NTVG — Uncertainties Surrounding Current Gender Care
This commentary by Jilles Smids and Patrik Vankrunkelsven appeared on November 7, 2023, in the Nederlands Tijdschrift voor Geneeskunde (NTVG). It responds to a clinical lesson on young people with gender incongruence that had previously appeared in the same journal. The authors identify five problems with that lesson.
The five objections
First, the authors argue that there is insufficient evidence to consider puberty blockers and sex hormones standard care. Second, the lesson does not distinguish between gender dysphoria that begins in childhood and dysphoria that emerges only during adolescence. Third, the claim that 98 percent continue using hormones in the long term is insufficiently substantiated. Fourth, they argue that puberty blockers may actually undermine the period for reflection they are intended to provide. Fifth, in their view, the lesson does not accurately reflect the literature on possible harmful effects on brain development.
The authors and the background
Jilles Smids is a bioethicist at Erasmus MC in Rotterdam. Patrik Vankrunkelsven is professor emeritus at KU Leuven. The clinical lesson to which they are responding is titled Young People with Gender Incongruence and was written by clinicians from Radboudumc, Amsterdam UMC, and Genderteam Zuid-Nederland. A clinical lesson is intended to show doctors, through patient cases, how care works in practice. The commentary focuses on the scientific basis for that practice, particularly the use of puberty blockers.
Responses and afterword
On November 12, 2023, a general practitioner responded to the article, thanking the authors and writing that they shared their concerns. Smids posted an extensive response on November 28, 2023. In it, he states that concerns among medical professionals are widespread but are rarely voiced openly. He identifies two dilemmas: the possibility that the treatment itself causes harm, and uncertainty about the consequences for brain development.
What happened next
In May 2025, Smids developed his argument further in the article International Criticism of the Dutch Protocol. The Swedish policy choice to which the authors refer is described in the SBU report. In the Netherlands, the minister requested advice from the Health Council in 2024. On June 30, 2026, it concluded that hormone treatments achieve their physical objectives and that the available data provide no reason not to offer them. The council thus reached a different conclusion from the authors of this commentary.
Why it is included in this archive
The authors call for changes to Dutch policy and point to Sweden and Finland as examples. The piece shows that the debate over the Dutch Protocol is also taking place in the Dutch medical press.