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The Health Council of the Netherlands published the results of a two-year review last month, reaffirming support for gender-affirming care for trans youth under the country’s pre-existing model. Citing the harms caused by delayed treatment, the report concluded (based on Dutch-to-English translation services) that “non-treatment is therefore not a neutral option.”
“The committee concludes that somatic treatment for young people with gender dysphoria fits within the health law framework,” the committee noted. “It further finds that scientific research shows the intended physical effects are achieved, there are indications of some improvement in mental outcomes and that the number of instances of regret is low. The current data on unintended physical and mental effects are not concerning to the committee.”
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The findings are in line with the studies and commitments made by other European countries over the last few years. The moves debunk right-wing claims that Europe is pulling back support for trans rights after deciding it was all a failed experiment.
The Netherlands ranks thirteenth out of 49 on ILGA’s Rainbow Map of Europe and meets 18 of the 32 indicators for trans rights according to Transgender Europe.
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One of the leading challenges to trans care provided by anti-trans campaigners is the concern of “detransition” as trans kids get older. Anti-trans activists often cite outdated and inaccurate studies to promote the idea that this practice is extremely common. The Netherlands report found between 0% and 3.5% of youth who received gender-affirming care in the form of puberty blockers later ceased care.
The Dutch study also notes that regret and deciding to cease care are “two different things” and that social pressures can cause someone to stop receiving treatment even if they are still experiencing gender dysphoria. The report found “no cases of regret” but noted that it cannot draw definitive conclusions from that data due to the short follow-up duration and a high drop-out rate from study participants.
But the researchers nonetheless found that there were definitive net positives for the mental and physical health of the youth studied. “After starting [puberty blockers], they report better mental health compared with the situation before treatment,” the report explained. “This applies to emotional problems, depressive symptoms, suicidality and self-harm.”
The review was chaired by Professor Olaf Dekkers of the Leiden University Medical Center and was commissioned in May 2024, the month after the UK’s Cass Review was published by Lady Hilary Cass and recommended against most trans minors accessing gender-affirming hormone care.
The Dutch researchers noted there are distinct differences between UK and Dutch trans case models. The researchers suggested that the UK data collection is sparse and involved too little patient time that focused on working to affirm a “predetermined gender.” In contrast, the Dutch design of trans care “rests on a step-by-step exploration of gender identity,” which creates a lot of hoops for trans youth to get through. Puberty blockers and HRT are only considered “after extensive diagnostics, psychological assistance and indication setting under the guidance of a multi-disciplinary team.” For that reason, the Cass Review and its evidence were not considered applicable to the Dutch work.
While there have been concerns raised (including in the Cass Review) that there is not enough evidence to know that providing trans youth with puberty blockers and hormone therapy is the correct way forward, the Dutch review dismisses those concerns.
The researchers note that with children. it is not ethically feasible to conduct randomized controlled trials most of the time, and that means that the “level of evidence will necessarily be assessed as (very) low.” That is true in most pediatric medicine cases, and therefore, the evidence quality is similar to most other youth studies.
Crucially, they highlight that while the potential long-term risks of providing gender-affirming care to trans youth might be uncertain, the short-term effects of withholding it are well-documented. A lack of gender-affirming care has been shown to result in increased distress, poor mental health, and suicidal ideation. The researchers noted that the limitations caused by these effects in adolescence can lead to “fewer opportunities to form identity, develop talents and to make future plans.”
The report in part proves the negative harms that delaying care can bring by citing other countries’ attacks on gender-affirming care. “The recent anti-trans legislation in the United States aimed at prohibiting these treatments show that this has negative mental effects,” the researchers noted.
This has all led the Dutch team to conclude that there is a moral obligation to not only provide gender-affirming care to trans youth, but to reduce wait times to make it available to all who need it, when they need it.
“Non-treatment is therefore not a neutral option. In the public debate, treating is often presented as intervening, while waiting is treated as self-evident. From the perspective of autonomy, it becomes clear that delaying or withholding care also has consequences for young people’s lives and their developmental possibilities—and that those consequences are morally relevant. From that perspective, shortening the waiting times is morally urgent.”
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