Minors and Consent in Gender Care

The Medical Treatment Contracts Act (WGBO) regulates consent to medical treatment.

Legal Framework in the Netherlands

The Medical Treatment Contracts Act (WGBO) regulates consent to medical treatment. Up to the age of 12, parents make the decisions; from 12 to 16, consent from both the parents and the child is required; from the age of 16, the minor independently decides on their own treatment.

Specific Rules for Transgender Healthcare

For puberty blockers and cross-sex hormones, Dutch gender clinics apply additional requirements: an extensive diagnostic process, a multidisciplinary decision and — for minors — the consent of both parents.

International Developments

In the United Kingdom, the case brought by Keira Bell against the Tavistock clinic in 2020 led to stricter requirements. In the Netherlands, the House of Representatives discussed age limits and the role of parental consent in 2024.

Capacity to Consent

The legal age limits are based on the assumption that the young person has the capacity to consent: they must understand the information, be able to foresee the consequences and make a decision on that basis. The doctor assesses this for each decision. The more invasive and irreversible the treatment, the higher the threshold. Puberty blockers and hormones involve consequences that a twelve- or fourteen-year-old may find difficult to foresee, such as future fertility and sexual functioning.

Blockers as a First Step

Puberty blockers are often presented as a pause that provides time to think. British and Dutch research shows that almost all young people who start blockers subsequently continue with hormones. In the British study, this applied to 43 of the 44 participants. This raises the question of whether consent to blockers is in practice consent to the entire process. In 2020, the judges in the Bell v Tavistock case explicitly raised this question; see the timeline and puberty blockers.

Bell v Tavistock

In December 2020, the British High Court ruled that it was highly unlikely that a child under 13 could consent to puberty blockers, and doubtful that a fourteen- or fifteen-year-old could do so. The Court of Appeal overturned that ruling in September 2021: it is for doctors, not judges, to assess capacity to consent on a case-by-case basis. The legal case is explained step by step on puberteitsblokkers.nl. The case permanently changed the debate and contributed to the research that led to the Cass Review. In 2026, a British judge opened the door to a controversial trial involving puberty blockers for 226 children. For what happens when parents and child disagree, see when parents do not give consent.