November 25, 2023 - 8:00am

Scepticism of youth transgender medicine, which has been a major point of discussion in the UK and US for years, has finally made its way back to the Netherlands, as observed this week by the Society for Evidence-based Gender Medicine (SEGM). 

The Netherlands has long been the epicentre of transgender medical research, and its guidelines for youth gender transitions have become a model for other Western countries, where demand for such procedures has skyrocketed over the past decade. 

Two major stories have cast this research into doubt. A publication in the Dutch Journal of Medicine earlier this month offered a scathing critique of clinical guidance on youth gender medicine published in the same journal, arguing that it failed to acknowledge the lack of evidence supporting such interventions, failed to mention the fact that puberty blockers can impede the process of reflection which the drug is supposed to support, and misrepresented the literature on puberty blockers’ impact on brain development, among other issues. 

A Dutch public broadcaster, meanwhile, recently released a two-part documentary critical of youth gender medicine, sparking a large public debate. The documentary critically assessed the scientific basis for youth gender medicine and the effect of puberty blockers on children’s brains, and it inspired a wave of criticism and debate from Dutch trans activist groups. 

Now, the legal premise for adolescent gender medicine is also under fire in the Netherlands, according to SEGM. A paper published in a Dutch medical journal earlier this year argued that the 2018 Dutch Protocol, the official Government guidance on youth gender medicine, does not meet the qualifications to be considered standards of care. Standards of care must be evidence-based, have a limited ethical dimension, and be created in a properly designed process.

These findings are significant because it was the Netherlands which laid the foundation of youth gender transitioning. Published in 2011 and 2015, two studies (knows as the Dutch Studies) found that puberty blockers, cross-sex hormones and surgeries were an effective treatment for gender dysphoria, forming the foundation of paediatric transgender medicine throughout the Western world and inspiring the medical transitions of thousands of minors at mainstream medical institutions.

As concerns have grown over the safety and efficacy of cross-sex medical treatments and several countries have moved to restrict the procedures, the Dutch studies themselves have come under scrutiny for methodological issues and bias. The Dutch studies were the sole source of research behind the Endocrine Society’s statement in support of puberty blockers for gender dysphoric youths and the seventh version of the World Professional Association for Transgender Health (WPATH) Standards of Care guidelines, which were in place during the explosion in youth transgenderism. 

The prevalence of transgender identification expanded in the following decades, particularly among teenagers who were natal females; prior to 2000, patients with gender identity issues were almost exclusively male. Referrals to the UK Gender Identity Development Service rose from 94 in 2009-2010 to nearly 1,000 in 2015-2016. Many critics have argued this is evidence that transgender identification is a social contagion rather than an enduring, innate condition, and thus would be better treated with therapy than permanent biomedical interventions. 

Efforts to restrict youth gender transitions have been painted as Right-wing, religious and anti-scientific in nature. But as transgender care and the body of research behind it collapse under international scrutiny, that line will become increasingly difficult to toe. With each nation that restricts these treatments and each paper critiquing the evidence for trans medicine, youth gender medicine comes to appear more fringe, experimental and dangerous. 

is UnHerd’s US correspondent.