Young people
Gender identity in children and young people — development, care and the role of parents, school and social media.
Since around 2010, the number of children and young people presenting at gender care services as transgender or non-binary in Western countries has risen explosively. Clinics saw tenfold to twentyfold increases, mainly among teenage girls — a pattern that does not match the classic, early-onset picture of gender dysphoria as it was described for decades. Researchers point to the role of social media, peer clusters, and comorbid problems such as autism spectrum characteristics, eating disorders, anxiety and depression.
The UK Cass Review (2024) concluded that the scientific underpinning of early medical interventions in minors is "remarkably weak". Sweden, Finland, Norway and Denmark have adjusted their policy: puberty blockers and cross-sex hormones in minors are strictly limited and only offered within research settings. In the Netherlands that caution has only been implemented to a limited extent.
This section covers what is known about gender development in children, the role of puberty, the influence of social media and peer pressure, the concept of rapid-onset gender dysphoria, and the crucial role of parents. Good support for minors requires an exploratory, non-affirming approach that leaves room for underlying questions — not automatic agreement with a social or medical transition. What is sometimes presented as a "neutral intermediate step" (new name, pronouns, clothing style) is in reality an active psychosocial intervention whose outcomes have not been sufficiently studied.
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The acute shift since 2014
Between 2010 and 2025 the number of young people presenting at Dutch gender clinics increased fivefold. Internationally, research (Cass Review, 2024) shows a comparable pattern — with a shift in composition: where until 2010 it mainly involved young boys, since 2014 young girls have made up the majority of referrals. That is not a small detail; it raises questions about causes that the care guidelines (based on the old population) do not necessarily answer adequately.
What is normal in puberty
Gender-specific uncertainty in puberty is not in itself pathological. Adolescents explore identities, bodies change and social roles are recalibrated. The majority of young people come out of this phase with a stable identity that matches their sex at birth. Diagnostic instruments must therefore apply a high threshold: how do you distinguish a persistent, clinically significant dysphoria from a normal developmental phase?
The Dutch care pathway
Referral runs via the GP to Amsterdam UMC or another specialised centre. After intake, observation and diagnostics follow; with a positive diagnosis and specific age criteria, puberty blockers may follow, then possibly cross-sex hormones from around 16 and surgery generally from 18. Waiting times stretch to more than a year for the intake interview. Many young people start social transition through school and at home before that point.
The role of parents and school
In the Netherlands, parents are increasingly sidelined if they raise questions about their child's social transition at school. Since 2018 educational institutions have more often applied affirmative protocols — name change in administration, pronoun respect without parental consent. For parents who reflect critically, this leads to conflicts with the school, sometimes to involvement of youth services.
Social media and peer influence
Research (Littman, 2018; Kerschner, 2024) documents social-contagion patterns in which girls within friendship circles identify as trans or non-binary around the same period. The weight of this phenomenon is contested; its existence, after controlling for selection bias, less so. TikTok and Tumblr act as accelerators of identity formation outside parental view.
What the Cass Review changed
The Cass Review (UK, 2024) concluded that the evidence base for paediatric medical transition is 'remarkably weak'. The UK closed Tavistock GIDS, introduced a precautionary policy and restricted hormone prescribing to minors to research settings. The Netherlands has so far not translated that conclusion into its own policy, although the patient population is comparable in both countries.
Risks of early medical intervention
Irreversibility is the greatest risk. Puberty blockers present themselves as a 'pause button', but 96-98% of young people who receive them go on to cross-sex hormones (Carmichael et al., 2021) — a progression suggesting that they are more of a funnel than a moment of choice. Fertility, bone density and sexual function may be permanently affected.
Gender in children
Adolescents and gender
What is happening around gender and gender dysphoria in puberty? Information on treatment options, the scientific debate and the role of support.
Role of parents
How can parents deal with a child who has questions about gender? Information on listening, medical decisions and support for parents themselves.
Social transition in children
What is a social transition in children? Information on name and pronouns, the arguments for and against, and the consequences for the child and those around…
School and transgender children
How do schools deal with transgender pupils? Information on policy, name and pronouns, sanitary facilities and support for teachers.
Sport and transgender youth
Information on transgender young people in sport: physiological considerations, sports federation policy and the balance between inclusivity and fairness.
Social media and gender
How do social media influence young people's experience of gender? Information on online communities, the ROGD debate and critical media use.
Detransition in young people
Information on detransition in young people: motives, medical and psychological consequences, figures and support for detransitioned young people.
ADHD and transgender
Overlap between ADHD and transgender identity in adolescents, and clinical implications for diagnosis and treatment.
Autism and transgender
Increased overlap between autism and gender diversity: findings from Warrier 2020 and recommendations for clinical attention.
Depression and transgender
Increased prevalence of depression in transgender people: minority stress, clinical comorbidity and care provision.
Eating disorders and transgender
Increased prevalence of eating disorders in transgender young people and the link with bodily dysphoria.
Gender in children
How do children develop a gender identity? Information on gender development, gender variation and what this means for parents and carers.
Minors and consent in gender care
Consent rules (informed consent) for minors in gender care in the Netherlands: age limits, dual consent and case law.
OCD and transgender
Obsessive-compulsive disorder and gender dysphoria: differential-diagnostic considerations around gender-related obsessive thoughts.
Peer influence and gender identity
How peer influence within friendship groups shapes identity formation in adolescents, including around gender identity.
Pinterest and gender dysphoria
Pinterest boards' role in identity formation among adolescents with gender dysphoria: visual inspiration and peer aesthetics.
Social contagion hypothesis
The hypothesis that social influence (peer and media influence) contributes to the rise in adolescent gender dysphoria, and the scientific discussion.
Suicide risk in transgender youth
What is known about suicide risk in transgender young people? Figures, pitfalls in interpretation and recommendations.
TikTok and gender dysphoria
TikTok's role in the rise of adolescent presentations with gender dysphoria: algorithms, peer influence and clinical considerations.
When parents withhold consent
What happens when parents withhold consent for transgender care for a minor? Legal routes and the role of the children's court in the Netherlands.