Anyone in the Netherlands looking up a gender-care guideline assumes it was developed through the usual process: doctors, patients, scientists and insurers working together on a document and keeping one another accountable. An international investigation by investigative journalist Bernard Lane, published on September 23, 2026, in his newsletter Gender Clinic News, raises questions about that assumption in the Netherlands: advocacy groups were closely involved in drafting the 2019 Quality Standard for Transgender Care, while health insurers were excluded from the process.
What Lane reports: FOI documents and a missing party
Lane draws on documents released following a request under the Dutch Government Information (Public Access) Act. They reportedly show that advocacy organizations played a guiding role in the creation of the Quality Standard for Transgender Care—the document that has since determined when people in the Netherlands gain access to puberty blockers, hormones and surgery. Health insurers, who would normally be involved because they pay the bills and therefore have an interest in well-founded indications for treatment, were not at the table. That is striking: in almost every other Dutch guideline for expensive or irreversible care, insurers are involved precisely to prevent a single interest group from setting the standard.
Informed consent: treat first, understand later?
The second element Lane describes in relation to the Netherlands goes to the heart of what this network stands for: informed consent. Researchers associated with Amsterdam UMC, including child and adolescent psychiatrist Annelou de Vries, reportedly use an argument in conversations and publications that turns informed consent on its head: a young person can only truly understand the consequences of puberty blockers or hormones by undergoing the treatment. Taken seriously, this undermines the entire concept of prior informed consent—which assumes precisely that someone understands sufficiently what they are choosing before taking an irreversible step, not afterward.
That is no minor issue. Part of the criticism of the Dutch Protocol after three decades of research is precisely that the evidence for long-term effects has remained weak—if consent is already conceptually undermined beforehand, the weak evidence base becomes even harder for parents and young people to understand.
Not an isolated incident, but a pattern
Lane does not present the Netherlands as an isolated case. His overview describes similar tensions worldwide: in the United States, endocrinologist Richard Santen points out that nine out of ten authors of the Endocrine Society guideline and 117 of the 121 authors of the WPATH guideline had financial or professional interests in the care they recommended—unlike the fully independent composition of the British Cass Review. In South Africa, a patient organization called for a guideline to be withdrawn following criticism of WPATH’s role in it, and the journal itself acknowledged that no peer review had taken place. The picture that emerges is this: internationally, guidelines that directly influence care are more often developed with too little challenge from outside their own circle than with too much.
For child protection and careful diagnosis, that challenge is not incidental but essential—see also what is needed for careful diagnosis in minors. A guideline developed without the party that pays the bill, and that redefines prior consent as something that only emerges afterward, lacks precisely the checks that should ensure it.
Anyone specifically interested in how informed consent should work legally and ethically for minors can find a detailed analysis at dutchprotocol.nl, in the dossier on ethical criticism and informed consent.
Distinguishing source material from interpretation
Lane reports what the FOI documents and statements by the researchers involved reveal; he does not draw a legal conclusion about the Quality Standard himself. The conclusion that the absence of insurers and the redefinition of informed consent pose a risk to careful decision-making is our interpretation of those facts—not a judgment already expressed in those terms in the source material.
Sources
Bernard Lane, "Biased brains", Gender Clinic News, September 23, 2026: genderclinicnews.com/p/biased-brains.