Timeline of gender care

Q: When did gender care begin in the Netherlands?

Around 1975, when the gender team of the Vrije Universiteit in Amsterdam was given a permanent place. That team grew into one of the largest and most influential gender centres in the world. Since 1 August 1985 the court has been able to change the sex recorded on the birth certificate. In 1987 the first European outpatient clinic for children and young people with gender problems opened in Utrecht.

Q: What was the Reimer case?

In the Reimer case a boy was raised as a girl after a failed circumcision, on the advice of the psychologist John Money. Money reported a success, and the case was cited in textbooks as proof that gender is learned. In 1997 follow-up research showed that the boy had rejected the role of a girl from an early age. With that, the best-known evidence for Money's theory became the best-known evidence against it.

Q: Since when has the Dutch Protocol been under discussion?

From 2018 the model came under pressure. In 2020 Finland made psychosocial support the first step. In 2021 the British institute NICE rated the evidence for blockers and hormones in minors as of very low certainty, and in 2022 the Swedish health authority concluded that the risks outweigh the benefits. In 2024 the Cass Review appeared.

Q: When was the sterilisation requirement for transgender people abolished?

On 1 July 2014, with the Transgender Act. From 1985 the court could change the sex recorded on the birth certificate only after physical adaptation and in the case of permanent infertility. Since 2014 surgery or infertility is no longer required and an expert statement is sufficient, from the age of sixteen. That arrangement still applies.

The key moments in gender care, from the work of John Money in the 1950s to today's international reorientation.

How the concept of gender came about

Modern thinking about gender begins in 1955. In that year the psychologist John Money in Baltimore first used the word gender for the behaviour and role of men and women, separate from the body. More than ten years later, in 1966, the endocrinologist Harry Benjamin published his book The Transsexual Phenomenon and Johns Hopkins Hospital opened the first American gender clinic at a university.

The Reimer case dates from the same period. On Money's advice, a boy was raised as a girl after a failed circumcision. Money reported a success, but in 1997 it turned out that the boy had never accepted the role of a girl. In 1979 the Harry Benjamin association, later WPATH, drew up the first Standards of Care. In the same year Johns Hopkins stopped performing sex reassignment surgery after a critical study. A year later the American manual of psychiatry for the first time included diagnoses for transsexualism and for gender identity disorder in children: the DSM-III.

The Netherlands: from Amsterdam to the Dutch Protocol

In the Netherlands gender care was given a permanent place around 1975 with the gender team of the Vrije Universiteit in Amsterdam, which grew into one of the largest and most influential gender centres in the world. Since 1 August 1985 the court has been able to change the sex recorded on the birth certificate, at that time on condition of physical adaptation and permanent infertility.

The medical treatment of young people began in the Netherlands. In 1987 the first European outpatient clinic for children and young people with gender problems opened in Utrecht. In 1998 Cohen-Kettenis and Van Goozen described the first young person whose puberty had been suppressed with medication. In 2006 the publication of the full treatment model followed: puberty blockers from the age of twelve, hormones from sixteen and surgery from eighteen. That model became known as the Dutch Protocol.

The Amsterdam group supported the model with two studies. The first outcome study from 2011 described seventy young people during treatment with puberty blockers: depressive symptoms decreased, the gender dysphoria itself did not change. The follow-up study from 2014 described 55 young adults after blockers, hormones and surgery and became the most cited evidence for the protocol.

The model spreads across the world

In 2009 the Endocrine Society, the international association of endocrinologists, included puberty suppression in its first guideline. With that, the Dutch Protocol became worldwide practice. In 2013 the DSM-5 replaced the diagnosis gender identity disorder with gender dysphoria. In the Netherlands, on 1 July 2014 the Transgender Act abolished the requirement of surgery or infertility for changing the registered sex; since then an expert statement has been sufficient, from the age of sixteen. In 2019 the Netherlands got its own national standard, the Kwaliteitsstandaard Transgenderzorg Somatisch, which follows the Dutch Protocol.

The turning point from 2018

From 2018 the model came under pressure. In that year Lisa Littman described in PLOS ONE a pattern of rapid-onset gender dysphoria in adolescents, a publication that was followed by a fierce methodological debate. In 2020 Finland made psychosocial support the first step, and the British court ruled in Bell v Tavistock that young people under sixteen are unlikely to be able to consent to puberty blockers. That ruling was overturned on appeal in 2021.

After that the assessments followed one another quickly. In 2021 the British institute NICE rated the evidence for blockers and hormones in minors as of very low certainty. In 2022 the Swedish health authority concluded that the risks outweigh the benefits, NHS England announced the closure of the Tavistock gender clinic and version 8 of the WPATH guideline appeared, from which the minimum ages were removed shortly after publication. In 2023 the Norwegian investigation board Ukom advised revising the national guideline.

In 2024 the Cass Review appeared, the final report of four years of research led by Hilary Cass. Later that year the British government made the ban on puberty blockers for minors with gender dysphoria permanent. In 2025 the US Department of Health and Human Services published its own critical assessment and the US Supreme Court ruled that states may ban this treatment for minors.

Where the Netherlands stands now

So far the Netherlands has held on to the existing care. In 2024 the House of Representatives asked for research into the outcomes of the Dutch treatment of young people, after which the ministry asked the Health Council for advice. In 2026 the Health Council advised the minister that Dutch care for young people is carefully organised. You can read the background under Dutch developments.

How to read the timeline

The timeline lists the moments that shaped this course of events, from old to new. Each moment has its own page with an explanation and the sources on which the text is based. What other countries have decided is set out per country under policy by country and under international developments. The reports and studies themselves can be found in the archive, and the substantive discussion under science and debate.