Episode 66

66 - Pioneers Series: Where It All Started - The Dutch Researchers Steensma & De Vries

Published on: 11th March, 2022

The reason this interview is so important is bc the concept of puberty blockers originated with these two researchers (along w/ cohen kettenis.) We talk about patient zero and the 22 year follow up w/ this person. We get into the nitty gritty details about the 2 studies on which all puberty blocker treatment is based: we ask why they selected certain methods, talked about eligibility criteria, and the 15 participants who didn’t make it into the final study. We even touch on Jazz Jennings, social media, ROGD and detransition. This conversation felt, to us at least, like we barely scratched the surface: we were frankly left with more questions than answers, which we are so eager to talk about in our post series analysis. You’ll probably notice the vast differences between the perspectives of these researchers and of myself and Stella, but nonetheless it was a productive and fascinating conversation. 

Bio: Steensma 

Thomas D. Steensma, Ph.D., is a health psychologist, principal investigator and part of the outpatient management team at the Center of Expertise on Gender Dysphoria at Amsterdam UMC, The Netherlands. 

Trained as a child and adolescent psychologist, his clinical work is focused on the counseling and treatment of people of all ages with gender incongruence and Differences in Sex Development (DSD). 

As principal investigator, his research lines are focused on psychosexual development, gender identity development and treatment evaluation of youth with gender incongruence. Over the years, he has published over 50 peer reviewed articles in international journals and several book chapters in close collaboration with prominent scientists in the field of gender and sexology. He has co-supervised several Ph.D. and master students. 

His recent scientific work is focused on understanding the developments in our field focusing on the change in observed sex ratios and the influence of media attention on gender referrals and understanding the processes and factors involved in non-binary gender identity formation. 

He is currently part of the working group for the text revision of the DSM-5 chapter on Gender Dysphoria. In the development of the 8th version of the Standards of Care of the World Professional Association of Transgender Health (WPATH), he is part of two working groups: Assessment and Therapeutic Approaches of Non-Binary People and Assessment, Support and Therapeutic Approaches of Children. 


Bio: de Vries 

Annelou de Vries is a child and adolescent psychiatrist and full staff member in the dept of child and adolescent psychiatry working at the Amsterdam UMC. 

Annelou de Vries is leading the Child Psychiatry Department of the Center of Expertise on Gender Dysphoria of the Amsterdam UMC. She is president elect of the European Professional Association of Transgender Health (EPATH) . She is co-chair of the adolescent chapter of the Standards of Care revision of the World Professional Association of Transgender Health (WPATH).  

At present, her lines of research focus on 1) the co-occurrence of autism and gender dysphoria, 2) capacity for informed consent of transgender adolescents, 3) long term follow up of transgender adolescence into middle adulthood, 4) sexual development of transgender adolescents,  5) shared decision making in transgender care, and 6) pathways in gender identity exploration and affirmation. 


Young adult psychological outcome after puberty suppression and gender reassignment 



Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study 




Extended Notes

  • When did Thomas and Annelou first hear about the concept of puberty blockers?
  • Thomas and Annelou talk about the very first case of puberty suppression.
  • Were there any counseling measures attempted to relieve the distress of this first case?
  • Stella asks about the follow-up from the study by Peggy Cohen Kettenis in 2011 where a transitioner could not sustain a long-term relationship and was still ashamed of their genitals.
  • Thomas talks about the motivation behind follow-ups and the aim of each study.
  • Stella asks about the gender dysphoria scale used in their studies in 2011. Why were the scales changed after treatment?
  • Thomas talks about the Utrecht Gender Dysphoria Spectrum Scale by JK McGuire and how they are using this now.
  • Annelou explains their 2014 clinical study and the different follow-ups they made on these cases.
  • Stella mentions that the majority of the seventy children in their study developed a level of obesity while on treatment. Annelou and Thomas describe their selection process.
  • There were fifteen people that were not followed up upon in the second study. Annelou talks about one of the patients who died through the cross-sex surgery.
  • Did the puberty blockers create a problem to transition? Did this occur with the children in their studies? Annelou and Thomas talk about the different surgical techniques for transitioning.
  • Where in the early stages did the work of chronologists and surgeons come into play? What was the influence of the medical community on how they conceptualize gender distresses and how to treat them?
  • Are there cases that the diagnosis for the child coming in was not gender dysphoria but other psychological issues? Annelou shares their process of assessment through multidisciplinary meetings.
  • Thomas shares that it’s not their job to decide whether the patient has gender incongruence but rather understand and find out how that feeling developed.
  • Stella questions the significant improvements in these studies to be associated with maturing of the child. Thomas explains their population.
  • The scale is not ideal but after treatment, the patient would say their gender dysphoria has improved a lot. That’s the reason they go through the treatment.
  • Annelou shares the different distresses that the LGBTQ community suffers from that are not only limited to gender. Therefore, mental health isn’t the best outcome measure.
  • Can you become gender dysphoric as a teenager because of the obsession on gender? Stella asks in relation to today’s generation.
  • Part of adolescence is searching for one’s identity and it’s the role of parents to help these adolescents form for the rest of their lives.
  • Annelou shares her thoughts about Lisa Littman’s study on ROGD.
  • There is so much more going on than the reasons others think that things are changing. Thomas shares it’s important to explore things first and not go fast.
  • He also shares the societal influences in the changes they observe today vs. in the past.
  • The Littman study is framed as a warning but the decisions in terms of the medical steps are still as difficult as they were 20 years ago.
  • It depends on which theory you work but both Thomas and Annelou share that the phenomenon of gender diversity has not changed significantly over time.
  • Thomas and Annelou share their thoughts on de-transitioners.
  • We used to think that gender incongruence was something permanent, but we now have what we call fluidity. It’s important to be really careful going through these processes.
  • The safe and slow approach on gender dysphoria in the U.S. vs. Amsterdam. Stella asks them both what is the difference.


This podcast is sponsored by ReIME and Genspect. Visit Rethinkime.org and Genspect.org to learn more.


For more about our show: Linktr.ee/WiderLensPod.

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About the Podcast

Gender: A Wider Lens Podcast
Two therapists explore the expanding concept of "gender" from a psychological depth perspective.
Gender dysphoria has become a minefield for public discussion, with many afraid to express their views or question the narrative. Our mission is to examine this important and complex topic from a range of perspectives, but always through a psychological lens. By openly considering and examining gender identity, transition, and the transgender umbrella, we hope to give all interested parties permission to engage these fascinating topics with less fear and more honesty. Interviews and discussions will involve clinicians, medical professionals, academics, transgender people, parents, detransitioners and other interesting individuals whose lives have been touched by the concept of gender.

Conversations between two practicing therapists give listeners an opportunity to contemplate gender from a depth perspective not currently taken up in most of today’s accessible debates. As a result of their work with gender dysphoric therapy clients as well as their personal divergent experiences with gender, Stella and Sasha hold a refreshing and informed perspective.

Is gender identity a facilitation of development and expression of creativity, or can it be a defense against painful existential realities of living in a human body? What can we discover about masculinity, femininity, identity, gender performance, and sexuality when we peer beneath the surface and dive into a deeper psychological exploration? What is the relationship between body, mind, identity, culture, and psyche?

This podcast engages listeners in an intimate and fascinating behind-the-scenes inquiry about a topic as taboo as it is salient today.

Thank you to our sponsors:
Genspect - an international organization which offers an alternative to WPATH. Providing a range of education, resources and supports to anyone impacted by gender distress, Genspect unites many different organizations globally, and gives voice to 1,000s of previously untold stories. For more info, visit genspect.org.

GETA - an association of therapists who believe that individuals experiencing gender related concerns ought to be treated using a whole person approach. GETA connects like minded clinicians, provides educational resources and trainings, and helps people with gender dysphoria find support. For more info, visit genderexploratory.com.
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About your hosts

Stella O'Malley

Profile picture for Stella O'Malley
Stella O’Malley is a psychotherapist and author who works in private practice in Ireland. Her work focuses on parenting, family dynamics and working with teenagers.

Much of Stella’s counselling and writing focuses on mental health and the importance of well-being and she is a regular contributor to the media. She is also the resident psychotherapist for the current TV series, Raised by the Village, a family programme that helps troubled teenagers reconnect with themselves and their families.

Stella's first book, Cotton Wool Kids, was released in 2015 while Bully-Proof Kids: Practical tools to help kids grow up confident, resilient and strong was released in 2017. Stella’s latest book Fragile, was released in 2019 and focuses on overcoming anxiety and stress.

Stella was the presenter of the documentary Trans - Kids: It’s Time To Talk broadcast on Channel 4 in November 2018 and she contributed a chapter to the 2019 book, Inventing Transgender Children and Young People.

The Jungian analyst, Lisa Marchiano, and Stella launched Secrets of the Motherworld in September 2019, offering thoughtful exploration of the most intimate aspects of motherhood in a bid to help mothers feel less alone.

Stella is a Clinical Advisor for the Society for Evidence-based Gender Medicine and a founding member of the International Association of Therapists for Desisters and Detransitioners. She is also the lead facilitator for the Gender Dysphoria Support Network.

Stella holds a B.A. in Counselling and Psychotherapy and a M.A. in Cognitive Behavioural Therapy.

Sasha Ayad

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Sasha Ayad is a Licensed Professional Counselor who works in private practice, and has treated adolescents for over 10 years. Her work focuses on teens and young adults struggling with issues of gender dysphoria and gender identity.

She became interested in the sharp rise in teenagers who declare a trans identity for the first time during adolescence. She discovered, through working with hundreds of families, that many teens were developing gender dysphoria only after adopting a transgender identity. She questions the practice of medical transition for children and teenagers, and her clinical work focuses on developmentally appropriate, least-invasive-first talk therapy.

Sasha is also a founding member and Clinical Advisor in the Society for Evidence-based Gender Medicine and a founding member of the International Association of Therapists for Desisters and Detransitioners.

Sasha’s previous work experience includes:
- School counselor for middle and high school students at a charter school for underserved communities

- Behavioral therapy with children on the autism spectrum

- Individual and group counseling for women and children impacted by domestic abuse and sexual violence

- Developed and ran the first counseling program at a large state supported living facility for adults with intellectual disability

Sasha holds a B.S. in Psychology and an M.Ed. in Counseling Psychology.