State bans are enacted. The Supreme Court is poised to weigh in. President Trump declares that there are only two genders and threatens to withhold federal funds from hospitals that provide pediatric gender treatments. We hear from kids, parents and providers caught in the middle about the complicated decisions they are making.

The heated debate is not limited to the U.S. In England, a pediatrician tasked with figuring out how the country’s health care system should provide the care finds that the evidence is “remarkably weak.” One major medical group argues that’s missing the point — and repeating history.

A small Midwestern gender clinic gets consumed by a growing political fight when a whistleblower goes public. She had begun to see the treatments as harmful, and decided the political route was the only way to fix it.

In Boston, a psychologist helps set up the first youth gender clinic in the U.S., adapting the Dutch approach. Across the country, a rising star in the field questions their methods. Meanwhile, demand increases worldwide as the types of patients seeking care change.

The new treatment is codified into a protocol, and the Dutch publish a landmark study that launches the field of youth gender medicine. A former patient describes the benefit of early treatment in a society that is still hostile to trans people.

The story of youth gender medicine starts in The Netherlands, with a clinical psychologist and a 16 year-old who was determined to go through life as the gender he long felt he was. 

Since 2021, nearly half the states in the U.S. have passed bans on medical treatments for transgender minors. The Trump administration is now targeting the care, and in the coming weeks, the Supreme Court is expected to weigh in.

“The Protocol” is the story of youth gender medicine — where it came from, who it was meant to help, and what may come next in the legal and political fights over its future.