The Dutch Model is falling apart

Finally. the Dutch are speaking up. The country that recklessly decided that it was a good idea to offer experimental treatment to healthy young teens that blocked all sexual development is at long last starting to take notice of the profound flaws involved in this aggressive and invasive treatment. The decision of the well-respected Dutch newspaper NRC to publish a scathing critique of the so-called “Dutch protocol” and, by extension, “gender-affirming care” in general, heralds the beginning of the end of the extraordinarily authoritarian notion that clinicians should offer treatment that irreversibly alters a child’s future sex life and impairs their future ability to have children.

In this ground-breaking article, journalist Jan Kuitenbrouwer and retired academic Peter Vasterman make the case for independent research and offer a welcome exposé into the many flaws pertaining to experimental medical treatment for gender-distressed children. The problems with these medical treatments, developed in the Dutch gender clinic a couple of decades ago, mostly developed so that the teenagers could look more like the opposite sex and didn’t feel stressed by their sexual development, are now becoming very apparent as a result of the media attention given to the rising number of young detransitioners all across the world. With over 43,000 members on Reddit/detrans, no longer can informed clinicians pretend that detransition is “vanishingly rare”. The truth is that the clinicians have no idea how many detransitioners there are – detransitioners tend to avoid these clinics as they often view them as the scene of the attack. Studies that seek to ascertain satisfaction levels post-transition record extremely high numbers of participants who are “lost-to-follow-up”. It’s all a shameful and shoddy mess.

Up until 2010 the Dutch clinic was like other gender clinics around the world, a largely unknown medical centre that treated an average of 200 patients per year, among them were roughly 60 children and young people. Then, reflecting trends all over the western world, a startling uptick began, and by around 2013, the numbers had suddenly doubled and continued to increase rapidly.  Now in 2022, there are more than 5,000 people in treatment – 1,600 of which are minors, and almost 6,000 people on the waiting list for treatment.

The 2006 Dutch study which first outlined the approach which became known as the “Dutch protocol” was sponsored by Ferring pharmaceuticals, who marketed Triptorelin- a puberty blocker (the millions of dollars of profits involved in this industry have yet to be officially documented). As the numbers were initially very small, few took notice of this niche market, however as the numbers began to grow, sharp-eyed women noticed the issues related to blocking children’s sexual development- and pioneering organisations  4^th Wave Now and Transgender Trend decried these life-changing medical interventions on highly vulnerable children.

4th Wave Now, 2016:

Transgender Trend, 2018:

According to the “Dutch protocol”,  in order to be eligible for puberty blockers, children subjected to these irreversible treatments must have gender dysphoria from an early age and experience a significant dip in the mood at the start of puberty. The Dutch also decreed that the patients need to be psychologically stable and have access to emotional support. However, this is not how it has played out. Instead, a brand new cohort has emerged, and these young teens, usually female, often autistic, and almost always very vulnerable, have created a huge and unexpected demand in gender clinics all over the world. 

Until now, the Dutch seemed proud of their pioneering treatment, despite the fact that there is no long-term evidence base to support it. For the first time, with this article, the Dutch are engaging in some self-reflection on their harmful and astonishingly heavy-handed approach. Kuitenbrouwer and Vasterman point out that “what we are seeing now is an entirely new type of patient…They often do not present until puberty has already started, and they often have no history of gender dysphoria. It is not a disorder, but an ‘identity’. Many have additional psychological issues – as a result of their gender dysphoria, or the cause?”

Trans organizations say the exponential growth in kids wanting to transition, which started around 2013, is explained by increased societal awareness and acceptance of gender diversity, however, the Dutch reporters wonder, “Is it a coincidence that this explosion coincided with the spectacular growth of social media?” Other analysts point to influencing factors such as social contagion and social media influencers.

The Dutch continue: “Following extensive scientific evaluations of the treatments, health authorities in Sweden, Finland and UK have decided to emphasize psychological treatment in children and to prescribe puberty blockers only in very severe cases or, as in Florida, to stop prescribing them completely.” These countries, following critical analysis on the horrible fallout on young people who were subject to the “14-16-18” age recommendations for puberty blockers, cross-sex hormones and surgical interventions respectively, and then lived to regret it and subsequently detransitioned, have reviewed their guidance and now favour conventional psychotherapy rather than medical treatment for gender-distressed young people.

“According to the Swedish review (2021), the available data are not sufficient to properly assess the effects on gender dysphoria, psychosocial conditions, cognitive functioning, and physical health. ’The risks currently outweigh the possible benefits,’ says the Swedish health authority. The Finnish report (2020) comes to a similar conclusion, as does the British ‘Cass Review’ (2022). The leading British pediatrician Hilary Cass condemned the British application of the Dutch protocol and, based on her report, the Tavistock gender clinic, the largest in the world, was immediately closed.”

The harm that the Dutch protocol has unleashed upon the world is becoming increasingly recognized. In their article, Kuitenbrouwer and Vasterman recognize the reality: “puberty blockers are not a ‘pause button’ but a self-fulfilling prophecy. Almost all treated children move from puberty blockers to cross-sex hormones at 16. In practice, puberty blockers do not appear to be a pause button for reflection, but the start button for transition.”

“More and more is becoming known about the long-term side effects of puberty blockers. They interfere with physical sexual development, hinder the development of the bones, can cause anorgasmia and infertility and interfere with the ability to make rational decisions.”

“The scientific substantiation of the Dutch protocol also appears to be rather shaky. Almost all publications that the Dutch gender clinic relies upon originate from its own practitioners. Where is the confirmation from outside researchers?”

Indeed.

Kuitenbrouwer and Vasterman evidently have done their research and have found the massive flaws involved. “The research that is always cited is that of child psychiatrist Annelou de Vries and the Amsterdam gender team, published in 2011 and 2014 . The results show that the 55 children treated first with puberty blockers and then with hormones reported positive results a year and a half after surgery.”

While positive results for young people eighteen months after irreversible treatment should certainly be noted, the decision not to offer regular follow-ups on these 55 participants is extraordinary to the point of suspicious. These studies are the entire reason why thousands of children all across the world have had their sexual development blocked in a bid to help them medically transition, among zealous trans lobby groups, these studies are considered the gold standard – and yet an examination of the results quickly raises eyebrows among seasoned researchers.

Our interview with de Vries and Steensma, on Gender: A Wider Lens revealed strange anomalies in this study. The study began with 70 participants in 2011, and 15 were excluded from the follow-up study in 2014 for reasons such as diabetes and obesity. Why is there no research available to show what happened to these 15 participants? 

One of the participants tragically died as a result of what is now called “gender-affirming” surgery – why did this not put an immediate end to this terrible experiment on children?

Why did the researchers switch the questionnaires post-transition – so that biological girls received a questionnaire for boys and vice-versa – and thereby ruin any credible analysis of their efficacy as a treatment for gender dysphoria? 

The Dutch studies were certainly inventive, but it is amazing that they have ever been considered a model to emulate.

The Dutch journalists note other issues in the research; “This research has since been put through the wringer in numerous publications, not only because of the lack of a control group and a random sample (from the total of 196 children treated), but also because of the use of incomparable questionnaires. Conclusion: this is not a sound evidence base.”

“To date, De Vries results have not been replicated. An attempt by a research team at the Tavistock clinic failed, with the results disappearing in a desk drawer . Only recently were they released by order of the British court.”

“And if this treatment has such a solid scientific basis, why did De Vries recently receive an NWO grant for a five-year study into the “missing evidence base ”? Has irreversible, life-changing treatment been carried out on De Boelelaan in Amsterdam for more than twenty years without an ‘evidence base ‘?”

Yes, sadly, and almost unbelievably, it has.

“The Dutch trans clinicians stick their heads in the sand. At her installation recently as professor of Gender and Sex Variations at the Amsterdam UMC, Baudewijntje Kreukels accused critics of being ‘opponents of […] transgender care’ and that opinions are more important than scientific findings. What you call gossip. It is precisely the existing transgender care that would benefit from less wishful thinking and more science. The [critics] are stirring precisely because they are in favor of transgender care. But responsible, proven care.”

“The Netherlands has long been a guiding country in this respect. That status creates obligations. Before the capacity of Dutch trans health care is drastically expanded, the existing health care must be critically and independently evaluated. All reasons for the Health and Youth Care Inspectorate to take action.”

Finally, the truth of the Dutch mess is being revealed, and we give thanks to journalist Jan Kuitenbrouwer, sociologist Peter Vasterman and NRC for exposing the rot at the heart of this harmful and experimental treatment.

Suggested additional reading:

• The Dutch Protocol for Juvenile Transsexuals: Origins and Evidence Michael Biggs (2022)
• Gender: A Wider Lens podcast  An interview with the Dutch clinicians, Thomas Steensma and Annelou de Vries