And so, after four years of hard work, Leibowitz, de Vries, and the rest of the group called their peers traitors and the community they wanted to take care of. “We understood from the beginning the tremendous need for these standards,” Leibowitz told me. “I’m not sure we acknowledged the enormity of the controversy. Our world, the world of gender surveillance, is the result of an explosion. ”
In the 1950s and in the 1960s, a small group of doctors in Europe and the United States began talking about how to assess adults who wanted to make the medical transition. Harry Benjamin, an endocrinologist who originally named him WPATH, admitted that the people he admitted to treating (mostly trans women) were “born in the wrong body.” Fearing dissatisfied patient litigation, doctors quickly dismissed patients because of mental stability. And they arbitrarily included only those who thought they would become an identified gender, as Beans Velocci, a historian at the University of Pennsylvania, wrote last year in an article in the TSQ: Transgender Studies Quarterly. Some doctors promised that trans adults would live as heterosexuals after the transition.
All of the small group of clinicians who wrote the first Standards of Care were gendered. When WPATH was founded in 1979, transgender advocates gained more and more influence in the organization, but many transgender people saw post-standard versions as imposing paternalistic and humiliating barriers to treatment. For some genital surgeries, the standards identified adults who had to live for a year as a gender and referred to two mental health professionals. SOC8 is the first version to reject these requirements, adopting a “decision-making” model between the adult patient and the surgeon.
The leap to medical transition for young people occurred in the Netherlands in the 1980s. Peggy Cohen-Kettenis, a Dutch clinical psychologist specializing in children, began receiving references from adolescents suffering from gender dysphoria (then called gender identity disorder). But therapy wasn’t the main answer, Cohen-Kettenis told me over the phone in the spring, retiring. “We could sit and talk forever, but they really needed medical treatment.” As their bodies developed the way they didn’t want to, “they did worse because of it.” Instead of waiting until the age of 16, she decided to help her patients start hormone treatment in the Netherlands and elsewhere. He checked them every week, then every month. “To my surprise, the first couple was doing much better than when they came,” he said. “That encouraged me to keep going.”
Cohen-Kettenis helped establish a revolutionary treatment protocol. Patient Zero, known as FG, was sent around 1987 to Henriette A. Delemarre-van de Waal, a co-pediatric endocrinologist who co-founded a gender clinic in Amsterdam with Cohen-Kettenis. At the age of 13, FG was disappointed with her passing from puberty to women, and Delemarre-van de Waal put up with her protections against puberty, which was then followed by Cohen-Kettenis. The medication would interrupt the development of secondary sexual characteristics, preventing the FG from experiencing the feeling that her body was betraying her, gaining her time and then making it easier for men to go through puberty if she later decided to take testosterone. Transgender adults, who were also treated by Cohen-Kettenis, said that sometimes they would rather have made the transition earlier in life if they believed they would achieve a masculine or feminine ideal. “Of course I wanted to,” FG said in an interview with historian Alex Bakker in his 2020 book on the Amsterdam clinic, “The Dutch Approach,” about anti-puberty. “I later realized that I was the first, kobaya. But I didn’t care. ‘
Over the next decade, Cohen-Kettenis and Delemarre-van de Waal designed an evaluation for young people who looked like candidates for medical treatment. In family questionnaires and sessions, Cohen-Kettenis looked at the causes of a young person’s gender dysphoria, whether therapy or medication or both could be better addressed. The policy was to delay treatment for people with problems such as inattention and eating disorders or those who did not have a stable and supportive family, in order to eliminate the factors that could hinder treatment. “We did a lot of other work before we started, which caused them a lot of frustration,” Cohen-Kettenis said. “Maybe we were too selective in the early stages.” In retrospect, he believes that young people who could have benefited were excluded.