Is social transition really irreversible?

A name, clothing, and pronouns can formally be reversed. The Cass Review writes that help may be needed if a child or young person wishes to reverse their decision, because it can be a difficult step to take. Whether social transition increases the likelihood of a medical transition has not been established: according to the Cass Review, no causality can be inferred from the available studies.

Does social transition increase the likelihood that gender dysphoria will persist?

That has not been established. Steensma et al. (2013) found that childhood social transition was associated with persistence of gender dysphoria for those registered male at birth, but not for those registered female. According to the Cass Review, no causality can be inferred from this, because social transition was also associated with more intense gender dysphoria. The report does consider it possible that social transition in childhood may change the trajectory of gender identity development, and therefore advises a more cautious approach for children than for adolescents.

Social Transition in Children

Q: But the Cass Review is British — does it apply to the Netherlands as well?

The Cass Review concerns English care. In June 2026, the Dutch Health Council wrote that the English literature and data on which the Cass Review relies are not necessarily applicable to the Netherlands, because care in England was organised differently. The evidence on social transition itself is thin internationally: the University of York systematic review found no robust evidence for the benefits or harms of it in children and young people.

Q: May a school socially transition a child without informing us as parents?

Parents have parental authority over their child until the age of eighteen, and this includes responsibility for their mental and physical wellbeing (Art. 1:245 and 1:247 of the Dutch Civil Code). The Cass Review wants parents to be actively involved in decision-making unless there are strong grounds to believe that this may put the child at risk. We consider it problematic that a school bypasses parents.

Empty elementary school classroom with tables, wooden chairs, and a green chalkboard. — Photo: Nathan Cima via Unsplash

A social transition in a child — a new name, new pronouns, different clothing, often combined with secrecy at school or within the family — is often presented as a ‘reversible experiment’. The Cass Review (2024) sees it differently: according to the report, social transition should be viewed within the NHS as an active intervention, because it may have significant effects on psychological functioning and longer-term outcomes (source). Because of the weakness of the research, it is unclear whether social transition alters the trajectory of gender development.

What is a social transition?

With a social transition, a child is treated in daily life as belonging to the opposite sex: a new name, different pronouns, different clothing, a different hairstyle, and different use of toilets and changing rooms. No medical intervention — but it is still an intervention in the child’s self-image, relationships with peers and family, and the way the child gives language and meaning to their own identity. A brief explanation of the concept in simple language can be found at gender123.nl.

Cass Review: an active intervention

The Cass Review writes that social transition may not be thought of as an intervention, because it does not take place in a healthcare setting, but that in an NHS setting it should be viewed as an active intervention (para. 12.5, translated). Because of the weakness of the research, it is unclear whether social transition alters the trajectory of gender development (para. 12.31). The report considers it possible that social transition in childhood may change the trajectory of gender identity development and therefore advises a more cautious approach for children than for adolescents (para. 12.36). The report also states that there is no clear evidence that social transition in childhood has positive or negative mental health outcomes (para. 12.36). Cass Review (full report). The systematic review by the University of York for the Cass Review likewise found no robust evidence for the benefits or harms of social transition in children and young people (source).

Steensma et al. (2013) found that childhood social transition was a predictor of persistence of gender dysphoria for those registered male at birth, but not for those registered female. According to the Cass Review, no causality can be inferred from this: social transition was also associated with more intense gender dysphoria, and it is not known which of the two influences the other (paras 12.26, 12.27 and 12.34; source). See Steensma (2013) and desistance. Young people told the Cass Review that social transition reduced their gender dysphoria and made them feel more comfortable, but that the reactions of those around them can make it difficult (para. 12.14).

Who is actually in charge here?

According to the Cass Review, one key difference between children and adolescents is that parental attitudes and beliefs affect a young child’s ability to socially transition, whereas adolescents have more personal agency (para. 12.4; source). The report also notes that some parents felt ‘forced’ to affirm their child’s assumed identity or risk being painted as transphobic and/or unsupportive (para. 12.16).

It becomes particularly problematic when schools or support professionals socially transition a child without the parents’ knowledge or consent. The Cass Review heard from many English parents that their child had been socially transitioned and affirmed in their expressed gender without parental involvement, usually after a teenager had come out at school (para. 12.16; source). According to the report, parents should be actively involved in decision-making unless there are strong grounds to believe that this may put the child at risk (para. 12.36). In the Netherlands, parents have parental authority over their child until the age of eighteen (Art. 1:245 and 1:247 of the Dutch Civil Code). How schools can respond to a request for a different name or different pronouns is discussed by genderopschool.nl. See Schools and transgender children.

Reversing is not straightforward

Formally, a name, clothing, and pronouns can be ‘reversed’. The Cass Review writes that help may be needed if a child or young person wishes to reverse their decision, which can be a difficult step to take (para. 12.36; source). In a US study of children who had fully socially transitioned between the ages of three and twelve (Olson et al., 2022), 93 percent still identified as transgender at the end of the study, on average 5.4 years later, and the majority went on to medical interventions (para. 12.25 of the Cass Review). The participants had enrolled themselves, and the Cass Review stresses that no causality can be attributed from such studies (para. 12.34). Whether social transition increases the likelihood of a pathway involving puberty blockers and hormones has therefore not been established.

What, then, should be done?

The alternative is neither denial nor punishment. It is to take the child’s feelings seriously, allow room for gender-atypical expression, carefully assess any underlying issues (autism, trauma, loneliness, intensive media use), and avoid irreversible social steps while the child is still fully developing. Watchful waiting is a sensible starting point. See also The role of parents.

But the Cass Review is British — does it apply to the Netherlands as well?

May a school socially transition a child without informing us as parents?