Dutch House of Representatives Calls for Research into the Dutch Protocol

In February 2024, the Dutch House of Representatives held its first extensive debate on the medical treatment of young people with gender dysphoria. Parliament called on the government to investigate the outcomes of the Dutch Protocol.

The Motions

On 15 February 2024, Member of Parliament Rosanne Hertzberger submitted a motion. She called on the government to investigate the physical and mental health of young people after treatment according to the Dutch Protocol and compare them with young people in European countries where different care is provided. The House adopted the motion. A second motion, submitted by Diederik van Dijk and Mirjam Bikker, called for the further development of the Dutch quality standard to take into account the more cautious approach adopted in the United Kingdom, Finland and Sweden.

The Background

In the preceding years, Finland, Sweden and England had revised their policies; see Finland in 2020 and Sweden in 2022. In the Netherlands, treatment had until then primarily been a matter for the professional community, as set out in the Somatic Quality Standard for Transgender Care.

The Request for Advice

On 13 May 2024, the Ministry of Health, Welfare and Sport asked the Health Council of the Netherlands for advice on transgender care for young people. A month earlier, the Cass Review had been published in England. The government’s response to the review and the motions is set out in the parliamentary letter of 4 June 2024.

The Zembla Broadcast

The debate did not come out of nowhere. In October 2023, investigative programme Zembla aired an episode about the Dutch Protocol. In it, doctors and methodologists from abroad argued that the scientific evidence for treating young people was insufficient and that the group now seeking treatment differs from the group on which the protocol was based. It was the first time that a major Dutch television programme had extensively highlighted the criticism from abroad. The broadcast led to parliamentary questions and strong reactions from clinicians and advocacy organisations.

The Reactions

Clinicians at Amsterdam UMC pointed out that care in the Netherlands is organised more carefully than in countries where things had gone wrong, with extensive diagnostic assessment before each step. They said they, too, wanted to see more research. Advocacy organisations representing transgender people feared that the debate would lead to restrictions on care, for which waiting lists had already been years long. Critics of the treatment, by contrast, argued that the Netherlands had relied on its own research for too long and ignored assessments from abroad.

Why the Health Council

The Health Council of the Netherlands is the independent scientific advisory body to the government and parliament on public health matters. The council has existed since 1902 and works with committees of experts from different fields. By involving the council, the ministry placed the assessment outside the professional community that provides the care itself. This was also at the heart of the criticism: the quality standard had been drawn up by the clinicians and patients themselves, without an independent assessment of the evidence.

Significance

As the country where the protocol originated, the Netherlands held a unique position. While other countries reassessed Dutch studies, there had been hardly any public debate about them in the Netherlands itself. The motions brought the issue onto the political agenda in a prominent way for the first time.

For the first time, Dutch politicians commissioned an independent assessment of the treatment. The Health Council issued its advice on 30 June 2026 and concluded that the care is organised carefully; see the Health Council’s advice.