Protocol › Follow-up · Last reviewed 2026-05-16
Follow-up and aftercare
Summary
The Dutch Protocol included three documented measurement points: T0 before the start of GnRHa, T1 at the start of cross-sex hormones, and T2 about one year post-operatively. Standardised instruments included the Utrecht Gender Dysphoria Scale, the Body Image Scale, CBCL/YSR and the Beck Depression Inventory. Long-term follow-up beyond T2 was added in later cohort studies — see /studies/follow-up-studies-overview/.
1. Original measurement points
The measurement points directly follow the three phases of the protocol — see /protocol/the-three-phases/.
| Point | Timing | Content |
|---|---|---|
| T0 | Baseline, before GnRHa | Diagnostics, questionnaires, somatic status |
| T1 | At start of cross-sex hormones (~16 yrs) | Re-evaluation, repeat questionnaires |
| T2 | ~1 year post-operatively | Functional outcomes, psychological status |
2. Outcome measures
- Utrecht Gender Dysphoria Scale — 12-item questionnaire, dysphoria intensity.
- Body Image Scale — body-image-specific dissatisfaction.
- CBCL / YSR — behavioural and emotional problems.
- Beck Depression Inventory — depression score.
- Trait Anxiety Inventory — anxiety score.
3. Limitations
Various reviewers (including SBU 2022 and Cass 2024) have noted that the original follow-up of up to one year post-operatively — mean age around 20 — limits statements on long-term effects on identity, fertility, bone and cardiovascular health.1 Later cohorts have introduced longer follow-up periods; see /studies/follow-up-studies-overview/ and /studies/sample-size-and-attrition/.
Critical note
The UGDS — the central measurement instrument for dysphoria — uses different wordings for MtF and FtM, which complicates direct T0/T2 comparison (Biggs 2023). A more recent Finnish register study (Ruuska et al., 2026, cited in public commentary) reports that psychiatric care needs after treatment in fact increase rather than decrease — findings that are hardly visible in the original Dutch Protocol measurement instruments, which focus on self-report of dysphoria and not on psychiatric care consumption.2
See also
- The three phases — to which the measurement points T0/T1/T2 connect.
- Follow-up studies — overview — all published follow-up cohorts.
- De Vries et al. (2014) — the psychological outcome study at T2.
- Sample size and attrition — who dropped out of the original cohort.
- Methodological criticism — among other things on UGDS comparability.
- SBU (2022) — Swedish systematic review on strength of evidence.
- Cass Review (2024) — recommendations for long-term follow-up.
- People register — Cohen-Kettenis, de Vries, Steensma.
- International comparison — follow-up practices per country.
- Timeline — follow-up studies in chronology.
- FAQ · Glossary · For parents.
Footnotes
- SBU. Hormone therapy at gender dysphoria in adolescents — a systematic review. Stockholm: Swedish Agency for Health Technology Assessment; 2022.
- Biggs M. J Sex Marital Ther. 2023;49(4):348–68. Genderzorgen. Transgender care under scrutiny. Substack, 10 April 2026 (translation by editors).