The Role of Parents

Q: My child says they are transgender. Do I have to affirm that immediately?

Loving your child does not automatically mean agreeing with every statement or every desired intervention. The Cass Review advises avoiding premature decisions, considering a partial rather than a full transition, and having families who are deciding on a child’s social transition before puberty seen by a clinical professional as early as possible. According to the report, parents should be actively involved in decision-making.

Q: May I refuse medical treatment for my child?

Up to the age of 12, the care provider fulfils their obligations towards the parents with authority. From 12 to 16, the consent of the parents is required in addition to that of the child, with exceptions. From the age of 16, the young person can give consent themselves. For hormones from the age of 16, the Cass Review advises extreme caution.

Q: What if the school or care providers act behind my back?

Ask for access to the file, ask for written statements and, if necessary, involve a lawyer or the Dutch Health and Youth Care Inspectorate. The Cass Review heard from many parents in England that their child had been socially transitioned without their involvement, and holds that parents should be actively involved in decision-making unless there are strong indications that this puts the child at risk.

Q: Where can parents turn for help?

For peer support, international parent organisations such as Genspect, SEGM and the Bayswater Support Group are an option. A GP or psychologist with a cautious approach can help — ask explicitly about their treatment philosophy before accepting a referral.

Parent and child walking along the water’s edge at sunset — Photo: PattayaPatrol, CC BY-SA 4.0, via Wikimedia Commons

Parents bear the primary responsibility for their child’s wellbeing — not the school, not TikTok, not a professional, and not the opinion of a twelve-year-old at any given moment. Parents may feel pressured to immediately affirm a new gender identity in their child. Loving parental doubt is not a form of rejection, but of care. Protecting, observing, weighing things carefully — that is not opposition, that is parenting.

“Affirm or lose your child” does not stand up as evidence

Parents who seek help for a child with gender dysphoria are sometimes told that the choice is: affirm everything, or risk suicide. The Cass Review states that the evidence does not adequately support the claim that gender-affirming treatment reduces suicide risk, and that some clinicians feel pressure to support a medical pathway on the basis of reports that it does (paragraphs 15.36 and 15.43). The report also stresses that the distress of these young people is real (source). See also the Cass Review. Parents may ask questions, take time, explore alternatives and set boundaries.

Watchful waiting and how things develop in children

In the United Kingdom, 'watchful waiting' remained in use until 2011, according to the Cass Review: being lovingly present, giving space, not pushing, and letting time do its work. The report states that WPATH 8 switched from watchful waiting in children to advocating social transition as a way of improving children’s mental health (paragraph 12.8; source). According to the Cass Review, studies of children who met the diagnostic criteria for gender dysphoria found that gender incongruence persisted into adulthood in 10 to 33 percent; in earlier studies it was around 15 percent (same source). See also the Steensma study (2013), in which the intensity of gender dysphoria in childhood was associated with its persistence (PubMed).

According to the Cass Review, the gender-affirmative model — a new name, pronouns and clothing, and in time blockers and hormones — has become dominant in many countries. Internationally there is also a turn towards greater restraint. Since 2022, the Swedish Socialstyrelsen has recommended that hormonal treatment of minors be given only in a research setting and outside that only in exceptional cases (source). In 2023 the Norwegian commission Ukom advised classifying puberty blockers and hormonal and surgical treatment of minors as experimental treatment (source). In 2020 the Finnish COHERE described gender reassignment of minors as an experimental practice (unofficial English translation). In Denmark, Ugeskrift for Læger wrote in 2023 that the approach has become more cautious (source). In England, NHS England decided on 12 March 2024 to no longer provide puberty blockers routinely (source).

The parent as guardian, not obstacle

The Cass Review heard from many parents in England that their child had been socially transitioned and affirmed in the chosen gender identity without their involvement, usually after a teenager had come out at school and was afraid of their parents’ reaction. Some parents therefore felt ‘forced’ to affirm their child’s presumed gender, or to risk being cast as transphobic and unsupportive (paragraph 12.16; source). The report states that outcomes for children and adolescents are best when they have a supportive relationship with their family, and that parents should therefore be actively involved in decision-making, unless there are strong indications that this puts the child or young person at risk (same source). See also Schools and transgender children.

The rights parents have regarding sex education in primary school, from the duty to provide information to the participation council, are set out at lente-kriebels.nl.

Taking underlying problems seriously

According to the systematic review for the Cass Review, children referred to gender clinics have higher than expected levels of autism, ADHD, anxiety, depression, eating disorders, suicidality, self-harm and adverse childhood experiences (source). The Cass Review states that for some young people it is likely that the stress of the teenage years expresses itself as gender distress (same source). Parents who properly identify these underlying vulnerabilities and have them treated also help their child if the gender issue persists.

Medical decisions and parental authority

In the Netherlands, the rule is: up to the age of 12, the care provider fulfils their obligations towards the parents with authority (art. 7:465 para. 1 of the Dutch Civil Code (BW)). From 12 to 16, the consent of the parents is required in addition to that of the child (art. 7:450 para. 2 BW), with exceptions; see also consent from both child and parents. From the age of 16, the child can enter into the treatment agreement and give consent themselves (art. 7:447 and 7:450 para. 1 BW; source). For hormones from the age of 16, the Cass Review advises 'extreme caution', with a clear clinical reason not to wait until 18 (recommendation 8; source). What happens if parents refuse is explained under when parents do not give consent.

Support for parents

Internationally there are networks of parents who are critical of gender-affirmative care and who share their experiences (including through SEGM, Genspect, Bayswater Support Group). Contact with other parents in the same situation can help to escape the guilt and isolation that the debate can cause. The support group Cry for Recognition offers a leaflet as a guide for parents.

My child says they are transgender. Do I have to affirm that immediately?

May I refuse medical treatment for my child?

What if the school or care providers act behind my back?

Where can parents turn for help?