Thinking about The Protocol

I’ve been working my way through the New York Times’ new podcast, The Protocol.

It's fascinating as a historical document because it reflects what the likely consensus will be on what went wrong with pediatric gender medicine in the US: too much of a good thing, applied too loosely and broadly, cruelly politicized by The Bad People.

But as a work of journalism, I think it’s a failure.

We’ll be going over what Azeen Ghorayshi got wrong—or left out of the picture entirely—on Informed Dissent over the next few weeks. (We took on the first and second episodes in the podcast we recorded on Friday morning, so consider tuning in for that.)

But there are other things on my mind. I didn’t think the New York Times would deliver a real reckoning of what went wrong and why. I’m far too jaded at this point. But one of the reasons listening to The Protocol feels so disheartening is that I suspect it will defer any half-serious reckoning in any other liberal public forum in the United States. That’s because Ghorayshi finally acknowledges the discomfort many New York Times readers feel when they think about pediatric gender medicine, and then immediately contains that discomfort: you feel uncomfortable because some gender clinicians took things too far. But there’s nothing else to see here. These interventions were well-founded, they were absolutely appropriate for some kids—maybe they were appropriate for your kids, too!

Over the past few months—in particular, over the past few weeks—every conversation I have seems to confirm that we will roll back the clock 15, maybe 20 years, but that pediatric gender medicine is not going anywhere. We’ll spare the most obvious cases of social contagion (the revolution leaps and sometimes overleaps!) and we’ll keep sacrificing highly gender-nonconforming, mostly gay kids.

I don’t know that there will ever be a more radical accounting of what went wrong. Sometimes it feels like we have done something so terrible that no one can ever face it. The excesses of the past 10 years will excuse or erase the abuses and missteps of the past: It must have been right for some kids some of the time or else we never would have done it.

It also strikes me how many uncomfortable—maybe unthinkable—conversations would have been required to set the record straight.

How can we expect that of a field that evolved to avoid ordinary human discomfort, trafficked in magical thinking, made impossible promises, buried inconvenient or painful realities? Gender medicine attracted people who preferred skating on the surface to plumbing the depths, people who wanted to do the right thing—of course they did!—but valued looking good/progressive/enlightened over figuring out what the right thing to do was.

It’s easy for Ghorayshi to ask tough questions of (and take cheap shots at) my friend Jamie Reed. I don’t think there’s anything that Ghorayshi can throw at Jamie that Jamie would be not willing to think about, accept, reject, challenge. But to drag into the light questions of which other interviewees wish to be unconscious is much more delicate.

To the gender clinicians Ghorayshi lifts up as paragons of respectability, Ghorayshi would have had to say: tell me, be specific, what were you assessing for? Have you ever had a patient come back and say he or she regrets going down the pathway you set them on? Do you ever have doubts about the work you’ve done? You’re caricaturing your critics. Respond to their real concerns, not your inventions.

To Annelou De Vries: You say patients were screened to exclude young people who found it more acceptable to be trans than gay and yet they were almost all gay, weren’t they? Have you ever asked yourself what you have really been treating all these years?

Of FG, Ghorayshi would have had to ask: But what if you hadn’t transitioned? Can you imagine what your life might have been like if you’d never heard of the idea of being born in the wrong body, if you’d never been prescribed puberty blockers,* if your father hadn’t railed against a child whose masculine presentation and emerging homosexuality discomfited him? FG’s friend—the friend who wanted to be a boy, too, every bit as much as FG did, but who ended up a butch lesbian—hovers in the background like a ghost.

But if you can’t ask uncomfortable questions, don’t be a reporter. Serve ice cream, answer phones, write the kind of upbeat, impersonal messages that line greeting cards, I don’t know. But don’t bother with journalism.

*Listening to both FG and Manon, I kept thinking about what Ivan Illich said: “Culture makes pain tolerable by interpreting its necessity; only pain perceived as curable is intolerable.” Before GnRH agonists existed, puberty was a nonnegotiable—nonnegotiable and thus tolerable—part of human development. The existence of a protocol to suppress puberty made puberty optional for the first time in human history and thus intolerable for a generation of gender-distressed kids.