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 by Amsterdam UMC in the 1990s, was presented as the international gold standard for decades. As of 2026, that protocol is facing intense international criticism. While countries such as Sweden, Finland, the United Kingdom and Norway have thoroughly revised their policies, the Netherlands has so far held on to the original model for a strikingly long time — although the first cracks are now becoming visible here as well.

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 assessment, puberty suppression with GnRH analogues around Tanner stage 2, and cross-sex hormones from around age 16 in cases of persistent dysphoria — potentially followed by surgery. The original rationale was that puberty blockers provided a 'pause button' to explore dysphoria without unwanted physical development becoming irreversible. See also the Dutch Protocol.

International criticism has increased sharply in recent years. The original Dutch studies (de Vries 2011, 2014) were based on only 55–70 carefully selected patients, without a control group, with short follow-up and a confounding combination of blockers and hormones. The results have not proved replicable in other countries. The Cass Review and Sweden's SBU independently concluded that the evidence base is 'remarkably weak'. The Nederlands Tijdschrift voor Geneeskunde also published an extensive overview article on this international criticism.

The Dutch care landscape

Specialised gender care for young people in the Netherlands is provided by the Knowledge and Care Centre for Gender Dysphoria at Amsterdam UMC (VUmc location) and Radboudumc in Nijmegen. There are more providers for adults, including UMCG in Groningen and various independent practices. Waiting times are very long: at Amsterdam UMC, young people may wait several years for an initial intake. A study by the centre itself found that more than four in five referred young people began a medical pathway. An overview of the clinics, including critical commentary, is maintained by genderzorgnederland.nl.

The number of referrals has risen sharply over the past decade, with a notable shift towards adolescent girls and young people with comorbid conditions such as autism, depression and eating disorders — the same demographic shift observed in all Western countries, and one associated in the international literature with rapid onset gender dysphoria and social dynamics.

Recent developments (2024–2025)

In January 2025, it became known that the gender clinic at Amsterdam UMC would temporarily stop accepting new adult patients: adults on the waiting list would not be invited for an intake for the time being. The minister cited a shortage of psychologists as the cause; see the archive article on the Amsterdam UMC gender clinic. The announcement confirms that the current care model is structurally unsustainable.

In June 2024, the minister sent a parliamentary letter on gender care for minors to the House of Representatives in response to the Cass Review (see also the archive article on the parliamentary letter). In it, the minister acknowledged the weak evidence base and announced oversight of the revision of the Dutch quality standard, which at the time was scheduled for completion in September 2025. That deadline was not met. The House of Representatives had already debated the growing criticism of the Dutch Approach in 2023 through parliamentary questions.

Policy: tightened, but no change of direction

Under pressure from international developments, the Dutch professional community has tightened the criteria for treatment in recent years. Puberty suppression is no longer prescribed routinely and requires extensive multidisciplinary assessment. The 2019 Somatic Quality Standard for Transgender Care has been under revision by professional associations since December 2023, with support from the Knowledge Institute of the Federation of Medical Specialists. The agreed completion date of 30 September 2025 was not met. The register of the National Health Care Institute now lists 30 September 2027 as the final deadline.

An independent review modelled on the British example was delayed for a long time. It was not until May 2024 that the ministry asked the Health Council for advice, after the House of Representatives had called for an investigation. That advice was published on 30 June 2026 and concluded that care in the Netherlands is organised carefully, although limited data are available on adverse effects. This outcome differs from the assessments in the UK, Sweden and Finland; see the Health Council's advice. As far as is known, the National Health Care Institute has not taken a position on whether puberty suppression for gender dysphoria should be covered by the basic health insurance package. In May 2023, the minister wrote to the House of Representatives that, according to the National Health Care Institute, it is up to clinical practice to provide the research on which such an assessment can be based, and that the institute itself is not conducting a systematic review of the Dutch model.

Political and social debate

In 2024 and 2025, the House of Representatives held several debates in which the Cass Review and the Scandinavian policy changes were explicitly cited. Several Dutch doctors and scientists have publicly called for an independent review. In the media — including the NTVG, Elsevier Weekblad and HP/De Tijd (columnist Jan Kuitenbrouwer) — criticism of the policy has become increasingly explicit in recent years. The NTVG commentary is summarised at Uncertainties surrounding current gender care. At the same time, Amsterdam UMC and patient organisations have warned that excessive restrictions could increase the suffering of young people with severe dysphoria.

Adults

For adults, hormone therapy and surgical procedures remain available through specialised clinics and are covered by the basic insurance package when a diagnosis has been established. Waiting times are also considerable here, and diagnostic procedures have become stricter in recent years. As of 2025, the Amsterdam UMC gender clinic is temporarily not accepting new adult patients. Detransition care is still in its infancy in the Netherlands; dedicated pathways for people experiencing transition regret are scarce.