Section I · Last reviewed 2026-05-16
The Dutch Protocol
What the protocol formally claims to be, where it actually comes from, and which assumptions have never been tested.
What is documented here
This section describes the Dutch Protocol as formulated by the original VUmc authors: a phased pathway of puberty suppression, cross-sex hormones and surgery in adolescents. We describe it not to endorse it, but to show on which assumptions a globally applied treatment rests. Every independent evaluation since 2020 (Cass, SBU, NICE, COHERE, Ukom) concluded that the evidence under these assumptions has "very low certainty". Read each claim below alongside the assessment in /evaluations/ and /debate/scientific-criticism/.
Subpages
- Definition — what the protocol formally claims to be
- Origins — Cohen-Kettenis, Delemarre-van de Waal, VUmc 1980s–1990s
- The three phases — psychological evaluation, puberty suppression, cross-sex hormones
- Age criteria — Tanner stages, age limits originally and loosened in the rollout
- Inclusion criteria — diagnostic conditions, abandoned almost everywhere internationally
- Exclusion criteria — comorbidity, autism, trauma — not consistently enforced in practice
- Informed consent — how consent was originally arranged; why critics call it effectively impossible
- Follow-up — limited to 1 year post-operatively; long-term effects unmeasured
- Changes over time — how the original was stretched
- Current status Netherlands — the Netherlands continues the protocol without its own evidence review
Related
- Scientific basis — the evidence base.
- Evaluations — what independent evaluators conclude.
- International comparison — all countries in table form.
- For parents · For clinicians.
- People index · Timeline.
- FAQ · Glossary