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Gender care in the Netherlands
The Netherlands is internationally known as the country where the gender-affirmative treatment model for young people began. The so-called "Dutch Protocol", developed in the 1990s by Amsterdam UMC, was for decades presented worldwide as the gold standard. As of 2026 that protocol is under heavy international criticism. Where countries such as Sweden, Finland, the United Kingdom and Norway have thoroughly revised their policy, the Netherlands has so far held strikingly long to the original model — although the first cracks are starting to show here too.
The Dutch Protocol
The Dutch Protocol was developed in the 1990s by Peggy Cohen-Kettenis, Henriette Delemarre-van de Waal and later Annelou de Vries and Thomas Steensma at Amsterdam UMC (then VUmc). It consists of three phases: psychological diagnostics, puberty suppression with GnRH analogues around Tanner stage 2, and on continued dysphoria cross-sex hormones from around 16 years old — possibly followed by surgery. The original logic was that puberty blockers offered a "pause button" to explore dysphoria without unwanted physical development becoming irreversible. See also the Dutch Protocol.
International criticism has grown considerably in recent years. The original Dutch studies (de Vries 2011, 2014) rested on just 55-70 carefully selected patients, without a control group, with short follow-up and a confounding mix of blockers and hormones. Results have not proved replicable in other countries. The Cass Review and the Swedish SBU independently concluded that the evidence base is "remarkably weak". An extensive overview article on this international criticism appeared in the Nederlands Tijdschrift voor Geneeskunde too.
The Dutch care landscape
Specialised gender care for young people is provided in the Netherlands by the Knowledge and Care Centre for Gender Dysphoria of Amsterdam UMC (VUmc site) and the Radboudumc in Nijmegen. For adults there are more providers, including UMCG in Groningen and various independent practices. Waiting times are very long: at Amsterdam UMC young people can wait several years for a first intake.
The number of presentations has risen sharply in the past decade, with a striking shift to adolescent girls and young people with co-morbid problems such as autism, depression and eating disorders — the same demographic shift observed in all Western countries, and which in the international literature is linked to rapid onset gender dysphoria and social dynamics.
Policy: tightened, but no change of course
Under pressure from international developments the Dutch professional body has tightened indication assessment in recent years. Puberty suppression is no longer prescribed routinely and requires extensive multidisciplinary assessment. Amsterdam UMC is working on a new Dutch quality standard, which is reportedly expected in 2026.
However, there is no formal, independent evaluation along British lines. In contrast to the UK, Sweden, Finland and Norway, the Netherlands has not carried out a government-commissioned systematic review. That is striking: the country in which the protocol was developed is therefore one of the last to put it under critical scrutiny. The central government is following developments, and the National Health Care Institute is currently assessing whether puberty suppression for gender dysphoria belongs in the basic insurance package. An outcome that would limit reimbursement would de facto bring Dutch practice into line with the Scandinavian countries.
Political and social discussion
In 2024 and 2025 the Dutch House of Representatives held several debates in which the Cass Review and the Scandinavian policy changes were explicitly cited. Various Dutch doctors and scholars have publicly called for an independent evaluation. At the same time, from Amsterdam UMC and patient organisations comes the warning that overly large restrictions would increase the suffering of young people with severe dysphoria. The debate in the Netherlands is politically and scientifically more sensitive than in almost any other country, precisely because of the historical attachment to the Dutch Protocol.
Adults
For adults hormone therapy and surgical interventions remain available via specialised clinics, reimbursed through the basic insurance package on a confirmed diagnosis. Here too waiting times are considerable and diagnostics have become stricter in recent years. Detransition care is still in its infancy in the Netherlands; specific pathways for people with transition regret are scarce.