International comparison
Over the past five years, Northwest Europe has witnessed a striking shift in the direction of youth gender care. Countries that previously embraced the Dutch model have, following independent evaluation, significantly tightened or reversed their policies. The convergence of conclusions is telling: it is precisely the healthcare systems with public funding and without intense partisan polarization around the issue that have sharply restricted medical pathways for minors.
The Netherlands: pioneer and blind spot
The Netherlands is internationally known as the originator of the Dutch Protocol. However, the original outcome studies are small, uncontrolled, and methodologically weak; the current patient population—predominantly adolescent girls with comorbid conditions—differs substantially from the original cohort. Nevertheless, Amsterdam UMC and University Medical Center Groningen continue to apply the protocol largely unchanged. Independent evaluation and transparent publication of outcome data are scarcely available in the Netherlands—an notable lag compared with neighboring countries.
United Kingdom: the Cass Review
The Cass Review (2024) is the most thorough independent evaluation of youth gender care in the world. Its conclusion: the quality of evidence for puberty blockers and cross-sex hormones in minors is "remarkably weak." The NHS has stopped making puberty blockers available outside clinical research and has closed the Tavistock clinic. Care has been reorganized into regional, multidisciplinary centers, with an emphasis on psychological assessment and attention to comorbid conditions.
Sweden: SBU report
The SBU report (2022) by the Swedish Agency for Health Technology Assessment and Assessment of Social Services concluded that the evidence for puberty blockers and cross-sex hormones in minors is insufficient; in 2022 the Swedish health authority Socialstyrelsen judged that the risks probably outweigh the possible benefits. The Karolinska University Hospital had already independently decided in 2021 to stop prescribing blockers outside a research setting. SEGM describes Sweden’s policy change as the de facto abandonment of the Dutch Protocol.
Finland: COHERE
In 2020, Finland became the first country to fundamentally revise its national guideline. The COHERE guideline establishes psychotherapy as the first-line treatment, calls for extensive assessment of comorbidities, and reserves medical interventions for minors for "exceptional cases." The Finnish approach was explicitly based on a systematic review of the evidence, not political considerations. The recommendation itself is discussed in PALKO Finland 2020; a brief explanation is also available on transplek.nl.
Norway and Denmark
Norway’s independent healthcare authority, Ukom, has classified puberty blockers as an experimental treatment. Denmark (2023) has significantly restricted access and explicitly opted for psychotherapy as the main treatment for adolescents. The Danish approach emphasizes that approximately 90% of young patients should not undergo medical transition.
United States: political paralysis
The US is deeply polarized. On one side are WPATH, the American Academy of Pediatrics, and the Endocrine Society, which defend affirmative care—institutions whose independence has been compromised by the WPATH Files and internal documents. On the other side are states that restrict or ban youth gender care through legislation, as well as scientific organizations such as the Society for Evidence-Based Gender Medicine (SEGM), which challenge the evidence base. The 2025 HHS report, commissioned by the federal government, concluded in line with Cass that the evidence base is weak.
Belgium
Belgium offers youth gender care through several specialized centers. Following a critical report by VRT NWS (2024) and public questions concerning Ghent University Hospital, a national debate has emerged about the use of puberty blockers in minors. A formal revision of the guidelines is under way.
Common trend: away from the affirmative model
The common thread across Northwest Europe is psychotherapy as the first-line treatment, caution regarding medical interventions for minors, longer observation periods, attention to comorbid conditions, and transparent treatment as experimental care. This reflects the findings of independent systematic reviews. This caution is not limited to Europe: in May 2026, Singapore’s Ministry of Health issued a guideline containing a ban on hormonal and surgical treatment of gender dysphoria in minors. Given its role as the originator of the original protocol, the Netherlands has been notably slow to follow this shift in direction.