Frequently asked questions

The Dutch Protocol is a phased clinical pathway for adolescents with persistent gender dysphoria, developed at the VUmc (Amsterdam) between 1987 and 2006. It has three phases: psychological diagnosis, puberty suppression (GnRHa) and cross-sex hormones. See /protocol/definition/.

The first GnRHa treatment of a 13-year-old adolescent took place in 1987–1988. The first publication followed in 1998 (Cohen-Kettenis & van Goozen); the formal protocol description in 2006 (Delemarre & Cohen-Kettenis). See /protocol/origins/ and /timeline/.

GnRHa (gonadotrophin-releasing hormone agonist) suppresses endogenous puberty. In the original protocol presented as "fully reversible"; the Cass Review (2024) and Levine et al. (2022) raise questions, including about bone density and cognitive development. See /protocol/the-three-phases/ and /evaluations/cass-review-2024/.

The original protocol had three age thresholds: GnRHa from Tanner stage 2 (around 12), CSH from 16, surgery from 18. WPATH SOC-8 removed age limits after publication. See /protocol/age-criteria/.

The original core publications concern 70 (de Vries 2011) and 55 (de Vries 2014) adolescents. The Amsterdam cohort 1990–2018 comprises 1,766 referrals for GnRHa, of which 720 also received CSH (van der Loos 2022). See /studies/sample-size-and-attrition/.

The fading of cross-gender identification in children before or during puberty. Classic studies (Steensma 2013, Singh 2021) report persistence of ~12–27%; more recent studies (Olson 2022) on already socially transitioned subgroups show much higher persistence. See /debate/desistance-research/.

Clinical cohort studies report 0.5–7% detransition; self-selected online surveys report higher figures, not generalisable. Methodology and definitions vary widely per study. See /debate/detransition-research/.

The British Cass Review (April 2024) concludes that the scientific underpinning for GnRHa and CSH in adolescents is "remarkably weak" and recommends prescribing these treatments only within research, screening ASD comorbidity as standard, and prioritising psychosocial interventions. See /evaluations/cass-review-2024/.

Sweden (Karolinska 2021, SBU 2022, Socialstyrelsen 2022), Finland (COHERE 2020), the UK (NICE 2020, Cass 2024, NHS halt on GnRHa 2024), Norway (Ukom 2023), Denmark (2024), Finland and parts of the US have introduced substantial restrictions. See /international/comparison/.

The Netherlands largely continues the protocol under the Quality Standard Transgender Care (2018, revised 2023). A ZonMw evaluation programme runs 2022–2027. An official Dutch revision based on the international evaluations had not been published as of May 2026. See /protocol/current-status-netherlands/.

In March 2024, Environmental Progress (Michael Shellenberger, Mia Hughes) published internal WPATH discussions in which clinicians question, among themselves, the scientific underpinning, fertility loss and informed consent in minors. See /evaluations/wpath-files-2024/.

According to the Cass Review and the Dutch researchers themselves, international rollout departed from the Dutch original on several points: looser inclusion criteria, shorter diagnosis, lowered age limits, higher ASD comorbidity, different population (late-onset FtM). See /international/spread/.

The original authors cited ethical objections to a no-treatment control group. Critics argue that the absence of a control structurally limits the strength of the evidence and that the "natural history" of untreated dysphoria thereby remains unknown. See /studies/methodological-criticism/.

English court case (Keira Bell v Tavistock GIDS, 2020/2021) on whether minors are competent to consent to GnRHa treatment. The High Court initially ruled negatively; the Court of Appeal overturned the ruling on procedural grounds in 2021. See /debate/legal-cases/.

No. This site documents the Dutch Protocol as a scientific, clinical and policy phenomenon. Not medical, legal or policy advice. See /disclaimer/ and /methodology/.