Research and Statistics

Q: How many people in the Netherlands are transgender?

There are no exact official figures. Self-report studies find rates ranging from 0.6% to more than 1%, depending on the definition. Clinical dysphoria according to DSM-5 criteria is considerably less common. In public communications, the figures are regularly inflated by counting all forms of gender non-conformity as "transgender".

Q: Is there evidence that gender treatment works for young people?

According to systematic reviews from the UK (Cass), Sweden (SBU) and Finland (COHERE): no, not convincingly. The quality of evidence is predominantly very low. On this basis, these countries have significantly tightened their policies. No convincing evidence has been found that blockers improve psychological well-being or reduce suicidality.

Q: Why are more and more people being referred to gender clinics?

The sudden, geographically specific, sex-specific explosion — particularly among adolescent girls — does not fit a stable biological phenomenon. Social media, peer influence and the availability of trans identity as a framework for explaining adolescent distress are increasingly cited as the main factors. The increase began around 2010 and coincided with a demographic shift. See ROGD.

Q: How high is the detransition rate?

Recent studies find rates between 7 and 30%, substantially higher than the previously reported <1%. The difference lies in the selection bias and follow-up duration of older studies. Those studies were based on clinical cohorts with substantial attrition and short observation periods. Recent figures come from self-report studies and cohorts with longer follow-up.

This overview brings together the most important scientific research and statistics on gender dysphoria and medical gender care. The common thread is that the evidence base is considerably weaker than the confidence conveyed by many publications and clinical guidelines. Systematic reviews from the UK, Sweden and Finland independently conclude that the quality of evidence for the central interventions — puberty blockers and cross-sex hormones for minors — is predominantly very low.

Prevalence and the explosion in referrals

Clinical studies from the 1960s to the 1990s estimated the prevalence of gender dysphoria at between 1 in 10,000 and 1 in 30,000, with a clear predominance of biological males. More recent self-report studies — using much broader definitions — arrive at figures of 0.5 to 1.7% of the population. More important than this absolute figure is the demographic shift: since around 2010, the number of referrals to youth gender clinics in the Netherlands, the UK and Scandinavia has increased ten- to twentyfold. The sex ratio has reversed: most current referrals are adolescent girls, often with co-morbid autism, anxiety or depression. No existing biological explanation can plausibly account for such a rapid, geographically specific and sex-specific increase; sociocultural factors, social media and peer contagion are increasingly cited as the main explanations. The Dutch figures are discussed in detail in the articles on the growth of transgender healthcare since 2012 and the number of young people who identify as trans or gender-diverse. English-language figures and research findings are collected by topic on Stats for Gender, an initiative of Genspect.

Effectiveness: what does the evidence really say?

The Cass Review (2024) commissioned the University of York to conduct systematic reviews. Conclusion: the quality of evidence for puberty blockers and cross-sex hormones in young people was predominantly low. No convincing evidence was found that blockers improve psychological well-being, reduce suicidality or "buy time". Earlier systematic reviews by Sweden's SBU (2022) and Finland's COHERE (2020) independently reached the same conclusion. Levine, Abbruzzese and Mason (2022) document methodological problems in the WPATH SOC-8, including the removal of age thresholds without an evidence base.

The Dutch Protocol revisited

Amsterdam UMC published the original outcome studies between 2006 and 2014 that made the Dutch Protocol known worldwide. The sample was small (n=55 for the main publication), had no control group, substantial loss to follow-up, and selectively chosen outcome measures. One participant died from complications following vaginoplasty and was not included in the outcome analysis. A British attempt at replication (Carmichael et al., Early Intervention Study) found no improvement in psychological outcome measures. Applying the protocol to the current patient population — adolescent girls with co-morbid problems rather than young children with early-persisting dysphoria — is not scientifically justified.

Long-term outcomes and mortality

A Swedish cohort study by Dhejne et al. (2011) found significantly elevated mortality and suicide risks among adult post-operative trans people compared with the general population, including ten years after transition. The authors stressed that this underscores the need for ongoing psychiatric care, but it also refutes the idea that transition systematically "cures" psychological distress. A large Danish registry analysis (2023) again found excess mortality. The absence of RCT evidence and the short follow-up period of most studies make strong causal claims problematic.

Detransition: probably far more common than reported

For decades, detransition rates of <1% were published. These figures were based on clinical cohorts with substantial loss to follow-up and short observation periods. Recent self-report studies and cohorts with longer follow-up report rates of between 7 and 30%. transkompas.nl explains why the earlier regret figures were so low by examining attrition during follow-up. Detransitioners often report that underlying issues — trauma, internalized homophobia, autism and dissociation — were not adequately investigated before medical treatment. See detransition.

Statistics in the Netherlands

Amsterdam UMC reported a tenfold increase in referrals among young people between 2010 and 2020. Waiting lists have grown for years. Statistics Netherlands (CBS) records legal changes of sex, but clinical outcome data are not published centrally and transparently. As a result, an independent long-term evaluation of Dutch practice is effectively impossible — a scientific and administrative shortcoming noted, among others, by the National Health Care Institute.

Methodological problems summarized

The common thread in the criticism is: small and highly selected samples, no control groups, short follow-up, high loss to follow-up, inconsistent and favorably selected outcome measures, and publication bias. In addition, this is a research field in which dissent was discouraged until recently and in which patient organizations and activist advocates carry considerable weight on guideline committees. Good medicine requires unfavorable findings to be published just as readily as confirming ones.

How many people in the Netherlands are transgender?

Is there evidence that gender treatment works for young people?

Why are more and more people being referred to gender clinics?

How high is the detransition rate?