely important and also confirm where this cohort comes from. It's grim no matter what. I know the Amsterdam clinic did a retrospective study of patients seen in the first 20 years of the Dutch protocol (https://pubmed.ncbi.nlm.nih.gov/36763938/). Possible these 30 patients were drawn from this much larger data set... but then why would there only be 30 "trans-autistic" patients (out of 1766 total) and not a much larger sample of autistic patients, since clinic estimated ~20% of their gender patients to be autistic.
Also, approximately 19% of the patients in the original Dutch Protocol cohort have discontinued their adopted gender (details withheld).
https://doi.org/10.1093/jsxmed/qdad062.088
This may overlap with but is larger than the original Dutch cohort of 70. But yeah.
I must admit I stopped giving them the benefit of the doubt a long time ago, but I suspect that they intentionally buried the desistance rate by pooling the Dutch Protocol cohort with other patients.
It sounds like the Dutch clinicians may have obscured the fact of these two suicides(?!) for years. Talk about a potential smoking gun! I hope there is some mechanism (legal/regulatory) to force them to clarify the relationship between these two dead patients and “The Protocol.” Lifesaving indeed.
I don’t know about other listeners, but I feel a sort of proprietary interest toward the five of you. I am so grateful that you are out there, braving the slings and arrows, and brilliantly articulating from five extremely different and valuable POVs why the whole transitioning of children is so entirely problematic, that I feel proud on behalf of all that you do. I hope you feel that pride. The extent of knowledge and dedication and downright goodness with which you critique all of the insane BS of The Protocol is a gift. YOUR podcast is a necessity in the world right now, and you are brilliantly meeting the need. Don’t underestimate your positive impact.
I am very much looking forward to listening to all of you discuss the rest of The Protocol. One thing that really made my blood boil is how Laura Edwards Leeper is presented. She is presented like a blameless saint in all of this — that she went and learned from the best of the best and then because of understaffing and the ideology running amok all around her, her purity in understanding and assessing so-called trans kids was threatened. First of all, they do not mention the flaws in the Dutch study, including the switching of the scales at the end and the very dubious idea that anyone including patient zero actually fares better in the long run from these interventions, much less whether there were/are less invasive, more holistic ways to help by maybe just allowing for homosexuality and gender nonconformity. And second of all, they don’t challenge Leeper’s claim that she really knows how to identify (as Jaime later says in the series, but actually has changed her mind on now) the one kid out of 15 who is “true trans.”
I also noticed the failure to mention the switching of the scales, which is an obvious methodological error. This could easily have been rectified by including a contemporary critic of the Dutch model at this moment in the podcast. Instead critics — Hillary Cass and Jamie — were presented as part of a chronological narrative that avoided a deep dive into the validity of The Protocol.
Excellent analysis, y’all! Really appreciate all of the points you made, and I acknowledge the emotional toll that listening to this podcast may be taking on some of you. Know that the sacrifices you all are making by putting yourselves out there will lead to many people being saved from the harm that my family has experienced.
Lisa, great, concise summary of the basic thesis of the podcast. I totally agree. And Sarah, I agree with your frustration that this is going to leave people with the idea that this “care” is still appropriate for a lot of kids.
Cori, I really appreciated your comment about “imposter syndrome.” That is what I sense from my trans son. Seven years into hormones, he’s just not comfortable in his own skin, even though he was so sure that estrogen would magically do that for him. I wish more people considering this treatment could hear your story.
And Jamie, yes! Please do an episode I can send to my normie friends and link to in comments on social media. Break it down in terms my educated, liberal, well-intentioned NYT-reading family can understand. Their four biggest misconceptions are:
1. That there is such a thing as a trans kid, born in the wrong body, and, like being gay or left-handed, it’s innate and we shouldn’t try to change it.
2. That the gender-affirming “care” process is cautious and data-driven. I thought this, too, until we went to the Duke gender clinic and realized their job was to scare me into putting my son on estrogen as soon as possible by threatening suicide and estrangement.
3. That this “care” helps people and improves their outcomes.
4. That almost no one regrets it.
Thank you all. Looking forward to hearing your thoughts on the other four episodes.
Thank you for listing the four biggest misconceptions!
The first one I think is huge. I've been meaning to ask our hosts if they would consider doing an episode just on that.
The belief that being trans is innate, like being gay, is the biggest obstacle I've found in trying to talk to people about this. They always ask with incredulity, "Don't you believe there are actual trans people???"
Jamie Reed
Your point in the Dissenting the Protocol podcast about a female who had puberty blocked at age 12 sounding like an adolescent really struck me. This is because puberty blockers induce a condition I was born with, called secondary hypogonadism (or hypogonadal hypogonadism). In the 1980s, I was treated for this at the University of San Francisco, now a gender clinic, because I couldn’t go through puberty naturally. My treatment involved a medically induced puberty with androgens, the appropriate sex-based hormones for my male biology.
When puberty blockers are given to a 12-year-old without reintroducing the correct sex-based hormones, physical and mental development halts at that age. Without those hormones, the individual remains in a state akin to a “eunuch” from ancient Greece—adolescent, docile, and easily manipulated. This effect is evident in boys and, as you noted, likely in girls too. Cross-sex hormones don’t resolve this because they’re not suited to the child’s biological sex, leading to permanent issues like underdeveloped genitals and loss of sexual function.
I was fortunate to receive proper treatment, which fully reversed my condition, allowing me to physically and mentally mature. The claim that puberty blockers are “fully reversible” comes from cases like mine, where appropriate hormones are used. However, even with proper treatment, men like me often struggle with a form of gender dysphoria into adulthood due to the distress of disrupted puberty, despite being mentally and physically mature.
The current protocol of blockers followed by cross-sex hormones guarantees untreated hypogonadal hypogonadism, with all its physical and mental effects, effectively creating modern-day eunuchs with added complications from cross-sex hormones. I’ll discuss this further at my presentation during the Genspect conference in Albuquerque, New Mexico, this year. Thank you for highlighting this critical issue.
James
I think I’m your normie NY Times reader. Maybe. Liberal academic, friends with trans-identifying kids, a few trans-identified students and colleagues. I appreciate all your critiques of The Protocol. But to answer your question, Yes, listening to this will make normies think more critically. IDK I might have crossed over the normie line but I was who you are talking about maybe less than a year ago.
I’m so relieved to hear this and I hope you are representative! The whole time I was listening my blood pressure was going up and up every time they made some vague claim or inference that went unchallenged: “oh we wanted to help young people transition because adults who weren’t allowed to transition (because doctors were mean and gatekeepey and acted like they were mentally ill) committed suicide” and nobody fact checked it to say “well actually the largest Swedish study showed the suicide rate was 19x higher for medically transitioned adults than controls!” And I was getting really upset thinking hey I know that but no one else does! People listening are going to think oh this really is lifesaving care!
People complain about Joe Rogan letting bullshit go unchallenged on his podcast but this is THE NEW YORK TIMES!
I listened to the whole series yesterday and they never once challenged the suicide narrative, never mentioned that multiple children in the U Wash puberty blocker study DID commit suicide, never mentioned that the UK debunked the suicide myth, never mentioned Brigg’s paper on it…
did mention the stupid study with I thought about 27 kids who identified as trans, where 13 said they had thought seriously about suicide...
"One frequently-cited study from “The Time” found that nearly half of the young trans people surveyed had seriously considered dying by suicide. About a quarter of them said they had actually tried to."
I mean, transgender trend tore this apart ages ago... Study 1 here: https://www.transgendertrend.com/the-suicide-myth/
Also that study about kids who were accepted or rejected for treatment (I think the ones who were rejected didn't meet the dutch criteria)...maybe you say later but the point I got from it, if it is the same study I am thinking of, Smith et al.? , is that almost all those who were rejected...no longer wanted medical transition a few years later. They grew out of it.
In response to Sarah's comment about how Protocol is taking the Laura Edwards Leeper line: that there are true "trans" kids and we just need to pull back a bit and do more evaluation. This is been Jesse Singal's line for a long time--let's just be more careful! And trans some kids. (Although he may be moving away from that, slowly.)
Yes, I agree, it's a phony baloney line, and it could sustain the carnage a bit longer.
But! Speaking as someone who used to believe that line (let's just slow down a bit and find the true trans), learning *anything* more unravels that belief. It may be a way station, in other words, on the journey towards understanding there is no true trans.
By critiquing the affirming model and calling for moderation, perhaps Protocol might inadvertently lead some observers to realize there is no moderation in harming children. Maybe?
Pretty sure that Jesse Singal is no longer this credulous of the ‘true trans’ concept.
He still thinks we need more research. If there are no true trans that who would benefit from this research?
I thought the whistleblower episode did quite a hit job on Jamie. They concentrated a lot on some woman who said Jamie had ruined her life (or some such hyperbole), yet no one would know of her if she'd not come forward to dispute the email about legal action etc.
The whole series had the feel of a propaganda piece, not an attemp to educate or explain. They had an agenda, it seemed to me.
One thing I'm interested in learning is about a comment Sarah made that taking wrong sex hormones does not actually result in wrong sex puberty. I suppose the reason is that puberty is about more than just the hormone but I've never seen that explained.
The way I think about the "wrong sex puberty" notion is to consider the definition of puberty: the maturation a child into an adult capable of reproduction. So there can be only one puberty - the maturation of the reproductive system you were born with. In both sexes that involves growth and maturation of the reproductive organs including sperm and ova maturation so they are capable of fertilisation - a boy can't have a girl's puberty because he does not have a girl's reproductive organs and vice versa. Taking supraphysiological doses of cross sex hormones produces some of the secondary sex characteristics of the opposite sex, but that's not puberty.
Yes, this is what I meant, but expressed more clearly!
Exactly--at the end of puberty you have someone who can reproduce (a female who can get pregnant, a male who can make someone pregnant). Outside of disorders.
These young people are having their puberty interrupted and their development modified. They get some of the physical changes the opposite sex gets with puberty but they don't go through "puberty" of the opposite sex.
There are also a lot of brain changes that occur and the whole point of Sallie Baxendale's paper was that they have no idea how these blockers interfere with that--she also gave a talk at the SEGM 2023 NYC conference which is on youtube: https://www.youtube.com/watch?v=z5ZnRKqqByg
The paper is more formal, the talk is about 20 min. It seemed very understandable to me, she is a good speaker.
It is not clear if the clinicians pushing this understand these medically treatd young people are not going through the "other puberty." One endocrinologist who co-authored the Endocrine Society guidelines said, when other endocrinologists pointed out these chemical imbalances looked very dangerous: (https://academic.oup.com/jcem/article/104/11/5102/5482265)
" In no case does the guideline recommend “high-dose cross-sex hormones”; rather, it offers protocols designed to achieve hormone levels in the physiological range associated with the individual’s affirmed gender identity. "
This is simply false. These are high dose cross sex hormones. Females are given testosterone to reach male levels, which are high doses for females, and analogously for males and estrogen.
Maybe I'm asking the wrong question. The genderists are accepting that they won't mature sexually , but that's kind of the point of the treatment. My interest is in what else puberty brings, such as maturation of the brain, growth spurts, other non sexual changes and whether the wrong sex hormones trigger those changes. If they do, then in a way it doesn't matter if they've lost the chance of sexual maturity (from their distorted perspective).
One thing I read this afternoon was that the growth spurt does still occur as long as the growth plates in the bones haven't fused, which normally happens towards the end of normal puberty at 15 or so (so how is that affected by this fake puberty?). And that makes me wonder about FG who had testosterone at 18; is he child sized as a result?
Yes. Propaganda piece.
The doctors and therapists doing this should have realized there was something wrong when they were medicalizing gender nonconformity and proto-gay kids, but they didn't. They *really* should have started questioning what they were doing when they got on board with transitioning and medicalizing straight, gender conforming, highly sensitive and emotionally dysregulated teenage girls with no history of gender distress or confusion and a sudden onset of a trans identity, but that also didn't cause them to seriously question what they were doing. Why? Of course, there are the issues of politics and fears of being called transphobic or being anti-human rights, but I think there's another very important reason that may be less obvious in the gender non-conforming proto-gay kids but is very obvious in the teen girls: most doctors and therapists do t have the training, skills, or personal distress tolerance to sit with and actually help support and build coping and resilience skills with these kids with big intense emotions. We so frequently like to compare this to the lobotomy scandal because of the surgical aspect, but there's another parallel. Doctors and families who adopted lobotomies as a viable treatment option because they didn't have any other skills or options for treating these difficult cases. One of the reasons lobotomies fell out of style was the development of antipsychotic meds. Doctors and families had other options. Ben and Cori rightly talk about teaching resilience. It's also about creating a culture where resilience and distress tolerance are valued and therapists are trained in properly working with these highly distressed and dysregulated youth.
This is what some of the Tavistock whistleblowers have said. And some such as Marcus Evans have noted that some of the clinicians themselves seemed to be in a rush, like the kids, not willing to actually, themselves, take "time to think."
I decided to watch the video version of this, and Lisa, when you introduced yourself as incredibly grumpy, I thought the caption was going to read, “Lisa Sullen Davis.”
I always watch video version for strong parasocial bonding
Lol. I think we're both making the same mistake, but I'd miss Sancho too much if I stopped now...
Excellent analysis in this episode, thank you!
Yes, please please, do an episode just of Jamie and the Protocol podcast. Do it soon, so that people who google Jamie have something that directly addresses these issues.
Doing that tomorrow!
I am torturing myself by listening a second time through because the first time I just couldn’t stop yelling out questions into the void that I wish had been asked and refuting ridiculous, irresponsible statements that were made. And, Jaime, I just cannot abide how you were treated. You are the only one they challenged. They pandered to everyone else and nodded along, only slightly challenging Laura Edwards Leeper. So in summary, they only challenge anyone who questions any of this. Which makes all the activist vitriol against “Protocol” very uninformed because unfortunately, I think it just advances the affirmative model. I honestly don’t know how you kept your cool with the two of them (especially during that moment when he tried to play therapist with you in a thinly veiled gotcha moment sharing his pseudo psychological insight that your feeling like you were not allowed to be your true self in your job is just like how trans people feel. Therefore, how dare you not allow them to be their true selves by interfering with their life saving/affirming care… ) or with that unhinged mother yelling “me, me, me.” How telling was that? You perfectly and calmly made Helen Joyce’s point that in the face of liver damage and all the rest, these parents have to cling to having done the right thing. I am so glad you all are doing an extra episode.
I am thankful to all of you for listening to "The Protocol." I have not done so, because my shock that anyone, then or now, could believe in, make excuses for, or try to sculpt a "middle ground" out of this merda, is everpresent.
I do understand Ben's initial shot of joy that perhaps maybe the social-contagion contingent of straight young girls might soon be spared. We are talking about tens, maybe hundreds of thousands of precious young women!! ANY reduction in this insanity is crucial--and reasons why it is monstrous perpetrated against one set of people are also reasons it is monstrous against another set of people. It doesn't mean we abandon the fight to pull the monsters off the bodies of the proto-gays.
It looks as if they are trying to take the middle-leave the teen girls alone, but throw the rest under the bus (younger kids, boys) with assessments which still, after 20 years, have not been shown to determine who will be better off with these interventions than without them.
I'm sure there were assessments for all sorts of other harmful treatments, just because they've been doing them for a while doesn't mean they distinguish anything useful, such as who would be better off than not with these interventions--which they keep saying here--thank goodness!!
Let the record show that NO ONE is better off with these "interventions."
Nobody would be having this conversation if the intervention was gouging someone's eyes out, because they're uncomfortable looking at their body. Or slicing someone's ears from their head, because they didn't like the pitch of their voice. And yet, and yet! Chopping someone's healthy dick up/off with a knife: there are people who think there COULD be a circumstance in which that would make him better off?! Wrecking someone's clit, destroying her healthy breasts: there are creatures walking around so insensate that they could even connect "better off" with these acts?!
Let all of our conversations, podcasts and writings serve to pull away the euphemisms. We need to intercept the flow of lies to well-meaning normies.
My response to The Protocol is that it is more propaganda than journalism. It reminds me of what Nixon proposed during the Watergate scandal, a limited hangout. Admit that there are problems, as a means for avoiding the more serious issues.
The most glaring indication for me was the failure to address a fundamental problem with the Dutch study, that it reversed the questionnaire for males and females after the blockers had been administered. This is such a glaring methodological problem that it calls into question the integrity of the entire research project. It is practically inconceivable that professional journalists, who took two years to report this series, could have missed this failing.
How could this be? Well, the other tell is that they failed to interview any critics of the protocol who could have alerted them to this problem, though they did report the sampling problems that the author admitted and which were later noted by the Cass Review. There was obviously a lack of journalistic will to get to the truth.
Instead, interviews were presented in a series, which presented the conflict between evaluation, and what is essentially affirmation on demand. But even with this severely self-limited remit, they failed. The final episode (which I assume you will be discussing in a future episode), provides no essential summary or draws any conclusions about this conflict. It just leaves the listener with a vague understanding that, as Reagan said during the Iran-Contra scandal, ¨Mistakes were made."
Rather than reckoning with these mistakes, we are presented with a series of first-person accounts that reiterate the recurring theme of the podcast: there are children who were suffering, and something needed -- and continues to need -- to be done. But now, those mean old Republicans--aided by whistleblower Jamie, who is all but accused of being insensitive to their plight--want to ban this essential care for so many suffering children. It all but shouts a cliche made famous by the Clinton sex scandal: "Dear God, won't somebody please think of the children?
So what we have is not journalism, but scandal management that, to paraphrase the Simpsons, tugs at the heart while it clouds the mind.
Tobin’s rationale of The Protocol is helping people ‘to better understand’ the bases of GAC prior to Skrmetti release? Well, they sure failed there. No depth. All-affirming journalism. Complete lack of knowledge about what undergirds medical science and practice. And there’s only 1 whistleblower in the world, Jamie Reed? I’d think they were incompetent if it didn’t seem apparent that they’ve brainwashed themselves into Affirmation Uber Alles.
Commenting for a second time because I've just gotten to the episode where they interview Jamie. Oh my god. I don't think I've ever heard a worse interview conducted by such an interviewer at such a prestigious publication. Why is Azeen trying to debate Jamie? Why are she and Austin being so condescending? It literally sounds like they've called Jamie into the principal's office to lecture her about something she's in trouble for. They are so charitable to every other interview subject except her. That sounds like it must have been such an uncomfortable room to be in. Also, why the obsession with the feelings of the parents? It feels like they're trying to placate their audience of parents who have transitioned their children that "no, no, don't worry, you did the right thing" without actually being able to back that up.
Agree! "you're a person of extremes" and "you have an anarchist tattoo!" Jamie is the only person who's credibility is undermined -- and in such a personal way (subtext: you really are unstable). Kudos to you Jamie for your commitment to integrity and ability to maintain your composure. Thank you for your courage.
Jamie, the way you point out how FG is still stuck pre-puberty is an amazing and so true realization. That’s such an insight about the whole movement. How can people grow in themselves and the world if they embrace a counter-factual as their identity and are told my others they are entitled to require that be affirmed by others? Wow. This explains so much of the odd personality traits that this group seems to exhibit in common.
Tobin’s (sp?) rationale for The Protocol was to help people
“to better understand”