Congratulations, Joe and give your daughter a hug for me. Here's to different, more healthy cultures. If you haven't seen this, it's a good overview: https://transrightsmap.tgeu.org/map
Joe and JD, I’m queer-identified and trans and moved to the Netherlands from California a year ago. I live between Leiden and The Hague and am finding it challenging to form friendships and community. Any chance you’re not too far away?
No offense, but as a Dutch person and the many American tourists I have encountered who consider a 2 hour drive to "not be far away" I doubt it will be a lot, distance-wise :P .
I’m delighted to live in a country where I can get by fairly well even as an elder without owing a car! I walk a lot, have an e-bike, and for longer distances, I love the trains and buses!
Given you mention the trains and buses, I assume you live in what we call the Randstad, where public transportation is often a very viable option...But outside of it...ehm, not so much :P .
I get what you mean but from the reverse perspective. I've encountered a number of visitors from Europe to the US who have no freaking idea how big the place is. Figure that the Netherlands is a bit less than twice the size of New Jersey and you can sense how in context a two-hour drive doesn't seem a huge deal. :-)
While it is comforting to read for me as a Dutch person that The Netherlands feels more safe (even though it should not be like this), please be on the lookout.
We have 10-12 parties who are openly anti-trans, in open and sometimes less open ways. That's a majority in the House. 2 Of these parties (CDA and VVD) are coalition parties now.
The rest is: BBB, PVV, SGP, CU, JA21, FvD, Lid Mona Keijzer (she is particularly vile and hostile towards trans people, especially on Twitter...), Groep DNA, and DENK. Denk unfortunately does not understand intersectionality: they decry discrimination when it's muslim people, but happily side with the extreme-right when another group is apparently "required" to be discriminated. Denk is primarly terrified of the Grey Wolves of Erdogan, the dictator of Turkey.
CDA already took off it's mask of reasonable Christians during the campaign in 2025 and right after and has been moving more extreme-right, shown by (including other things) their anti-trans vote at the 18th of December 2025 when they voted against democracy for trans people and trans children. Their stance on the law change proposal that was brought in for discussion (self-ID law change) was not completely new, because they have been using some absolutely vile and disgusting language to oppose it back in 2022.
The VVD is openly pro-fascist: on a Trumpian motion brought in by the extreme-right to christo-fascist BBB to "declare anti-fa illegal", they voted "yes".
VVD, in the past has been dwelling with Hilary Cass' her report, and was annoyed with the fact the healthcare for trans children didn't see a radical reform within 6 months!
More evidence to support the thing that we've already known. At the same time as the US is working to undermine WPATH and healthcare across this spectrum of need, it's good to see more impartial data to deter their onslaught of bias, misinformation, and lies.
And just like that, the 'phobic child abusers have to quit claiming, "all the Europeans are stopping it [GAC for youth] even the Dutch have stopped the Dutch protiocol!"
This is outstanding news!!! Hooray for the Netherlands and for al the fine work of the people on that nation's Health Council who did such a well researched and comprehensive study.
Thanks, Erin, for your great work and dedication to keeping us informed.
The repudiation of the Cass Review is particularly interesting. It was embraced enthusiastically by “moderate” groups who wanted a pretext to justify their abandonment of politically inconvenient trans Americans. I’m sure this will be reported just as as widely and factually. /sarc
I’d love to know what Hilary Cass’s participation consisted of…
Probably asking her what her views on this are and aligning it with the international guideline. "Oh, she deviates heavily from it, yep, ignore her."
That said: Cass has been making the case in UK parliament or something that resembles it (I do not understand the UK's political system well) for an 11 year old trans child to go on puberty blockers...
I have yet to look through the report to see if Cass' deliberations are public anywhere in it, or if they are kept confidential.
If they are kept confidential, given her backpedalling on her own report, I would not be surprised that in the safety of confidentiality she suddenly turned.
That said: it is, to me, quite worrying that they also decided to listen to Cass, just as anti-trans extremist Lodewijk Smeehuizen, a law-professor was allowed to write an informative response to the expert group. Lodewijk Smeehuizen penned a piece in the Nederlands Juristenblad back in November or December 2025 where he tried to portray himself as this medical expert who suddenly became an endocrinologist, defended Cass uncritically, repeated Baxendale's lies about the supposed dangers of GnRHa's, claimed trans boys were overrepresented (these are old numbers of which it was shown back in 2022 already that the numbers have now been equal).
So, I’ve done more digging since yesterday. This is my layperson’s take, so grain of salt and all that.
It sounds as if Cass was interviewed as a more ‘conservative’ perspective on the subject. I imagine it would be impolitic to completely ignore the most recent and notorious review on gender affirming care for minors and it does increase the rigor of the exercise to include a spectrum of opinion.
I think the most critical refutation of Cass is regarding the lack of long term studies being an impediment to treatment. As this review points out, that is not uncommon across pediatric care, and highlighting it in the affirmative care space seems tendentious at best.
If there is a less exuberant takeaway from this review, it is that the Dutch model is highly controlled and centralized in comparison to even other nationalized health services. My instinct is that Cass and other skeptics (not to mention the outright hostile parties) will fall back on claims that their concern is less about care and efficacy and more about the inadequacy of NHS/[your country’s health service here] when compared against the Netherlands. “We can’t possibly match this unparalleled course of treatment!”
As a U.S. citizen this is only exacerbated. We have no centralized health care service to develop and impose firm standards of care or to track patient outcomes over time. The Dutch model features rigorous intake, a clear hierarchy of decision-making, and control of patient data over time. It’s no wonder they can say with great confidence that their regret rate is almost non-existent. U.S. care is incredibly fragmented, with the transfer of medical history equally so. I believe the reports that regret rates here are also very low, but the patchwork and somewhat erratic nature of our system exposes it to bad faith claims.
One thing I found particularly interesting about Dutch care is that minors with additional mental health issues are not allowed to proceed with care until that condition is mitigated? This runs counter to U.S. care, where comorbidity is reasonably common. Anxiety and depression are irrefutably on the rise among U.S. teens, and my experience is that this is only heightened among trans youth (including mine). I clearly need to get more detail on this, as I can see it being another point of distinction for skeptics to latch on to.
The Netherlands also does not have a centralized health care organisation like the NHS. I think if we had, we would've been in deep trouble way before this report.
When it comes to the Dutch model, it is important to remember that medical treatment is available at an absolutely minimal amount of locations (I believe it's 3 or 4, and maybe I am even wrong there and it's just 2).
The diagnostic phase is contested by trans people who do not like the gatekeeping nature of it. But it is still very much a big pillar of the Dutch treatment model.
From what I know, additional mental health issues are not an exclusion-of-care-by-default kind of thing: the VUmC mostly wants a trans child to be receiving care for those additional mental health care situations and be considered stable.
This is at least what I have heard from the few trans children I have encountered (both students on a school where I was a guest speaker in an informational lesson on LGBTQIA+ education, telling about my coming-out story as a trans woman).
The skeptics in The Netherlands, like anti-trans extremist Jilles Smids (who was a reviewer for the US HHS report...) have been shifting the goalposts and have been showing that trans children simply need to die.
Jilles Smids started out attacking medical care (and praising Hilary Cass for the heroin she is in his eyes) and in 2025 attacked the psychosocial care (which according to him, prior to that piece was considered by him to be non-existent, tying into his wildly unproven claims of "rapid medicalisation"...).
Smids is one of the co-organisors of the anti-trans hate-conference in the Vrije Universiteit. The other organising person? Lodewijk Smeehuijzen.
Smids by the way has ties to the SEGM: he spoke at their Athens conference in 2025. He also showed up in the scientific judgement of the law proposal meant to ban conversion practices for minors in The Netherlands. In it, he laundered the term "Watchful waiting" and tied it to a piece of Dutch research by VUmC researchers, who actually mentioned in that piece that if medical outcomes are not the predetermining factor for a successful transition (as many trans people have said it should cease to be because of the reductionary approach that it is based on) then what should it be.
The piece actually stated that research has shown that watchful waiting leads to lower mental health.
In the case of the VUmC personnel by the way this term actually means: advising parents to hold back on socially transitioning and raising their child as gender neutral as possible, but not by default holding off on medical care due to...well anything co-morbidity-related.
But the way Smids talked about it, made it clear that he was actually signalling to Cass' her review, in which watchful waiting is used as "Make sure that we frustrate a request for care as long as possible so that a trans child is forced into endogenous puberty in the hopes of that it might drive them towards suicide, all while with each appointment at a psychologist belittling them, bullying them, denying their trans identity in the hopes of increasing their depression as the ultimate "See! They can't receive treatment, they are way to unstable!"
That is how the watchful waiting remark was laundered into the debate about this law proposal by former lawyer Marieke Wijen-Nass from the extreme-right/christo-fascist BBB (party that also opposes abortion care).
Marieke Wijen-Nass literally and openly asked for a change to this proposal so that driving trans children towards suicide remained a possibility...
When you read the original studies that the Dutch protocol was based around, you will find that mental health issues were not considered to be a flat-out ban there either. The basic requirement was "If someone is considered stable, has help for the other problems outside of our treatment facility, someone can still get the go-ahead".
I have yet to read the full report to know what is in it, but my guess is that the language used around mental health unfortunately does not stipulate well the high level of scrutiny (physical and mental) during GnRHa treatment. The same applies to adults by the way: I was allowed treatment while showing signs of depression and having an autism diagnosis.
The go-ahead was given because I was seeing treatment outside of the VUmC during the decision-making. For depression I was taking an anti-depressant (that I could quit about a month after starting a T-blocker only already!) and hormones made me feel even better.
Yes, I see that the centralization and gate keeping occurs at the clinical level after referral from the GP. Still a distinction between the U.S. and the Netherlands, but there is a commonality in private insurance (mandated for you?) and the GP as the first line of discussion.
That’s heartening. While the clinical specialization and controls may still be called out as a difference, there is more similarity in the basics of healthcare structure than I imagined. Thanks for clarifying that.
Oh, and thanks also for clarifying the point on accompanying or unrelated mental health issues. It seemed a very high bar to clear if only trans youth with pristine mental health could receive treatment. This makes more sense.
Healthcare insurance is mandatory here, and private care is practically unheard of. It's a thing for more common elective forms of treatment, of which transgender healthcare is not a thing.
With elective forms of treatment, you can think of plastic surgery, or if someone wants to have a US style yearly exam to make sure everything is OK. Those types of exams are not common here: you go to the doctor when you have pain in a joint, or are experiencing mental health issues, that kind of thing.
Some general practitioners doctors, when you are presenting with symptoms that do not point in a clear direction can be thorough and request broad bloodwork to be performed just to rule out something they might be overlooking based on your story (and sometimes, looking at your file being like "Ah, I see it's been 3 years since your last broad test...let's request a new broad image if your internal, physical health".
As for the similarity: it is mostly the tremendously long waiting lists along with the gatekeeping that trans people here are calling out. The reason merely being that it is akin to someone visiting their GP with a broken arm. But now, just like with gender incongruent feelings or questions about this, contrary to almost any other ailment, their GP knows nothing about this, and sends you off to a specialist. But not an orthopedic surgeon, but a psychologist who will determine whether or not you need to be believed about claiming you have a broken arm.
Some trans people are actively reaching out to general practitioners to inform them and better help them in the first-line of care.
Because the weird thing here is that if a child experiences precocious puberty, a general practitioner is often far from hesitant to administer them after an endocrinologist has performed the first several injections.
But as soon as it's a trans person, general practitioners can have a tendency to back off sometimes.
When it comes to the mental health issues: if anxiety, depression and other things were considered a flat out prohibition on care, we'd see virtually no trans children receiving care. With the ~100 year probably being a slightly higher number than it might actually be, the number is mostly limited by the gatekeeping model (which leads to long times between intake and treatment, and treatment at a psychologist and thus a spot in mental healthcare taking a long time as well) and the personnel shortage.
The rising levels of depression and anxiety are a thing here as well (unfortunately), due to the high levels of bullying through (social) media, the constant attacks on care and the existence of trans children.
With mental health an approach is taken that next to having received or receiving healthcare outside of the VUmC (or a different place offering medical care for trans children) the child is closely monitored. If the situation worsens upon initiation of the GnRHa's, sometimes an attempt is made to change the dosage. If that doesn't help, a consideration for starting hormones earlier can be weighed against our systems of major-age-minor assessment regulations (I suspect it's similar to Gillick and Frasier competence assessment but I am not sure, I've not heard it being referred to like this in Dutch healthcare).
The current treatment plan is to start hormones the year you turn 16 (previously: when having turned 16). GnRHa's, for as far as I know, have seen their age limit be dropped with researchers obviously stating the obvious: "A normal age for puberty starts when the body is programmed to do so. You can't put an age on that."
This is in response to WPATH guidelines, along with researchers also stating that in precocious puberty cases we don't make this distinction what so ever.
A trans boy I once met during the lessons, was severely depressed prior to GnRHa's. He was allowed to go on them. His depression got much better. Hormones made it disappear almost completely, to the point he himself now speaks more about somber moments.
That said: some comorbidities can be reason not to give you treatment, something I experienced back in 2011. I had just heard I would have to stick to a medically necessary diet for the rest after research showed I had an auto-immune disease and was obviously not very happy about this and it showed in the questionnaires I filled in.
Along with having no clear idea of what the female role would mean for me and how I would "fill in" that new role in life, I was diagnosed but did not receive treatment, and was advised to seek help outside the VUmC for mental health help on particularly this subject.
Looking back, I think that was a wise decision (even though the gender ward back then was absolutely rigid in it's thinking, and there was only a strictly binary option: you wanted hormones, but only if you were planning to go for surgery, there was no in-between choice possible).
I responded really strongly to hormones and I think going through that experience back then would've caused some severe issues honestly.
Slight addition: private care is basically for the rich/happy few. It's much more of a thing for celebrities, though in some cases, some celebrities have also opted to not go for private care, because they felt like being in a normal hospital can also provide a weird form of support for others going through the same thing.
“When it comes to the mental health issues: if anxiety, depression and other things were considered a flat out prohibition on care, we'd see virtually no trans children receiving care.”
This is my anecdotal experience as well. The baseline for most kids is troubling enough before you add the stress of being a member of a numerically small and often misunderstood group. It’s hard to watch your child struggle with anxiety and suicidal thoughts but we are closer than ever as a family and are remaining patient with our inhospitable conditions.
So happy to hear good news, this is great and really puts me in a positive mood. I know we all expected these results, but it’s still nice to have data confirming it. Thanks for reporting!!
Finally a country with the understanding this community has needed :
The Dutch spent two years studying gender-affirming care for transgender youth and reached a conclusion based on evidence—not political ideology or themes guided Cass Review. They found that this care is beneficial, medically necessary for many patients, and can significantly improve health and well-being.
That stands in stark contrast to the religious fearmongering, misinformation, and right-wing propaganda pushed in the United States. Science should guide healthcare—not politicians chasing headlines or culture wars. Transgender youth deserve evidence-based care, dignity, and compassion, not lies and political attacks.
Glad to see one of these national-level reviews where the officials listened to the bloody scientists for a change. Too bad it'll be ignored here in the Benighted States, just like it will be on TERF Island... but at least folks in the EU will have that much more protection.
The German-Swiss guideline publication back in May 2025 also saw a massive collection of experts, including people with the lived experience having participated in the review. It reserved 4 whole pages to completely destroy Cass, and even a Dutch "study" (methodologically flawed beyond repair) by Sarah Burke got absolutely annihilated by them, claiming: "The vagueness of the claims made including the broadness of the conclusions drawn from the problematically limited use of just 1 survey question made us declare that any scientific conclusion drawn from this study is to not be taken serious for it failing to meet scientific standards for rigor, precision and the intended population to be looked into. It is also important to realize that while the research makes far-reaching, unsupported claims about trans children, the research was not focused on them what so ever and uses the flawed term "gender non-contentedness", which in almost unanimous agreement of the experts in our board does not constitute a relation to gender dysphoria, nor gender-non-conforming behavior."
The Dutch study is good news, but unfortunately it isn’t going to change many minds on this side of the pond. The depth of hatred and bigotry that’s out there is profound, and it gets underestimated by a lot of people, including even some trans folks.
Someone I know who organized informational lessons on LGTBQIA+ people (oof the amount of knowledge that is lacking among middle and high school students is scary!) in my own city, said to have no problems with the political views of the fascist FvD party... A party that has openly called trans children serial pedosexuals, rapists, called for their doctors to be imprisoned, uses the anti-Jewish big-pharma conspiracy theory to claim that there's a "whole mass-industry behind forcing children into transition".
I just could not get it through to her that when she claimed "that people individually are not like that" that my response to that was "But it's their party line that is!"
It was like watching someone having entered an alternate universe without me being aware or something, I could not understand it at all.
And yep, I also experienced a trans person (The person from the lessons is not trans) regurgitating some of the FvD stuff...
Thank You, Erin! "Shine a light in the darkness," definitely rings true with your bringing this news to a weary U.S.. Now to continue the work to keep the established governing power in the U.S. from letting the Truth light the way for all of us.
This makes me so happy to see! We moved to The Netherlands to protect our trans daughter from the harmful policies Trump and company were pushing
Congratulations, Joe and give your daughter a hug for me. Here's to different, more healthy cultures. If you haven't seen this, it's a good overview: https://transrightsmap.tgeu.org/map
So did we. 2 weeks ago.
Joe and JD, I’m queer-identified and trans and moved to the Netherlands from California a year ago. I live between Leiden and The Hague and am finding it challenging to form friendships and community. Any chance you’re not too far away?
No offense, but as a Dutch person and the many American tourists I have encountered who consider a 2 hour drive to "not be far away" I doubt it will be a lot, distance-wise :P .
I’m delighted to live in a country where I can get by fairly well even as an elder without owing a car! I walk a lot, have an e-bike, and for longer distances, I love the trains and buses!
Given you mention the trains and buses, I assume you live in what we call the Randstad, where public transportation is often a very viable option...But outside of it...ehm, not so much :P .
You’re right!
And no offense taken! :)
I get what you mean but from the reverse perspective. I've encountered a number of visitors from Europe to the US who have no freaking idea how big the place is. Figure that the Netherlands is a bit less than twice the size of New Jersey and you can sense how in context a two-hour drive doesn't seem a huge deal. :-)
While it is comforting to read for me as a Dutch person that The Netherlands feels more safe (even though it should not be like this), please be on the lookout.
We have 10-12 parties who are openly anti-trans, in open and sometimes less open ways. That's a majority in the House. 2 Of these parties (CDA and VVD) are coalition parties now.
The rest is: BBB, PVV, SGP, CU, JA21, FvD, Lid Mona Keijzer (she is particularly vile and hostile towards trans people, especially on Twitter...), Groep DNA, and DENK. Denk unfortunately does not understand intersectionality: they decry discrimination when it's muslim people, but happily side with the extreme-right when another group is apparently "required" to be discriminated. Denk is primarly terrified of the Grey Wolves of Erdogan, the dictator of Turkey.
CDA already took off it's mask of reasonable Christians during the campaign in 2025 and right after and has been moving more extreme-right, shown by (including other things) their anti-trans vote at the 18th of December 2025 when they voted against democracy for trans people and trans children. Their stance on the law change proposal that was brought in for discussion (self-ID law change) was not completely new, because they have been using some absolutely vile and disgusting language to oppose it back in 2022.
The VVD is openly pro-fascist: on a Trumpian motion brought in by the extreme-right to christo-fascist BBB to "declare anti-fa illegal", they voted "yes".
VVD, in the past has been dwelling with Hilary Cass' her report, and was annoyed with the fact the healthcare for trans children didn't see a radical reform within 6 months!
Caution and alertness are always advisable, here perhaps more than other areas. Thanks for the info.
More evidence to support the thing that we've already known. At the same time as the US is working to undermine WPATH and healthcare across this spectrum of need, it's good to see more impartial data to deter their onslaught of bias, misinformation, and lies.
And just like that, the 'phobic child abusers have to quit claiming, "all the Europeans are stopping it [GAC for youth] even the Dutch have stopped the Dutch protiocol!"
Thank you Erin for making my week.
This is outstanding news!!! Hooray for the Netherlands and for al the fine work of the people on that nation's Health Council who did such a well researched and comprehensive study.
Thanks, Erin, for your great work and dedication to keeping us informed.
I’m sure we’re all shocked.
The repudiation of the Cass Review is particularly interesting. It was embraced enthusiastically by “moderate” groups who wanted a pretext to justify their abandonment of politically inconvenient trans Americans. I’m sure this will be reported just as as widely and factually. /sarc
I’d love to know what Hilary Cass’s participation consisted of…
Probably asking her what her views on this are and aligning it with the international guideline. "Oh, she deviates heavily from it, yep, ignore her."
That said: Cass has been making the case in UK parliament or something that resembles it (I do not understand the UK's political system well) for an 11 year old trans child to go on puberty blockers...
I have yet to look through the report to see if Cass' deliberations are public anywhere in it, or if they are kept confidential.
If they are kept confidential, given her backpedalling on her own report, I would not be surprised that in the safety of confidentiality she suddenly turned.
That said: it is, to me, quite worrying that they also decided to listen to Cass, just as anti-trans extremist Lodewijk Smeehuizen, a law-professor was allowed to write an informative response to the expert group. Lodewijk Smeehuizen penned a piece in the Nederlands Juristenblad back in November or December 2025 where he tried to portray himself as this medical expert who suddenly became an endocrinologist, defended Cass uncritically, repeated Baxendale's lies about the supposed dangers of GnRHa's, claimed trans boys were overrepresented (these are old numbers of which it was shown back in 2022 already that the numbers have now been equal).
So, I’ve done more digging since yesterday. This is my layperson’s take, so grain of salt and all that.
It sounds as if Cass was interviewed as a more ‘conservative’ perspective on the subject. I imagine it would be impolitic to completely ignore the most recent and notorious review on gender affirming care for minors and it does increase the rigor of the exercise to include a spectrum of opinion.
I think the most critical refutation of Cass is regarding the lack of long term studies being an impediment to treatment. As this review points out, that is not uncommon across pediatric care, and highlighting it in the affirmative care space seems tendentious at best.
If there is a less exuberant takeaway from this review, it is that the Dutch model is highly controlled and centralized in comparison to even other nationalized health services. My instinct is that Cass and other skeptics (not to mention the outright hostile parties) will fall back on claims that their concern is less about care and efficacy and more about the inadequacy of NHS/[your country’s health service here] when compared against the Netherlands. “We can’t possibly match this unparalleled course of treatment!”
As a U.S. citizen this is only exacerbated. We have no centralized health care service to develop and impose firm standards of care or to track patient outcomes over time. The Dutch model features rigorous intake, a clear hierarchy of decision-making, and control of patient data over time. It’s no wonder they can say with great confidence that their regret rate is almost non-existent. U.S. care is incredibly fragmented, with the transfer of medical history equally so. I believe the reports that regret rates here are also very low, but the patchwork and somewhat erratic nature of our system exposes it to bad faith claims.
One thing I found particularly interesting about Dutch care is that minors with additional mental health issues are not allowed to proceed with care until that condition is mitigated? This runs counter to U.S. care, where comorbidity is reasonably common. Anxiety and depression are irrefutably on the rise among U.S. teens, and my experience is that this is only heightened among trans youth (including mine). I clearly need to get more detail on this, as I can see it being another point of distinction for skeptics to latch on to.
The Netherlands also does not have a centralized health care organisation like the NHS. I think if we had, we would've been in deep trouble way before this report.
When it comes to the Dutch model, it is important to remember that medical treatment is available at an absolutely minimal amount of locations (I believe it's 3 or 4, and maybe I am even wrong there and it's just 2).
The diagnostic phase is contested by trans people who do not like the gatekeeping nature of it. But it is still very much a big pillar of the Dutch treatment model.
From what I know, additional mental health issues are not an exclusion-of-care-by-default kind of thing: the VUmC mostly wants a trans child to be receiving care for those additional mental health care situations and be considered stable.
This is at least what I have heard from the few trans children I have encountered (both students on a school where I was a guest speaker in an informational lesson on LGBTQIA+ education, telling about my coming-out story as a trans woman).
The skeptics in The Netherlands, like anti-trans extremist Jilles Smids (who was a reviewer for the US HHS report...) have been shifting the goalposts and have been showing that trans children simply need to die.
Jilles Smids started out attacking medical care (and praising Hilary Cass for the heroin she is in his eyes) and in 2025 attacked the psychosocial care (which according to him, prior to that piece was considered by him to be non-existent, tying into his wildly unproven claims of "rapid medicalisation"...).
Smids is one of the co-organisors of the anti-trans hate-conference in the Vrije Universiteit. The other organising person? Lodewijk Smeehuijzen.
Smids by the way has ties to the SEGM: he spoke at their Athens conference in 2025. He also showed up in the scientific judgement of the law proposal meant to ban conversion practices for minors in The Netherlands. In it, he laundered the term "Watchful waiting" and tied it to a piece of Dutch research by VUmC researchers, who actually mentioned in that piece that if medical outcomes are not the predetermining factor for a successful transition (as many trans people have said it should cease to be because of the reductionary approach that it is based on) then what should it be.
The piece actually stated that research has shown that watchful waiting leads to lower mental health.
In the case of the VUmC personnel by the way this term actually means: advising parents to hold back on socially transitioning and raising their child as gender neutral as possible, but not by default holding off on medical care due to...well anything co-morbidity-related.
But the way Smids talked about it, made it clear that he was actually signalling to Cass' her review, in which watchful waiting is used as "Make sure that we frustrate a request for care as long as possible so that a trans child is forced into endogenous puberty in the hopes of that it might drive them towards suicide, all while with each appointment at a psychologist belittling them, bullying them, denying their trans identity in the hopes of increasing their depression as the ultimate "See! They can't receive treatment, they are way to unstable!"
That is how the watchful waiting remark was laundered into the debate about this law proposal by former lawyer Marieke Wijen-Nass from the extreme-right/christo-fascist BBB (party that also opposes abortion care).
Marieke Wijen-Nass literally and openly asked for a change to this proposal so that driving trans children towards suicide remained a possibility...
When you read the original studies that the Dutch protocol was based around, you will find that mental health issues were not considered to be a flat-out ban there either. The basic requirement was "If someone is considered stable, has help for the other problems outside of our treatment facility, someone can still get the go-ahead".
I have yet to read the full report to know what is in it, but my guess is that the language used around mental health unfortunately does not stipulate well the high level of scrutiny (physical and mental) during GnRHa treatment. The same applies to adults by the way: I was allowed treatment while showing signs of depression and having an autism diagnosis.
The go-ahead was given because I was seeing treatment outside of the VUmC during the decision-making. For depression I was taking an anti-depressant (that I could quit about a month after starting a T-blocker only already!) and hormones made me feel even better.
Yes, I see that the centralization and gate keeping occurs at the clinical level after referral from the GP. Still a distinction between the U.S. and the Netherlands, but there is a commonality in private insurance (mandated for you?) and the GP as the first line of discussion.
That’s heartening. While the clinical specialization and controls may still be called out as a difference, there is more similarity in the basics of healthcare structure than I imagined. Thanks for clarifying that.
Oh, and thanks also for clarifying the point on accompanying or unrelated mental health issues. It seemed a very high bar to clear if only trans youth with pristine mental health could receive treatment. This makes more sense.
Healthcare insurance is mandatory here, and private care is practically unheard of. It's a thing for more common elective forms of treatment, of which transgender healthcare is not a thing.
With elective forms of treatment, you can think of plastic surgery, or if someone wants to have a US style yearly exam to make sure everything is OK. Those types of exams are not common here: you go to the doctor when you have pain in a joint, or are experiencing mental health issues, that kind of thing.
Some general practitioners doctors, when you are presenting with symptoms that do not point in a clear direction can be thorough and request broad bloodwork to be performed just to rule out something they might be overlooking based on your story (and sometimes, looking at your file being like "Ah, I see it's been 3 years since your last broad test...let's request a new broad image if your internal, physical health".
As for the similarity: it is mostly the tremendously long waiting lists along with the gatekeeping that trans people here are calling out. The reason merely being that it is akin to someone visiting their GP with a broken arm. But now, just like with gender incongruent feelings or questions about this, contrary to almost any other ailment, their GP knows nothing about this, and sends you off to a specialist. But not an orthopedic surgeon, but a psychologist who will determine whether or not you need to be believed about claiming you have a broken arm.
Some trans people are actively reaching out to general practitioners to inform them and better help them in the first-line of care.
Because the weird thing here is that if a child experiences precocious puberty, a general practitioner is often far from hesitant to administer them after an endocrinologist has performed the first several injections.
But as soon as it's a trans person, general practitioners can have a tendency to back off sometimes.
When it comes to the mental health issues: if anxiety, depression and other things were considered a flat out prohibition on care, we'd see virtually no trans children receiving care. With the ~100 year probably being a slightly higher number than it might actually be, the number is mostly limited by the gatekeeping model (which leads to long times between intake and treatment, and treatment at a psychologist and thus a spot in mental healthcare taking a long time as well) and the personnel shortage.
The rising levels of depression and anxiety are a thing here as well (unfortunately), due to the high levels of bullying through (social) media, the constant attacks on care and the existence of trans children.
With mental health an approach is taken that next to having received or receiving healthcare outside of the VUmC (or a different place offering medical care for trans children) the child is closely monitored. If the situation worsens upon initiation of the GnRHa's, sometimes an attempt is made to change the dosage. If that doesn't help, a consideration for starting hormones earlier can be weighed against our systems of major-age-minor assessment regulations (I suspect it's similar to Gillick and Frasier competence assessment but I am not sure, I've not heard it being referred to like this in Dutch healthcare).
The current treatment plan is to start hormones the year you turn 16 (previously: when having turned 16). GnRHa's, for as far as I know, have seen their age limit be dropped with researchers obviously stating the obvious: "A normal age for puberty starts when the body is programmed to do so. You can't put an age on that."
This is in response to WPATH guidelines, along with researchers also stating that in precocious puberty cases we don't make this distinction what so ever.
A trans boy I once met during the lessons, was severely depressed prior to GnRHa's. He was allowed to go on them. His depression got much better. Hormones made it disappear almost completely, to the point he himself now speaks more about somber moments.
That said: some comorbidities can be reason not to give you treatment, something I experienced back in 2011. I had just heard I would have to stick to a medically necessary diet for the rest after research showed I had an auto-immune disease and was obviously not very happy about this and it showed in the questionnaires I filled in.
Along with having no clear idea of what the female role would mean for me and how I would "fill in" that new role in life, I was diagnosed but did not receive treatment, and was advised to seek help outside the VUmC for mental health help on particularly this subject.
Looking back, I think that was a wise decision (even though the gender ward back then was absolutely rigid in it's thinking, and there was only a strictly binary option: you wanted hormones, but only if you were planning to go for surgery, there was no in-between choice possible).
I responded really strongly to hormones and I think going through that experience back then would've caused some severe issues honestly.
Slight addition: private care is basically for the rich/happy few. It's much more of a thing for celebrities, though in some cases, some celebrities have also opted to not go for private care, because they felt like being in a normal hospital can also provide a weird form of support for others going through the same thing.
“When it comes to the mental health issues: if anxiety, depression and other things were considered a flat out prohibition on care, we'd see virtually no trans children receiving care.”
This is my anecdotal experience as well. The baseline for most kids is troubling enough before you add the stress of being a member of a numerically small and often misunderstood group. It’s hard to watch your child struggle with anxiety and suicidal thoughts but we are closer than ever as a family and are remaining patient with our inhospitable conditions.
So happy to hear good news, this is great and really puts me in a positive mood. I know we all expected these results, but it’s still nice to have data confirming it. Thanks for reporting!!
Not to be repetitive, but... Thanks Erin! I'll take all the good news I can get!
Dank je wel for some good news! Good on the Netherlands not being intimidated by Anglo-American propaganda and vitriol.
Finally a country with the understanding this community has needed :
The Dutch spent two years studying gender-affirming care for transgender youth and reached a conclusion based on evidence—not political ideology or themes guided Cass Review. They found that this care is beneficial, medically necessary for many patients, and can significantly improve health and well-being.
That stands in stark contrast to the religious fearmongering, misinformation, and right-wing propaganda pushed in the United States. Science should guide healthcare—not politicians chasing headlines or culture wars. Transgender youth deserve evidence-based care, dignity, and compassion, not lies and political attacks.
Thank you for the good news!
Great news! Thank you, Erin!
Sweet!!!
Glad to see one of these national-level reviews where the officials listened to the bloody scientists for a change. Too bad it'll be ignored here in the Benighted States, just like it will be on TERF Island... but at least folks in the EU will have that much more protection.
The German-Swiss guideline publication back in May 2025 also saw a massive collection of experts, including people with the lived experience having participated in the review. It reserved 4 whole pages to completely destroy Cass, and even a Dutch "study" (methodologically flawed beyond repair) by Sarah Burke got absolutely annihilated by them, claiming: "The vagueness of the claims made including the broadness of the conclusions drawn from the problematically limited use of just 1 survey question made us declare that any scientific conclusion drawn from this study is to not be taken serious for it failing to meet scientific standards for rigor, precision and the intended population to be looked into. It is also important to realize that while the research makes far-reaching, unsupported claims about trans children, the research was not focused on them what so ever and uses the flawed term "gender non-contentedness", which in almost unanimous agreement of the experts in our board does not constitute a relation to gender dysphoria, nor gender-non-conforming behavior."
The Dutch study is good news, but unfortunately it isn’t going to change many minds on this side of the pond. The depth of hatred and bigotry that’s out there is profound, and it gets underestimated by a lot of people, including even some trans folks.
Someone I know who organized informational lessons on LGTBQIA+ people (oof the amount of knowledge that is lacking among middle and high school students is scary!) in my own city, said to have no problems with the political views of the fascist FvD party... A party that has openly called trans children serial pedosexuals, rapists, called for their doctors to be imprisoned, uses the anti-Jewish big-pharma conspiracy theory to claim that there's a "whole mass-industry behind forcing children into transition".
I just could not get it through to her that when she claimed "that people individually are not like that" that my response to that was "But it's their party line that is!"
It was like watching someone having entered an alternate universe without me being aware or something, I could not understand it at all.
And yep, I also experienced a trans person (The person from the lessons is not trans) regurgitating some of the FvD stuff...
Thank You, Erin! "Shine a light in the darkness," definitely rings true with your bringing this news to a weary U.S.. Now to continue the work to keep the established governing power in the U.S. from letting the Truth light the way for all of us.