Youth

Q: Why is it mainly teenage girls who present at the gender clinic?

The cause has not been clarified. Until 2010 it was mainly young boys who presented; since 2014 girls have formed the majority. That pattern does not fit the classic picture of gender dysphoria that arises early in childhood. Researchers point to the role of social media, groups of friends and additional problems such as autistic traits, eating disorders, anxiety and depression.

Q: Is doubt about your gender normal in puberty?

Yes. Uncertainty about gender in puberty is not in itself a disorder. Young people explore identities, their bodies change and social roles shift. Most young people emerge from this phase with a stable identity that matches their birth sex. That is why diagnostics must distinguish between a persistent, clinically serious dysphoria and an ordinary developmental phase.

Q: Are puberty blockers a pause button?

Probably not. Puberty blockers are often presented as a pause button, but 96 to 98 per cent of the young people who receive them go on to cross-sex hormones (Carmichael et al., 2021). That points to a funnel rather than a moment of choice. Fertility, bone density and sexual function can be permanently affected.

Gender identity in children and young people — development, care and the role of parents, school and social media.

Since about 2010 the number of children and young people presenting to gender services as transgender or non-binary has risen explosively in Western countries. Clinics saw ten- to twentyfold increases, mainly among teenage girls — a pattern that does not fit the classic, early-onset picture of gender dysphoria as it was described for decades. Researchers point to the role of social media, peer clusters and comorbid problems such as autism spectrum traits, eating disorders, anxiety and depression.

The British Cass Review (2024) concluded that the scientific basis for early medical interventions in minors is "remarkably weak". Sweden, Finland, Norway and Denmark have adjusted their policy: puberty blockers and cross-sex hormones for minors are severely restricted and offered only in exceptional cases. In the Netherlands that restraint has been implemented to a limited extent.

This section deals with what is known about gender development in children, the role of puberty, the influence of social media and peer pressure, the concept of rapid-onset gender dysphoria, and the crucial role of parents. Good support for minors requires an exploratory, non-affirming approach that leaves room for underlying questions — not automatic agreement with a social or medical transition. What is sometimes presented as a "neutral intermediate step" (new name, pronouns, style of clothing) is in reality an active psychosocial intervention whose outcomes have been insufficiently studied.

The acute shift since 2014

Between 2010 and 2025 the number of young people presenting at Dutch gender clinics increased fivefold. Internationally, research (Cass Review, 2024) shows a comparable pattern — with a shift in composition: whereas until 2010 it mainly concerned young boys, since 2014 young girls have formed the majority of referrals. That is no small detail; it raises questions about the causes that the care guidelines (based on the old population) do not necessarily answer adequately.

What is normal in puberty

Gender-specific uncertainty in puberty is not in itself a pathology. Adolescents explore identities, bodies change and social roles are recalibrated. The majority of young people emerge from this phase with a stable identity that matches their birth sex. Diagnostic instruments must therefore apply a high threshold: how do you distinguish a persistent, clinically significant dysphoria from a normal developmental phase?

The Dutch care pathway

Referral runs via the GP to Amsterdam UMC or another specialised centre. Intake is followed by observation and diagnostics; with a positive diagnosis and specific age criteria, puberty blockers may follow, then possibly cross-sex hormones from around 16 and surgery generally from 18. Waiting times run to more than a year for the intake interview. Many young people already start social transition before that time via school and home.

The role of parents and school

In the Netherlands parents are increasingly being sidelined when they question the social transition of their child at school. Since 2018 educational institutions have more often applied affirmative protocols — change of name in the records, respect for pronouns without parental consent. For parents who reflect critically this leads to conflicts with the school, sometimes to the involvement of youth care services.

Social media and peer influence

Research (Littman, 2018; Kerschner, 2024) documents patterns of social contagion in which girls within friendship circles identify as trans or non-binary around the same period. The weight of this phenomenon is disputed; its existence, after controlling for selection bias, is less so. TikTok and Tumblr act as accelerators of identity formation out of parental sight.

What the Cass Review changed

The Cass Review (UK, 2024) concluded that the evidence base for paediatric medical transition is 'remarkably weak'. The UK closed Tavistock GIDS, introduced a policy of caution and restricted puberty blockers for minors to a research setting. The Netherlands has so far not translated that conclusion into its own policy, although the patient population in both countries is comparable.

Risks of early medical intervention

Irreversibility is the greatest risk. Puberty blockers are presented as a 'pause button', but 96-98% of the young people who receive them go on to cross-sex hormones (Carmichael et al., 2021) — a progression that suggests they are more of a funnel than a moment of choice. Fertility, bone density and sexual function can be permanently affected.