How 1 Small European Study Changed Transgender Medicine in US

Katrina Trinko / September 30, 2022

What is the basis for the current aggressive transgender treatment for kids? Dr. Miriam Grossman, a child psychiatrist and author, says it’s rooted in a study done of 55 children in the Netherlands who suffered from gender dysphoria, and were given puberty blockers.

But there are problems with how American doctors are using that study, and Grossman explains why. She also discusses what psychiatrists think behind closed doors about the current transgender treatment, and resources for parents with a child with gender dysphoria.

Read a lightly edited transcript, pasted below, or listen to interview on “The Daily Signal Podcast”:

Kate Trinko: Joining us at the National Conservatism Conference is Dr. Miriam Grossman, a psychiatrist who’s been writing about gender ideology for well over a decade now. Dr. Grossman, thanks for coming on.

Miriam Grossman: You’re welcome. Thanks for having me.

Trinko: So, as a psychiatrist, how do you view the issue of gender dysphoria in minors?

Grossman: Well, we’re being told that gender dysphoria is a very unique condition, and that we must affirm the child’s chosen identity. We must affirm the way that the child wants to be present herself or himself to the world. So in other words, as a psychiatrist, I’m being told by professional organizations and by [the Department of] Health and Human Services that children need to be affirmed.

Gender dysphoria itself is an intense feeling of discomfort with your biology as a boy or a girl. And we’ve always known that this exists.

In psychiatry, it’s something that I learned about when I was in training many years ago, but it was so rare that we never expected to ever see anyone with gender dysphoria, because it was one in tens of thousands of kids. And it was almost always found in boys. For every girl that had gender dysphoria, there were six boys. What I’m speaking about now is way before the current epidemic and the current social contagion, which is what we have right now.

So gender dysphoria is an intense discomfort with one’s body as male or female, and an intense desire to be perceived as the opposite sex, to live as the opposite sex, and in many cases with little kids, they will insist that they are the opposite sex.

And so you have this idea of being born in the wrong body, which has now become sort of mainstream. It was never anything that was believed by individuals in the medical community, until recently. But right now, with what’s called gender-affirming care, that’s one of the premises really of gender-affirming care.

So gender dysphoria used to be an extremely rare condition and we saw it in two different populations, children, mostly boys, and middle-aged men in their maybe 30s or 40s. These were the individuals that would complain of gender dysphoria. And these are the individuals, also, who would sometimes eventually become interested in transitioning medically to the opposite sex.

Now, we have a completely different situation right now. And for about the past five to 10 years, we’ve experienced a new phenomenon, which is, we’re seeing gender dysphoria in a new population, which is adolescent, adolescent onset, and mostly girls. And it’s happening at phenomenally high levels.

So we’re seeing, the studies now, there was a study of the high schools and middle schools in Pittsburgh, and it showed about 10% of kids were identifying either as the opposite sex or as nonbinary, a new word—

Trinko: Wow.

Grossman: … meaning neither male or female, or some other category. And I think at this point, the 10% is actually an underestimate.

Trinko: That’s incredible.

Grossman: Yeah, we’re really reaching, and especially on college campuses, very high levels of kids that are questioning their biology and identifying as something else than just, let’s say, simply being male or female.

Trinko: So, obviously, the big debate right now is, if someone decides they’re transgender, what responsibilities does the medical profession have? And you mentioned in your talk at the National Conservatism Conference that there’s one study that you refer to as the “Dutch Protocol” that has really affected how the United States views this issue and how doctors here treat this issue. Can you tell our listeners a bit about this study?

Grossman: Sure. It’s very important to understand this. The approach that we have now that physicians and psychotherapists are being told they must follow is called gender-affirming care.

Recently, [President] Joe Biden and his assistant secretary of health and human services, Dr. [Rachel] Levine, also spoke to the American people, American parents, and instructed them that one of the most important things, one of the most crucial things that they can do for their kids who are identifying as transgender is to provide for them gender-affirming care, therapy, and medical interventions. These were called crucial. These things were called crucial.

So I just want to underscore that what is being called crucial is actually based on the results of one very small study that was done years ago in the Netherlands. And I will explain what that study is about, but I first want to emphasize that the Dutch Protocol is the foundation of the type of care that doctors like myself, therapists, endocrinologists, who prescribe hormones, surgeons, and so on are being told is the way to approach these children, gender-affirming care.

Now, what happened in the Netherlands years ago was that, until the ’90s, the only people that would transition to live as the opposite sex with hormones and surgery were adults. And almost only, I mean, the vast majority were men. And the results for those men were not so good.

The cosmetic results were not good. And that is because they had already gone through male puberty. And so they had been masculinized by the testosterone that surges during male puberty and beyond. And so they had many features that made it difficult for them to appear feminine, as a female. And their mental health, after transition, was found to not be so good. And there were still high suicide rates in that population.

So in Holland, a group of doctors had the idea that if we could intervene in these people’s lives before puberty, and we could prevent the masculinization and feminization that happens during puberty—I mean, when you think about it, you think of someone who hasn’t gone through puberty, they’re a child. They don’t appear masculine or feminine, really. They could really present as either. They’re androgynous in a way.

So it’s only with the onset of puberty and the changes that occur, the breast growth and fat redistribution and facial hair and all the other things that happen, that it becomes more clear when we look at somebody whether they are male or female.

So these Dutch doctors wanted to find a way to identify those kids who were most likely to persist with their gender dysphoria for the rest of their lives, which is not an easy thing. In fact, it’s impossible.

You see, we can’t predict who’s going to persist with the gender dysphoria and who will get through it and will, after a number of years, reach a point of being comfortable with one’s biology, with one’s body. And that is called desistance.

So the kids whose gender dysphoria doesn’t last, they’re called desisters. And those for whom it does last, they’re called people who persist. So those are the terms that we use.

So the Dutch group tried, and we cannot—oh, what I meant to say, Katrina, is that we have no way of predicting which kids are going to fall into what category. But, I mean, we have at least 11 studies that conclusively tell us that the vast majority of kids do desist as they get into puberty and go through puberty and become adults.

Trinko: So for most of them, it’s not a permanent thing.

Grossman: Correct. And I’m talking about huge numbers here, depending on the study, between 60% to 90% … of these kids. So this is a very tricky thing. We don’t know which kids are going to persist and which kids are not.

But the majority of them, well, at least in the little kids, we have a new population now of the teenagers, but at least in the little kids, we know that chances are good, if not very good, that they will not persist. Many of them end up to be gay and lesbian, but they are comfortable and at peace with their physical bodies.

So the Dutch got together 55 kids who they thought probably a good chance that they will persist with their gender dysphoria their entire lives. And these were, again, kids who started complaining about their sex and not wanting to be their sex, or insisting that they were the opposite sex at a young age, 4, 6 years old, little kids. And then they persisted with that for a number of years. It didn’t come and go. It was persistent and they were insistent of this situation.

So what they did is they took a medication that we now call puberty blockers. They were not invented to block puberty. They were invented—well, they were used for different conditions. One is called precocious puberty. So precocious puberty, it’s also a rare condition, in which kids, boys and girls, they enter puberty way too early.

Trinko: Oh.

Grossman: I mean—

Trinko: Talk about a nightmare.

Grossman: Yeah. It is a nightmare. It’s a nightmare. Girls, 6, 7 years old begin to develop breasts.

Trinko: Oh, poor kids.

Grossman: So the treatment for those kids is very often to give them medications that will stop that. I mean, these kids, though, you can do laboratory work and discover that they actually have a medical condition. They have elevated levels of the hormones that shouldn’t be elevated at that time in their life. So we treat them for a few years with blockers, they’re now called blockers. And then when they’re 11, 12 years old, those medications are stopped, and they do go into regular puberty.

Trinko: So I’m guessing the kids in the Dutch study were not going through premature puberty.

Grossman: Correct, correct. They had gender dysphoria. Now, this was the first time that puberty blockers were being used in this context. They’re also used in other conditions. They’re used with prostate cancer, endometriosis. They’re used in sex offenders, because they block testosterone and testosterone increases sex drive. So they’re used in people who might be incarcerated or have really gotten into trouble with their urges.

Trinko: So what were the outcomes of these 55 kids who were put on puberty blockers?

Grossman: It’s a complicated subject, but for the purposes of our discussion, I’ll just say that they followed these kids for a year and a half after surgery. A year and a half is a very short time.

Trinko: Right, for the rest of your life.

Grossman: They did discover, though, that after a year and a half—oh, wait, I didn’t say something very important. So, two main things. First, that these kids developed gender dysphoria at an early age. And second is that if they had any significant mental health issues, they were disqualified.

Trinko: Got it. So that would be anything beyond gender dysphoria, OCD, depression. I don’t know all the kids’ mental health issues.

Grossman: Well, right now kids with gender dysphoria are presenting with many, many mental health—many of them are on the autism spectrum. They have anxiety disorder, depression, OCD, eating disorders, self-injury.

There’s many different issues that they struggle with.

Trinko: So these kids in the Dutch study, no other existing issues.

Grossman: Right. They were excluded if they had significant psychiatric comorbidities. That was an exclusionary point. So they were psychologically, generally, healthy kids, but they had gender dysphoria from an early age.

So they got 55 of these kids and they put them through this protocol. And they found that a year and a half, they were still very young, I think they were still, maybe 20, 21 at the oldest, and they were in general doing well. And they had less gender dysphoria.

So now there are many issues that I’m not going to go into here with the problems related to this Dutch study. I mentioned one just a minute ago, which is that the follow-up was so short. We now know that regret with undergoing medical and surgical transition takes a long time. It can take up to eight or 10 years to experience that regret, No. 1, and then to process it and accept it internally to the point of being able to admit it. And then you have to admit it not only to yourself, but to others.

So that is a very complicated process, because you have to imagine here that these young people have, over the years, everyone in their lives, their families and their friends and their connections, they’ve all told them, “This is my identity. I have a new identity. I’m not male. I’m female. This is my new name. These are my pronouns. I’m sure. I’m 100%. This is who I am. Don’t challenge me. I know who I am.”

And then after years, and after these huge decisions that they’ve gone through, and perhaps their families may not have been 100% on board and they may have alienated their relationships within their families—this is a very complex thing.

Trinko: You mentioned in your talk, I believe, correct me if I got this wrong, that part of the problem with American doctors relying on this study was these kids didn’t have coexisting mental issues or comorbidities. And today in America, most kids with gender dysphoria do, so the study doesn’t really seem applicable. Is that correct?

Grossman: That’s correct. What I’m saying is that the current population, you have to compare apples and apples. This is not apples and apples. This explosion of young people right now who are clamoring for puberty blockers and cross-sex hormones and surgeries are a completely different population than those kids that were part of the Dutch study.

And like I said in my talk, if two people come to a doctor and they have knee pain, and one of them fell down and broke their kneecap and the other one has arthritis of their knee, we have to recognize there’s different ideologies, different things going on. We don’t just lump them together and treat one the same as the other.

But that is what we’re doing now. And it’s being done because the professional organizations somehow have been captured by the ideology, and they are coming out with guidelines and policy statements and so on. And telling professionals that the only way to go with these kids, the only ethical and effective treatment is to affirm kids, no matter how young they are, no matter how troubled they may be, to accept their chosen identity and to put them on a fast track toward medicalization.

Trinko: You mentioned the ideological capture, and I’m sure in medicine, as in many fields, there’s people who are just afraid to speak out. But what are you hearing behind the scenes from other doctors, other psychiatrists about this new and radical approach to gender dysphoria? What do they really think?

Grossman: Well, we can’t know statistics. There’s been no referendum. It’s not as if the American Psychiatric Association sends out a questionnaire to every psychiatrist in the United States, asking them questions about this issue, and then taking all the answers and coming up with some sort of statistic or consensus that this is what psychiatrists or endocrinologists or surgeons all believe has to be done. That’s just not how it works.

The problem is that the public is led to believe that there is a consensus. So when Rachel Levine stands up and says, I’m paraphrasing, I don’t have the quote in front of me, but something like, “The medical field is in agreement that this is the ethical way to treat these children,” and she’s presenting it to the American public as if there is some sort of consensus, that is simply false. That’s simply incorrect. There is no consensus.

In fact, there’s huge debates that are going on. The public doesn’t necessarily hear about them, but they are going on. Some of them are behind closed doors and people don’t want to be identified as opposing gender-affirming care. But trust me, more people than you might imagine are outraged and upset and just very, very disturbed about what we’re seeing here.

Trinko: So lastly, at The Daily Signal, a lot of the time when we run an article about gender dysphoria, we get emails from parents saying they have a child, or they know a child, and they don’t know what to do. They don’t know where to turn to help their child with gender dysphoria, beyond all the “experts” pushing this “gender-affirming care.” What would you recommend to a parent who finds themselves in this situation?

Grossman: First of all, the parent needs to know they are not alone. They are not the only parent on the face of the Earth that when their child comes home and makes a sudden surprise announcement, “Mom, dad, I’m no longer your daughter. I’m your son. Call me by this new name. Call me these new pronouns. And take me to an endocrinologist. I want to take hormones,” there are many thousands and thousands, if not tens of thousands, of parents that have been in that position and who refuse to just in a knee-jerk kind of a way go with it.

Because they know in their gut that they know their child and they know that there’s other things going on and they’re terrified, and they should be, of the idea that their child wants to medicalize. I mean, haircuts and clothing is one thing, but medicalizing, irreversible physical changes. If a girl takes testosterone, in about three months, her voice can be permanently lowered—

Trinko: That’s so fast.

Grossman: … for the rest of her life. And believe me, I talk to a lot of young women who are in the position of now regretting that. And they have to live with it for the rest of their lives.

They get on the phone with people, and everyone thinks that they’re a young man. People are confused. You go to the store, you go to whatever it may be, and they have to live with that.

And that’s the tip of the iceberg. I mean, a lowered voice is a relatively benign kind of a thing compared to other things that are happening, like impact on fertility, sexual dysfunction, cardiovascular risks, strokes, very serious medical, adverse effects.

So what can parents do? No. 1 is that they shouldn’t think that they’re alone for a moment. There’s many, many wonderful resources for parents who want information that is not immersed in the ideology. Parents who refuse to be dismissed.

You see, what’s going on in gender-affirming care is that the parents are actually being dismissed. Parents come into a therapist and say, “Wait a minute. What’s going on? Our child is autistic,” or, “Our child is being treated for autism. Our child was sexually molested a few years ago.” We need to look into all that stuff before we automatically say, “Oh, yeah, you’re a boy. Change your name, change your pronouns, put you on testosterone.”

And what’s happening, and I’m hearing this a lot from parents, is that the therapists will say, “If you don’t accept that you now have a son and not a daughter, you are the problem right now. And your lack of acceptance is going to increase the chance of your daughter ending her life.” So that’s a whole other discussion—

Trinko: The threat, yeah.

Grossman: … is the suicide thing. And maybe we can do that another time, because I know we don’t have much time.

But what I’m saying is that parents should not allow therapists to throw them under the bus. We’re talking about loving, devoted parents who from Day One, from the moment they found out they were pregnant or the moment they signed the adoption papers, are 100% devoted to this child and doing everything and more for this child. So it makes me very angry when I hear about therapists who throw these parents under the business and tell them that they’re the problem.

The parents are not the problem. The parents have very good reason to be concerned about what’s going on and to want to take it slowly and carefully and address all the other mental health issues that are going on first.

So there are a lot of websites. Let me just mention a few of them. I won’t be able to mention all of them, but first of all, I’ll mention my website, which is miriamgrossmanmd.com. And I have articles and videos. I wrote an important article for The Daily Wire going through the medical consequences of transitioning. It is behind a paywall, but it’s very thorough. And I think that it’s must reading for parents.

And then I have other articles and videos addressing other things, among them, the dangers of social transition. Because people may think that a new name and new pronouns and a haircut isn’t a big deal. But I explain how it’s actually kind of getting on the ramp that leads to an expressway toward medicalization. So it’s kind of a gateway. It’s kind of entering into that.

Now, these things are not easy. This is a very difficult challenge for parents, but there’s a tremendous amount of support. So I want, first of all, to also tell parents about a website, it’s www.segm.org, and that stands for Society for Evidence-Based Gender Medicine. And they’re going to find all the articles that they need there.

And I’m just going to throw in, I didn’t get to mention, very important, that in other countries, in England, Sweden, Finland, France, Belgium, Australia, and New Zealand, these countries are all taking a step back from gender-affirming care. So what we’re doing in this country, what we’re in a rush to do to our kids, they have done a 180.

And these are some of the most progressive, LGBT-friendly countries on the face—I mean, Sweden, Finland, they have done a 180 and they are now saying, “We don’t have the data. We don’t have good research that allows us to assume that this is the path we need to take with these kids. We need to stop and do more research and give these kids psychotherapy.”

Trinko: So for once we really should act more like Europe.

Grossman: In this case, yes, Scandinavia in particular, but yes, like Europe. So there’s SEGM, segm.org. There’s a fantastic site, it’s a Substack with essays by parents, must read. Everyone should read this Substack. It’s called PITT, Parents with Inconvenient Truths about Transgender. But the Substack is PITT. And you have hundreds of essays written anonymously by parents who have gone through it and are going through it. And you’re going to get the raw truth. That is the raw truth there from parents.

Trinko: It’s a very powerful site.

Grossman: There’s many others, they just need to search for—there’s parent groups. There’s support groups. There’s even retreats now that are happening, parent retreats. There’s an organization called Genspect, and great website, great information for parents. So there’s a lot going on.

And parents should not think that the message that Joe Biden and Rachel Levine is giving them is the message that they need to accept. It is not correct. It is not based on the real science over here about this.

And parents should get educated, get support from other parents. And there are therapists out there also who do this work with families and are not gender-affirming. They are what’s called gender exploratory, which means you wait, you talk, and you heal. And that is the answer to so many of these kids in distress.

Trinko: I’m sure that’ll be helpful to a lot of parents. Dr. Grossman, thank you so much for joining us today.

Grossman: Thank you for having me.

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