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Astonished by the rapid incursion of gender ideology through the culture, many people ask, “How did we get here so quickly?” One important factor was the medical community’s enthusiastic embrace of the radical treatment protocol known as “The Dutch Protocol,” which laid the groundwork for the radical and risky treatment that is now known as “gender-affirming care.”  

The Dutch Protocol originated in the Netherlands where researchers who treated adult transsexuals looked for a way to improve patient outcomes. (1) Hypothesizing that their adult patients might have had better outcomes had they transitioned earlier, clinicians began medically transitioning gender dysphoric adolescents in the 1980’s and 1990’s. (2) The researchers’ treatment plan included the use of puberty blockers to delay the onset of pubertal development, followed by cross-sex hormones to induce the development of secondary sex characteristics of the opposite sex. This marked a radical shift, as in the past, care for young people experiencing distress about their bodies focused on holistically treating the psychological issues underpinning this distress. Despite the low-quality evidence supporting this “care”, this treatment quickly became popular in nations across the globe, including the United States.  

Despite the low-quality evidence, the final Dutch study (2014) “underwent what’s known as ‘runaway diffusion’ a problematic but not uncommon phenomenon whereby the medical community mistakes a small innovative experiment as proven practice, and a potentially nonbeneficial or harmful practice ‘escapes the lab,’ rapidly spreading to general practice settings.” (3) As a result, many countries uncritically adopted the practice of affirming a child with body-related distress and encouraging puberty blockers as a “pause button” so they have time “to decide their identity,” cross-sex hormones as the next best step to “feel like a boy/girl” due to the cosmetic and bodily changes, and surgical transition so adolescents surgically modify their bodies to create an appearance that aligns with or is “in accord” with their “gender identity.”  

Now, many countries (ex. Finland, England, Sweden) are backing away from this protocol, as their own studies have shown no improvement or a worsening of clinical outcomes among young persons who have been treated according to this model. Under scrutiny, the Netherlands is facing criticism as many question their research which has never been able to be replicated but which caused irreversible harm to minors treated according to this protocol.  

In a recent documentary, Zembla, a Dutch journalism group, investigated the main gender clinic in Amsterdam (Amsterdam UMC) which pioneered the low-quality evidence most countries use today. They interviewed detransitioners/desisters, trans-identifying youth, the lead “gender-affirming care” doctors, psychiatrists who began to question the “care”, and many more. 

The scientific inadequacy of this model was starkly illustrated when Zembla continued to take a closer look at the studies from the clinic on the effects of puberty blockers on adolescent brain development (during puberty). Although one of the leading doctors asserted that hormone production simply resumes after the cessation of puberty blockers, the long-term effects of this treatment are unknown. Furthermore, it really doesn’t give children the opportunity to reflect on what they “really want,” but locks them into this new identity. As their own Dutch study shows,  100% of children involved went on to pursue cross-sex hormone treatment. (4) The promise of puberty blockers as a “time to think” and to gain clarity, failed to materialize.  

A notable point is that the doctors announced research about brain development 17 years ago, but the results of the studies were never announced. Thus, one might assume this means nothing harmful came as a result. However, Sarah Burke, a neuroscientist who did brain research at the Amsterdam clinic 12 years ago, stated that the research was limited, and the participating group was very small, leading to an inconclusive study. So, the true effects of puberty blockers on pubertal brain development are unknown. 

However, various animal studies show the impact of hormones on brain development. Burke states that studies conducted on mice, sheep, and monkeys illustrate that these hormones impact the areas responsible for emotional regulation, which is critical to making life-altering decisions.  

Perhaps most troubling, the original protocol stipulated that the teens subject to this care must have had distress about their bodies from childhood and must have no comorbid psychological diagnoses. But as the UK realized, the population of teens subject to this protocol, for the most part, experience late and rapid onset and have had significant comorbid psychological issues. (5)

The Dutch Protocol has been one of the most influential models for caring for young persons who are distressed about their bodies, launching the prevailing model of “gender-affirming care” today. As more and more individuals identify as transgender and seek treatment to ease their distress, it’s important to remember the shaky foundation of this protocol, the low-quality evidence supporting it, and the potential for drastic harm when young persons with healthy bodies are subjected to these experimental and risky life-changing interventions.  



(1) Michael Biggs, The Dutch Protocol for Juvenile Transsexuals: Origins and Evidence (2022)

(2) SEGM, “The Dutch Studies and The Myth of Reliable Research in Pediatric Gender Medicine” (2023)

(3) SEGM, “The Dutch Studies and The Myth of Reliable Research in Pediatric Gender Medicine” (2023)

(4) Annelou Vries, Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study (2011)

(5) Hannah Barnes, Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children (2023)