Dutch developments
For decades the Netherlands was the global face of gender-affirmative youth care. The Dutch Protocol developed in Amsterdam was regarded internationally as the gold standard. Both that protocol and wider Dutch policy are now under heavy scientific and social pressure — although the public debate here still clearly lags behind that in the UK and Scandinavia.
Amsterdam as the cradle
Since the 1970s gender care in the Netherlands has been concentrated around the hospital of the Vrije Universiteit in Amsterdam, now part of Amsterdam UMC. There doctors and psychologists began treating young people in the 1990s: first puberty blockers to pause physical development, later cross-sex hormones and, in adulthood, possibly surgery. The approach was described in an international journal in 2006 and became known as the Dutch Protocol. Follow-up studies from 2011 and 2014 reported favourable results in a carefully selected group, and clinics in other countries adopted the method. The story is told in Amsterdam UMC and the Dutch Protocol.
More referrals, longer waiting times
From about 2010 the number of referrals increased rapidly, and the composition of the group changed: there were more teenagers and more girls. Besides Amsterdam, the Radboudumc in Nijmegen and the UMCG in Groningen also offer gender care, but capacity did not keep up with demand and waiting times ran to years. Commissioned by the Ministry of Health, Welfare and Sport (VWS), Radboud University investigated the growth in demand for care; the report appeared in 2023. See Explosive growth in referrals and Waiting times and the care system.
The law
Since 1 July 2014 a person aged sixteen or over can have the sex recorded on the birth certificate changed with a statement from an expert. Before that, heavier requirements applied, including physical adaptation and infertility. In 2021 the government submitted a bill to scrap the expert statement as well. That proposal led to a long and sharp debate in the House of Representatives and beyond. The background can be read under Transgender Act in the Netherlands; the course of the bill is in the archive.
Criticism from abroad
While the Dutch Protocol was being followed in other countries, governments there began to reassess the evidence. Between 2020 and 2024 Finland, Sweden and England concluded that the basis for puberty blockers and hormones in young people is weak, and tightened their policy. The Cass Review paid attention to the Dutch studies and to the question of whether their results apply to the young people who present now. In the Netherlands articles on this appeared in the Nederlands Tijdschrift voor Geneeskunde. More in International criticism reaches the Netherlands.
Politics and media
Since 2023 questions have been asked in the House of Representatives about the scientific basis of care for minors; see Parliamentary attention. How Dutch newspapers, broadcasters and talk shows reported on the subject is described in Media and public debate and in the piece on television appearances by doctors. How the Dutch quality standard came about is discussed in the article on the guideline.
Why the Dutch situation matters internationally
Because the treatment of young people was developed here, the Dutch studies are discussed in virtually every foreign assessment. The question is always the same: do outcomes in a small, strictly selected group from the 1990s and 2000s also apply to the much larger and differently composed group that presents now? What Dutch researchers and practitioners publish about this is therefore also followed outside the Netherlands. A recent example can be found under news.
Further reading
The most important Dutch and foreign moments are listed in order in the timeline. What care for minors involves in practice can be read under youth and medical, and the experiences of people who went back on their transition under detransition. Recent reports can be found under news.
All topics
Photo: Jeroen van der Meyde/Tweede Kamer, CC BY 4.0, via Wikimedia CommonsTransgender Act: the withdrawn self-identification bill
The self-identification bill never became law; the government withdrew it in 2025.
Photo: Filipjack, CC0, via Wikimedia CommonsExplosive growth in referrals
The number of registrations at Dutch gender clinics has risen sharply since around 2010. Among young people, teenage girls in particular are now seeking care.
Photo: Choinowski, CC BY-SA 4.0, via Wikimedia CommonsAmsterdam UMC and the Dutch Protocol
From the 1990s onward, Amsterdam UMC (formerly VUmc) developed what became known as the Dutch Protocol: puberty blockers from Tanner stage 2, followed by cross-sex hormones from around age 16 and surgery from around age 18.
Foto: Aliaksei Lepik via PexelsInternational Criticism Reaches the Netherlands
Since the Cass Review (UK, 2024), international criticism of the Dutch Protocol has also reached Dutch professional journals.
Photo: Paul Berendsen, CC BY-SA 4.0, via Wikimedia CommonsWaiting Times and the Healthcare System
Waiting times at Amsterdam UMC and other centres stretched to several years.
Photo: Husky, CC BY 4.0, via Wikimedia CommonsParliamentary attention
Since 2023, there has been growing criticism in the House of Representatives regarding the scientific basis of gender care for young people.
Photo: Richardkiwi, CC BY-SA 4.0, via Wikimedia CommonsMedia and public debate
For a long time, Dutch media followed an almost exclusively gender-affirming narrative.
AI-generatedHow the Dutch gender care guideline was developed without health insurers, and why ‘informed consent’ is being redefined
Investigative journalist Bernard Lane mapped out internationally in September 2026 how conflicts of interest shape gender-care guidelines. The key takeaway for the Netherlands: activists were involved in the 2019 Quality Standard for Transgender Care, insurers were not, and doctors redefined informed consent as something you only truly understand after treatment.
AI-generatedHow Dutch TV Appearances Normalized Gender Care, Regardless of Evidence
In the late 1970s, doctors from the VU gender clinic brought transsexuality to Dutch television. The phones rang off the hook—but what did that actually prove?
For the wider context: see International developments and Science & debate.