Protocol › Origins · Last reviewed 2026-05-16

Origins: VUmc Amsterdam, 1980s and 1990s

Summary

The Dutch Protocol emerged in the late 1980s and early 1990s at the VU University Medical Centre (VUmc) in Amsterdam. It built on adult transgender care under Louis Gooren and on the child and adolescent psychology department under Peggy Cohen-Kettenis. The decisive innovation — administration of GnRH agonists to a 13-year-old adolescent — is dated to 1987–1988 and documented in the Cohen-Kettenis and van Goozen case report of 1998.

1. Prehistory: adult care

From 1972 the Vrije Universiteit Amsterdam provided gender care for adult transsexual patients, under the lead of endocrinologist Louis Gooren.¹ The emergence of a multidisciplinary approach for minors followed from the collaboration with the child and adolescent psychiatry department.

2. The 1987–1988 case

In 1987–1988 a GnRH agonist was prescribed for the first time to a thirteen-year-old adolescent (biologically female) with persistent cross-gender identification since early childhood. The case was published in 1998 by Peggy Cohen-Kettenis and Stephanie van Goozen under the title "Pubertal delay as an aid in diagnosis and treatment of a transsexual adolescent" — see /studies/cohen-kettenis-1998/.²

"After a thorough diagnostic procedure it was established that this girl had a primary, lifelong gender identity disorder of the transsexual type. (…) Hormonal delay of puberty was considered a useful diagnostic tool."

— Cohen-Kettenis & van Goozen, 1998, p. 247

3. Formalisation 2006

The standardised version of the protocol was described in 2006 by Henriette Delemarre-van de Waal (paediatric endocrinologist, VUmc) and Cohen-Kettenis in European Journal of Endocrinology — see /studies/delemarre-2006/.³ This article is regarded as the canonical description of the protocol in its original form.

4. Key figures

Name	Role	Period
Louis Gooren	Endocrinologist, adult transgender care	1972–2005
Peggy Cohen-Kettenis	Clinical psychologist, head of child and adolescent team	1987–2011
Henriette Delemarre-van de Waal	Paediatric endocrinologist	1990–2010
Annelou de Vries	Child psychiatrist, follow-up cohort	2000–present
Thomas Steensma	Desistance researcher	2005–present

5. Move to Amsterdam UMC

After the merger of AMC and VUmc into Amsterdam UMC (2018) the outpatient clinic continued under the name Knowledge and Care Centre for Gender Dysphoria, part of Amsterdam UMC, location VUmc. For current Dutch practice see /protocol/current-status-netherlands/.

Critical note

The protocol emerged from a single clinical case (1987–1988) without prior controlled study. Biggs (2023) notes that scaling up to standard treatment took place without the assumptions first being tested by independent research groups — a departure from the usual course in medical science, where new interventions are first validated by RCTs.⁴