Three decades of ‘Dutch Protocol’ research has not produced reliable evidence

Abstract

In ‘The Dutch Approach for Transgender Adolescents; Past, Present and Future Perspectives,’ clinicians and researchers from the Center of Expertise on Gender Dysphoria (CEGD) look back at three decades of CEGD research and conclude that, on the basis of these studies, they can now have ‘far more confidence’ in providing puberty blockers, cross-sex hormones, and surgeries to minors with gender dysphoria than they did in the late 1990s, when the treatment paradigm was first proposed. CEGD has indeed produced many important research papers, but none of these are the result of methodologically robust study designs. Independent researchers and methodologists who have conducted high-quality systematic reviews and meta-analyses have all concluded that the evidence base in this field is weak. This includes the CEGD studies. While it is unclear what effects these interventions may have on mental health outcomes, we know that they can cause infertility and are associated with other significant health risks. Therefore, it is concerning that, in 2026, leading clinicians and researchers at CEGD express more confidence in the Dutch approach, when the appropriate response to the many systematic reviews published over the past 6 years would be less confidence in its effectiveness and, consequently, greater clinical caution.