International Criticism Reaches the Netherlands
Since the Cass Review (UK, 2024), international criticism of the Dutch Protocol has also reached professional medical journals in the Netherlands. NTVG published an article on the international criticism of the Dutch Protocol; see the NTVG article and the discussion in the archive under NTVG on the international criticism of the Dutch Protocol. A group of Dutch doctors and scientists is publicly calling for the guidelines to be reconsidered and for an independent investigation into Dutch gender care for young people, modelled on the Cass Review.
Finland, Sweden and England
The criticism began outside the Netherlands. Finland revised its policy in 2020 and Sweden in 2022. In England, the final report of the Cass Review was published in April 2024. It concluded that knowledge about the risks and benefits of puberty blockers and hormones for minors is very limited. The British institute NICE had previously assessed the available evidence as being of very low certainty. An overview of those assessments can be found on the page about systematic reviews in gender care.
Zembla brings the criticism to the Netherlands
On 26 October 2023, Zembla broadcast the episode Het transgenderprotocol. Four methodologists and a professor of educational psychology stated that the research underpinning treatment in the Netherlands was scientifically inadequate. Most of them did not want to appear on camera under their own names because of the sensitivity of the subject. Methodologist Gerard van Breukelen of Maastricht University did, and pointed to the absence of a comparison group. Finnish professor of psychiatry Riittakerttu Kaltiala and her Swedish colleague Mikael Landén also spoke in the programme. Transgender Netwerk Nederland sent an urgent letter to the broadcaster before the programme aired.
Legal experts and doctors
In the Nederlands Juristenblad on 13 July 2023, Smeehuijzen, Smids and Hoekstra wrote that a leading medical protocol must be evidence-based, have limited medical and ethical implications, and be established through a sound procedure. In their view, it is highly questionable whether the Dutch Protocol meets the first requirement, and it does not meet the other two. The NTVG article referred to above was published on 29 May 2025 and was written by Jilles Smids of Erasmus MC. He calls for the guidelines to be revised and for care in which hormone treatment is a last resort. In the comments below the article, other readers argue that the Cass Review is not a scientific publication because it has not been peer-reviewed.
The response from clinicians
Child and adolescent psychiatrist Annelou de Vries of Amsterdam UMC told Zembla that a control group would be unethical because young people would then be denied treatment they need. She pointed to research that has been published since then. The clinicians further maintain that care in the Netherlands is organised more carefully than in countries where things went wrong, with extensive diagnostic assessment at every stage.
The Dutch outcome
In February 2024, the House of Representatives called for an investigation into the outcomes of treatment. The ministry referred the question to the Health Council. On 30 June 2026, it concluded that care for young people is organised carefully; see the Health Council's advice. The independent assessment critics had called for has therefore taken place, but with a different outcome from that in England. More about the policy can be found on the page about gender care in the Netherlands. Questions about the interests of committee members are discussed on genderzorgen.nl, in the article about interests within the Health Council.