Section III · Last reviewed 2026-05-16
International rollout
How the Dutch Protocol spread through guidelines and clinics — and how, since 2020, several countries have moved to revisions.
Summary
After the publication of the Endocrine Society guideline in 2009 and WPATH SOC-7 in 2012, the Dutch Protocol was widely adopted in Europe, North America and Australia. From 2020 onwards, several countries — Sweden, Finland, the United Kingdom and Norway — have re-evaluated practice and introduced substantial restrictions. For a direct overview: the comparative table.
Critical note
In international implementation, the Dutch Protocol has departed from the Dutch original on core points: looser inclusion criteria, a shorter diagnostic phase, lower ages at first referral, higher comorbidity. The Cass Review (2024) concludes that contemporary international practice cannot easily be justified as a "continuation of the Dutch Protocol". The picture in 2025 shows a growing gap between countries that continue the original model (including the Netherlands) and countries that are withdrawing on the basis of systematic evidence reviews.1
Subpages
- Comparative table — all countries in one overview
- Spread — how it became the global standard
- United Kingdom — Tavistock GIDS
- Sweden — Karolinska and SBU
- Finland — COHERE guideline 2020
- Norway — Ukom 2023
- Denmark
- Germany
- United States — Endocrine Society, AAP, WPATH
- Australia
- Worldwide status 2025
Related
- Evaluations — overview — the evaluation reports countries draw on.
- Guidelines international — primary documents.
- Current status Netherlands.
- People index · Timeline.
- FAQ · Glossary
Footnotes
- Cass H. Independent review of gender identity services for children and young people: final report. NHS England; April 2024.