A Review of the NYT's The Protocol Podcast

The youth gender medicine debate is even more a mess than I realized. Too bad the podcast is too.

The issue of youth gender medicine is probably one of the most toxic if not the most toxic in American discourse. There are real issues of youth wellness in play: On one hand, if some youth would truly to helped by medical interventions to, in effect, change their gender appearance, then perhaps we should let them. On the other hand, if other youth would be harmed by such interventions, we should make sure they are not prematurely exposed to useless or harmful treatments. Distinguishing between these two groups of kids seems paramount¹. Nonetheless, the main items on the menu at the moment appear to be either give possibly troubled youth unfettered access to gender medicine with minimal, if any, gatekeeping…or to ban it altogether.

We’d hope that there were knowledgeable, sane individuals guiding society toward the most rigorous procedures that will maximize the care for youth who both would and would not benefit from gender medicine. However, listening to the New York Times’ podcast The Protocol will certainly disabuse you of any such hope. Instead, it seems most everyone on both sides is irrational, unhelpful and/or confused, the podcasters included. The Protocol is entertaining at times, but more often it’s a frustrating mess. That’s part because the subject material is a frustrating mess, but the reporters, Azeen Ghorayshi and Austin Mitchell, can never seem to quite rise above it themselves.

First, let me get the stylistic elements out of the way. These types of “high concept” podcasts have, of late, veered toward the chatty, as if the reporters are sitting down with us at our kitchen tables having an heart-to-heart conversation about, say Ozempic or whether kids should get top surgery. I don’t really love this kind of cheesy style, which can come across both as informal and earnest in a grating kind of way. It reduces the credibility of the reporters. This is made worse by the tendency to insert the reporters into the center of the story (The WSJ podcast Trillion Dollar Shot did the same thing in really, really annoying ways). In this case at least twice the podcast takes time aside to cast reporter Azeen Ghorayshi as the victim of backlash to her past NYT articles on this topic (more on this in a second). Maybe that’s true, but it comes across as a conflict of interest and whiny.

Even worse though is the podcast’s god-awful style of fading interview audio from foreground to background, while Austin Mitchell’s voice narrates over it, basically saying what the interviewee was about to say anyway. It’s sooo, sooo distracting and trite an editing style. I was probably angrier about how overused this is in the podcast than anything happening to the kids in the story. I hope this doesn’t become a documentary trend. Let the interviewee speak for themselves and, if they go long (as I tend to do when interviewed) edit it down to the essentials.

Throat Clearing

Before I get into the meat of the podcast, let me clarify my own position on this (dear god, a positionality statement? No, just as it relates to my priors). Overall I’m probably somewhere in the middle on this, though certainly skeptical of unfettered youth gender medicine. The protocol is named after the Dutch Protocol, an early approach to youth gender medicine wherein youth might receive medical intervention only after a rigorous possibly year-long assessment, to screen out kids with other mental health concerns or who’s families were not supportive. The goal was to narrow treatment to only those kids who would legitimately benefit from it. I still think this is about the best (if imperfect) idea anyone has had on this issue, even if the podcast seems intent on torpedoing it in latter episodes.

I do think the American model of unfettered youth access to gender medicine is likely to go down as a rather remarkably medical scandal. However, I think full bans will also be viewed as its mirror image of unhelpfulness and rigidity. The podcast makes the case repeatedly that politics has too often replaced objectivity in this debate, which I think is fair on both sides. I worry too how much blowback trans adults may experience in a kind of foot-in-the-door legislative approach to rolling back trans care for adults as well as youth.

But…I also am not an expert in this topic and I find it more interesting in the popcorn and soda sense (sorry, that’s my nature), than anything I’m losing sleep over. So, I’m pretty open to being convinced one way or the other. Mainly The Protocol convinced me that almost everyone driving this particular train is a loon and a lot of people are going to get hurt.

Azeen Ghorayshi

As I noted above, Azeen Ghorayshi was not an uncontroversial choice to report this podcast. As a science reporter for the New York Times, she has covered the trans debate in ways that have been criticized by trans activists. This has led many trans activists to express the concern that the podcast would be biased which, honestly, I think is a fair critique. Note: biased does not necessarily mean wrong², but if the NYT wanted a fair and objective hearing on this issue, I don’t think Azeen Ghorayshi was the right person. As we say in psychology: the best predictor of future behavior is past behavior.

I’ve seen some people pooh-pooh these criticisms because they came before anyone had heard the podcast, but come on. Of course organizations can signal their final conclusions well in advance by whom they pick to weigh them. If PETA declares they’re running an objective scientific review on the benefits of eating meat, I think we can all guess what the outcome will be in advance. I think that pooh-poohing of concerns regarding Azeen Ghorayshi was patronizing.

As a fairly typical critique you can read this one in The Dissenter. I think they overstate their case in many places, as advocates do. However, I also found some of the concerns to be very fair. The degree to which the anti-trans side believes in its own fairy tales like “social contagion” (which, on this issue at least, has no good evidence, but who cares right?) has put some serious brakes on my own enthusiasm for and confidence in their cause. I’ve been pretty open minded about the Rapid Onset Gender Dysphoria pseudo-diagnosis, but I think it’s fair to consider studies that both do support its existence and those that do not.

But my point here is…if the NYT wanted to do an objective podcast on this issue…they couldn’t find anyone other than Azeen Ghorayshi? Surely, they must have foreseen the reaction (though maybe that was the point, ratings being ratings and all that). It could only but call the credibility of their whole podcast into question.

Episode 1

This episode considers the early days of youth gender medicine prior to any real studies on it. Much of the episode is an interview with a British man who was one of the first youth to go through youth gender medicine and is still happy with the result today. A lovely interview, but anecdotal of course. Historically interesting, overall, aside from that awful fade-in/fade-out style.

Episode 2

This episode follows the Dutch Protocol which, as noted above, was designed to be a rigorous approach involving long assessments of youth to make sure only those who would benefit from care would receive it. Early data on the Dutch Protocol seemed promising. At this point the reporters seemed pretty sympathetic to the Dutch Protocol.

Episode 3

This episode follows the importation of the Dutch Protocol with results that I think will prove to have been disastrous. Most of the rigor in the protocol was dropped. The reporters here are pretty clearly unsympathetic to the American approach. Frankly, so am I, but for that very reason I think it’s important to challenge our priors. To defend the American approach, the reporters pick Johanna Olson-Kennedy who has been super controversial both for sitting on some of her own inconvenient research results and is being sued for allegedly rushing at least one teen into gender medicine. Olson-Kennedy comes across as morally smug and defensive in her interview. Granted, I think there are a lot of loons in this space, even among the scholars, but I did wonder if they couldn’t possibly have gotten a more credible supporter of American-style youth gender medicine to make that case?

Episode 4

The wheels really come off the bus here. I found this episode extremely frustrating. Most of it is spent on Jamie Reed who achieved fame as a “whistleblower” regarding alleged unsafe practices at a trans youth medicine center in St. Louis where she worked. I guess it’s good we hear how borderline unhinged Reed actually seems to be…so much so I think she, more than anything, aroused new skepticism in me over the entire anti-trans movement. Reed absolutely believes in the full-ban laws. That’s fine. But her interview was all over the place, defensive, diversionary, filled with nonsense. At one point she weirdly claimed to have had gender dysphoria herself as a youth which…I mean, who can say,…but which really pushed my bullshit detector into high gear. At another point she claimed that 15 kids are harmed for every kid helped by youth gender medicine; a number that, of course, is entirely smoke. To their credit, even the interviewers pointed out that this was nonsense.

The entire interview was disorganized, so much so I wondered if the reporters thought Reed would bolster their cause only to discover she’s a dumpster fire. Later in the segment, the reporters caught an altercation between Reed and a woman who she falsely reported as threatening the gender clinic (based on second-hand stories Reed heard from a nurse). The inability of Reed to simply admit she’d make a mistake and apologize was entirely discrediting.

Honestly, it’s alarming that so much legislation seems to hinge upon this woman’s testimony. The interview is so very bad it made me question the reliability of whistleblowers more generally³, and think we ought to approach them with more skepticism than we do. I’ve seen and heard a lot of people who I generally find credible and trustworthy try to defend Reed, but my gosh…

Unfortunately, this episode seemed to throw the interviewers off their game and it becomes hard to know what they were after from this point on. It felt like they kind of had a narrative in mind, but Reed unintentionally torpedoed it. Maybe that’s not the case, but the uneven pacing of the podcast makes it a bit bewildering.

Episode 5

This episode focuses on the Cass Review, the UK’s big review of youth gender medicine, which came to negative conclusions about the reliability of the evidence supporting it. To be honest…I’ve generally thought of the Cass Review as the best evidence against youth gender medicine. But listening to the interview with Hilary Cass, I became less convinced rather than more.

To be fair, Cass is far more credible than Reed. But she also demonstrated a significant willingness to speak beyond the data (including on the idea trans identities may be socially contagious, for which there is no clear evidence, just lots of strong feelings⁴). Unfortunately, the reporters softball this interview, so we don’t get a real kick-of-the-tires on Cass’ review. By this point the interviews with Reed and Cass so undermined the anti-trans movement I was beginning to really rethink my perspective on this.

Fortunately, they then interview former World Professional Association for Transgender Health president Marci Bowers, who is so blatantly ideological I was reminded how much nuttiness there is on the other side as well. Bowers repeats the self-discrediting claim that there are “no two sides” in this debate which, of course, leads us to recognize it’s hard to be in a debate if there aren’t two sides. I hate when people use this argument.

This interview also felt discrediting for the reporters though. With Cass, they basically did everything but offer her crumpets and tea. With Bowers, Ghorayshi comes across as testy and defensive (Bowers did have a knack for taking control of the interview, even if she led it into fantasy-land). Ghorayshi comes across as emotionally invested in the anti-Bowers view, which of course is exactly what this podcast was criticized for by trans advocates in the first place.

Discrediting too, was just the podcast’s willingness to treat certain right-wing fever dreams like the social contagion hypothesis as fait accompli despite at least some credible research contradicting it (as noted earlier)⁵. By this point, I realized that the podcast actually spent very little time with research at all. We get discussion of the Dutch Protocol and Olson-Kennedy’s mysterious study (which the reporters boldly interpret as discrediting the Dutch Protocol…apparently by this point deciding the Dutch Protocol was dodgy because…why not?) But there have been a lot of studies on both sides that are very interesting and controversial…but we hear about almost none of them. Overall, this makes the podcast feel like it’s built on flimsy evidence, with only a superficial concern for a reasonably sized, if conflicted and controversial evidence base.

Episode 6

This episode brings us to the present with the various bans on youth gender medicine and the Supreme Court ruling this year which allowed those bans to continue. There’s an interview in this part with a clinician who left his job after the ban in his state. It’s actually one of the best interviews of the entire series as he comes across as one of the few truly sane and thoughtful people, conflicted about a complicated issue.

The rest of the episode is kind of wasted on a series of anecdotes of people briefly recounting their experiences with youth gender medicine. For a podcast that leaned kind of anti-, most of these anecdotes are surprisingly supportive of youth gender medicine. I’m not sure what the point was though…they’re anecdotes and not evidence. It seems like this time could have been better spent telling us more about research studies.

Conclusion

If you thought that the controversy over youth gender medicine was an irrational mess, this podcast will leave you with no doubt. Unfortunately, it can never quite rise above this itself. I think it’s been a bad trend that reporters end up in the middle of a story, and that happens here with Ms. Ghorayshi. It’s kind of like watching a weather reporter discussing a severe weather event only to get sucked into it themselves.

A failure to get deeper into the evidence, even if that didn’t result in conclusive findings, is a real weakness. I was left feeling like I’d learned very little about the data.

And, as mentioned, the production/editing style was just so, so bad and distracting it left me irritated through much of the podcast.

Ultimately, I don’t think people will come away from this with much they didn’t already have. People’s opinions will likely be dependent upon their a priori position on this issue (for me, it probably made me more skeptical of the anti-trans position, without reducing my skepticism of the pro-trans position). The decision to make Ms. Ghorayshi the lead reporter on this was a strategic mistake assuming (perhaps naively) that objective reporting was the goal here. Unless you’ve been living on the moon and hadn’t heard about the trans debate, there’s probably not much new here.

I wish I could give a more positive review, but NYT wasted their time on this one.

1. I still struggle to find controversy in the proceeding 3 sentences but, alas…

2. We might say, for instance, that Winston Churchill was quite biased against Nazi Germany in the 1930s at a time when the politics leaned toward appeasement. Indeed he was “in the wilderness” politically for much of that decade, in part due to his inflexibility to bending to the popular discourse. Nonetheless, if biased, he was still quite right about Hitler. I’m obviously not making a direct comparison between Azeen Ghorayshi and Churchill, just making a point about bias.

3. Admittedly, not for the first time. The Desantis whistleblower Rebekah Jones proved to be unreliable, and the “Facebook Files” whistleblower created an entirely misleading narrative about some weak studies (no, Facebook didn’t find that Instagram hurt girls).

4. An earlier interview with Laura Leeper did the same thing. Apparently the anti-woke side falls into the same trap of issue conflation as the left where if one holds an attitude on one thing (maybe youth gender medicine is dangerous), one predictably holds a particular view on a largely unrelated topic (social media is dangerous for kids) without any regards to or concern for actual evidence.

5. This should not be interpreted as being without critique. I asked a colleague about the Journal of Pediatrics study and I think we agree it has some serious limitations. Nonetheless, the finding that late-trans identifying youth don’t have more trans friends, still feels like at least an interesting, if far from definitive piece of evidence. This though illustrates my concern…it would have been interesting to dig into more studies like this, with both the authors and critics of the study, say. That would have been informative and educational. As is, this was a missed opportunity.