THE HAGUE – In a significant advisory report, the Health Council of the Netherlands has affirmed the country's approach to gender-affirming care for young people, known as the 'Dutch protocol,' describing it as a "careful process." The conclusion comes after a multi-year review prompted by government motions and a shifting international landscape where some countries have adopted a more restrictive stance on transgender healthcare for minors.
The council's advice to the Minister of Health, Welfare and Sport provides a measure of stability for transgender youth and their families who have faced uncertainty amidst an increasingly polarized public debate. The review was initiated in response to a growing and changing patient population and criticism regarding the long-term effects of treatments like puberty blockers and hormones.
Context and International Comparison
The Health Council noted that while other countries have become more cautious, direct comparisons are often misleading. The report suggests that some foreign healthcare systems may not have implemented the protocol with the same rigor as in the Netherlands. Specifically, it highlights that it is "not clear whether in other countries sufficient attention was paid to exploration and psychological guidance," a cornerstone of the Dutch approach.
The council found "indications for some improvement in mental outcomes" and noted that "the number of cases of regret is low" following treatment. However, it also transparently acknowledged the limitations of current knowledge.
Recommendations for the Future
While endorsing the current model of care, the council stressed that the lack of comprehensive long-term data is not a reason to halt or fundamentally alter the existing framework. It argued that "doing nothing can also be harmful to mental health." To address the existing knowledge gaps, the council issued several key recommendations:
- Enhanced Information: Young people and their parents must be thoroughly informed about the scientific uncertainties and potential long-term health risks associated with treatment.
- Long-Term Research: A call for more robust and extensive research into the long-term effects of treatment, including studies on detransition and regret. The council advises following larger groups of patients "well into adulthood."
Relief and Cautious Optimism from the Community
The report was met with positive reactions from transgender advocacy and support organizations. "I am glad that it has confirmed what we actually already knew," said Liora ten Brinke of the patient organization Transvisie. "We had no doubts about the carefulness of the care."
A group representing parents of trans children, Ouders van Trans Kinderen, also expressed support for the council's findings, emphasizing the negative impact of the heated public discourse. "We as parents see that our children are affected by this," the group stated via email. "It creates uncertainty about whether they can continue to receive the same good care they need."
Professor Robert Vermeiren, a child and youth psychiatrist at LUMC, called the council's advice to continue with the current care model a positive development. He co-authored a European paper two years ago warning against improper application of the protocol abroad. "The protocol is widely appreciated, but some foreign countries were not so careful," Vermeiren said, adding, "At the same time, we must continue to monitor this properly in the Netherlands." He strongly supports the call for more diligent research.
The university medical centers in Amsterdam, Nijmegen, and Groningen, which provide this specialized care, have stated they will first assess the implications of the advice for patient care and ongoing research before providing a detailed response.
Based on reporting by Trouw
