Landmark Official Dutch Review Recommends Trans Youth Care, Call For Expanding Treatment

The review finds that wait times must be shortened, that few people detransition, and that trans youth care has enormous benefits.

Photo by Delia Giandeini on Unsplash

In a landmark two-year review, the Health Council of the Netherlands—the country’s highest scientific advisory body—has delivered its verdict on gender affirming care for transgener youth. The council’s conclusions were universally positive for gender-affirming care: it endorsed the treatments as careful, lawful, and effective, framed quick access as a matter of the right to health, warned that “doing nothing” is harmful, cast aside the Cass Review as not applicable to Dutch care, reported zero cases of regret among trans youth patients, and called the reduction of the country’s years-long wait times “morally urgent.” In doing so, the Netherlands becomes the latest in a series of European countries to reaffirm and strengthen care for transgender youth, refuting a right-wing talking point in the United States that Europe is “pulling back.”

The review was commissioned in May 2024 in the wake of the Cass Review. The Health Council’s committee ran systematic literature searches and consulted outside clinical experts chosen for their differing perspectives on the care—a list that included Hilary Cass herself. The panel was chaired by Olaf Dekkers, a Leiden University Medical Center professor of internal medicine whose academic specialty is research methodology, and seated professors of health law and medical ethics alongside practicing physicians and psychiatrists. From that foundation, the committee dismantled the argument at the center of the American campaign against this care—that the evidence is too weak to justify treatment—answering that the evidence quality for trans youth care is in line with the norm across pediatric medicine, and that doing nothing carries documented harms of its own, pointing specifically to harms produced by America’s own care bans.

The committee concluded that the care is lawful and careful, and that it works as intended, stating in its summary: "The committee concludes that somatic treatment for young people with gender dysphoria fits within the health law framework. It further finds that scientific research shows the intended physical effects are achieved, that there are indications of some improvement in mental outcomes, and that the number of cases of regret is low. In the committee's view, the current data on unintended physical and mental effects are not cause for concern."

The advisory also rejected the framing that treating transgender youth is a risky intervention while not treating them is a neutral default. Delaying care, the review found, carries its own harms: youth develop unwanted and often irreversible physical changes—some of which can only be undone later with surgery—while mental health suffers in the meantime, and some young people locked out of careful care turn to unregulated hormones on their own. The committee's answer, in a passage aimed directly at that framing, calls the reduction of wait times a moral imperative: "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."

They also examined rates of stopping treatment and of regret—and found both to be rare to nonexistent, stating: "Dutch research shows that 0% to 3.5% of people with gender dysphoria stop hormone treatment that they began as minors. No cases of regret were found in the studies." The international picture matches: across five systematic reviews, between 0% and 8% of youth stop hormone treatment, with regret rates described as low. Among the Dutch youth who did stop puberty blockers, the most common reason recorded was that their gender dysphoria had resolved—an outcome the Dutch model counts as the system working, since blockers exist precisely to give young people time to explore. The committee also cautioned that stopping and regret should not, on their own, be read as a verdict on the care itself, noting that many forms of regret trace not to the treatment but to discrimination and social hostility toward the people who received it.

The review also documented benefits of treatment across several mental health outcomes: depression, suicidality, self-harm, and emotional wellbeing. "Dutch trans youth report on average worse mental health before treatment with GnRH agonists than their cisgender peers," the review states, using the clinical term for puberty blockers. "After starting GnRH agonists, they report better mental health compared with the situation before treatment. This applies to emotional problems, depressive symptoms, suicidality and self-harm." For gender-affirming hormones, the committee found: "The limited research does show a significant improvement in general functioning and wellbeing after treatment." The committee then pointed out what delays cost transgender youth. A youth overwhelmed by distress about their own body or struggling with depression and social withdrawal, it wrote, has fewer chances "to form an identity, develop talents, and make plans for the future"—and untreated gender dysphoria therefore damages "the right to an open future."

The review directly engaged the argument that "evidence-based medicine" and the GRADE rating system prove the evidence for trans youth care is too weak to act on. The GRADE tier that critics often cite measures study design, the committee explained, and in pediatric medicine, randomized controlled trials (RCTs) are largely off the table: "Ethical thresholds for conducting randomized controlled trials are much higher for children than for adults," the review notes—and in this field specifically, young people refuse to join a no-treatment control group, and blinding is impossible when treatment visibly changes the body. "A lack of RCTs has the consequence that the level of evidence will necessarily be assessed as (very) low." That places trans youth care on the same evidence tier as much of children's medicine: "For many questions in pediatric medicine, the evidence is low and will likely remain low," the committee writes, which is why evidence-based medicine, properly practiced, weighs research alongside clinical expertise and the patient's own individualized treatment goals.

The review's recommendations mark the latest step in an unmistakable movement across Europe: the expansion of transgender healthcare. For years, American coverage fixated on restrictions in the United Kingdom to claim the continent was turning back. That claim was always false, as more countries affirm the importance of such care. Germany, Austria, and Switzerland issued joint guidelines recommending the care, while France's pediatric endocrinologists published their first national consensus endorsing it. And now the country that pioneered gender-affirming care for trans youth has reviewed the care and found yet again that it gives those youth the greatest chance to thrive.