Studies › 2006 · Last reviewed 2026-05-16

Delemarre-van de Waal & Cohen-Kettenis (2006)

Clinical management of gender identity disorder in adolescents: a protocol on psychological and paediatric endocrinology aspects. Eur J Endocrinol. 2006;155(S1):S131–7.

Summary

This 2006 article is the formal codification of the Dutch Protocol. It describes inclusion criteria, diagnostic procedures, age limits (Tanner stage 2 for GnRHa, 16 for cross-sex hormones, 18 for surgery) and pharmacological details, including dosing schedules for triptorelin. It remains the most cited primary description of the protocol.

1. Content of the publication

Diagnostic criteria according to DSM-IV-TR.
Multidisciplinary setup (child psychiatrist, clinical psychologist, paediatric endocrinologist).
Inclusion and exclusion criteria — see /protocol/inclusion-criteria/.
Dosing schedules for triptorelin and leuprorelin.
Recommendations for follow-up and monitoring.

2. Methodological status

The publication is a clinical protocol, not an empirical study: it describes the method, not the outcomes. Empirical support followed in 2011 (de Vries et al., 1-year follow-up) and 2014 (de Vries et al., n=55 cohort).

3. Limitations

No randomised or controlled design.
Sample described in general terms; numbers not specified.
No formal meta-analysis or evidence grading.

Critical note

This article has been cited repeatedly as evidence for the Dutch Protocol, but contains no outcome data of its own. It is a description of method. When it appeared in an Endocrine Society supplement in 2006, no prospective follow-up research was yet available. The combination of protocol description + supplement publication + missing outcome data has been pointed to by critics as the source of the "evidence gap" identified in later reviews.¹