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.