#dutch protocol

By: Maia Poet

Published: Apr 11, 2025

When I began to find myself swimming in a sea of trans content at the age of 12 in 2012, one of the first stories of "trans kids" I saw was the story of Jazz Jennings. I watched grainy, low-quality footage from his 2007 special. Even though Jazz is only one year younger than me, I thought he was much younger—because I was seeing him at six years old when I was already 12. It didn’t occur to me until months later, when I saw one of his more recent media appearances, that I had been watching a video from five years ago. That was my level of life perspective at the age when I declared my trans identity— I didn’t understand that the change in video image quality was a sign of how old the video was. When I realized that Jazz was around my age, I was stunned.

From there, I consumed every video I could find about "trans kids." There were only a handful of documentaries and talk show appearances. Once I’d exhausted those, I moved on to watching content created by adult transitioners. I began studying the intricacies of hormonal and surgical “sex change.” I watched hours of footage of women ten years older than me binding their breasts, and vlogging about ‘top surgeries’. Within two years, many of them had full beards and were talking about their mastectomies the way I talked about going to the trampoline park with my family— as a joyous, gravity-defying liberation of the Self.

When I finally got my own phone and was old enough to make a Facebook account, I even messaged a few of these adult women whose gender transitions I had watched play out over the course of my adolescence. If I had more understanding of how the world works, I would have known that I could have lied about my age to get onto the platform earlier. I was that naive. In retrospect, as a young adult myself I’ll never understand why those adult transitioners chose to respond to the messages sent to them by a 14-year-old. But that’s beside the point.

The point is, that as a pre-teen, I became so obsessed with understanding this phenomenon that by my early adolescence I memorized all of the information available to me online at the time. And because I already had a habit of being an elementary-aged kid who read parenting books and researched niche medical conditions, it was easy for me to convince myself that I, too, was a "trans kid" who in the absence of experimental medical treatments, would very well die.

Far before most people had even heard of this issue—and long before it became a teenage identity trend—I knew almost everything there was to know about transgenderism. It’s odd now to see adults twice my age acting as though this phenomenon came out of nowhere. I didn’t just see it coming. As a 12 year old who adopted a trans identity in 2012, I predicted it. I grew up immersed in all things ‘trans’. I watched this phenomenon morph in real-time from the narrative of old-school transsexualism into the invention of the "transgender child," and finally as it pervaded into the dominant youth culture of my ‘non-binary’ generation.

Many times during my detransition journey, I’ve asked myself the same haunting question: Where was everyone when Jazz Jennings got castrated?

In order to answer this question, I will publish this piece in two parts. Part one will focus on the ways in which mainstream media and medical authorities partnered to create the “transgender child” within the Western collective consciousness. Part two will focus on how collective shifts within parenting trends and attitudes about child-rearing amongst middle and upper middle class families, in combination with rapid shifts in the availability of internet-connected technologies— created a perfect storm of factors which culminated in the ‘transgender tipping point’.

I hope these papers will inform the public about how trans issues have gone from an unknown obscure topic, to the subject of a raging culture war— seemingly in the blink of an eye. I believe that trying to dissect the culture itself through the case study of Jazz Jennings, readers will come away from these essays with a greater understanding of the complex sociocultural and medical underpinnings of today’s trans phenomenon. After reading this paper, let me know how I’ve done!

The Jazz Jennings Phenomenon

[ Barbra Walters interviewed six year old Jazz Jennings in 2007. The “trans kid” narrative had just been born. ]

In 2007, America was introduced to the story of Jazz Jennings, a six-year-old boy from Florida whose parents had decided to raise him as a girl and share his story publicly. Cameras followed Jazz and his family as he grew up, chronicling his transition for an audience captivated by what was presented as a courageous and heartwarming journey of self-discovery.

But beneath the uplifting narrative was a far more troubling reality. At age 11, Jazz was chemically castrated to halt his male puberty. In high school, he was prescribed cross-sex hormones, which, when paired with early puberty suppression, rendered him permanently sterile. By 14, he was the star of the reality show I Am Jazz. In 2018, at age 17, the cameras followed him, hugging a teddy bear, into the operating room as surgeons attempted to construct a simulacrum of female genitalia from his underdeveloped male anatomy—an operation so experimental that multiple follow-up surgeries were needed to address serious complications.

[ 17 year old Jazz held a teddy bear as he waited to be wheeled into the operating room for his penile inversion procedure, aged 17. ]

Despite the fact that every stage of this boy’s process of being indoctrinated, exploited and maimed—was filmed and broadcast for national and international audiences, widespread concern over what was happening to Jazz did not surface until about 2021—far too late to intervene or prevent the damage. With millions watching I Am Jazz, no prominent voice broke through the mainstream media to question what was unfolding before America’s very eyes.

So again we must ask: Where was everyone when Jazz Jennings got castrated?

The Creation of the “Transgender Child” Was Televised.

The short answer is that we were all sold a story. We were led to believe in the existence of a new category of person—the “transgender child.” Most Americans were familiar with the concept of a transsexual, which in the schema of the 2000’s-era adult, was either a gay drag queen who “took the next step” or a middle-aged, married crossdresser with a wife and kids. The transsexual wasn’t an adult female on testosterone. The transsexual certainly wasn’t a child. 

Jazz’s case was the first to introduce this idea to the English-speaking world, featured prominently on 20/20 with Barbara Walters. His parents claimed they had always known Jazz was “different”—even pointing to behavior as early as 15 months old, like unsnapping his onesie, as evidence of a cross-gender identity. Unlike Jazz’s older twin brothers, Jazz did not grow out of his ‘girly’ phase by the time he was a pre-schooler. He continued to be a gentle boy, not a rough and tumble one. So, his parents decided to see an “expert” gender therapist in 2003— while the child was probably still in diapers.

The documentary featuring Jazz Jennings, alongside a few other “trans kids” called My Secret Self presented gender dysphoria as an innate, intractable condition detectable in small children and treatable with a medical protocol we today know was imported from the Netherlands. While it acknowledged the experimental nature of these treatments, this fact was easily obscured by the narrative that without such extreme, irreversible interventions being done on young children- that these children were doomed to end their lives. Viewers were reassured: no permanent changes would occur until Jazz was older and better equipped to make informed decisions.

But this was a lie of omission. Social transition in childhood, especially when paired with puberty blockers, is not a neutral intervention—it entrenches a cross-sex identity and all but guarantees progression to cross-sex hormones. We now know that over 98% of children who begin puberty blockers proceed to further medical transition.

The idea that blockers merely “buy time” has been thoroughly debunked– but only after a generation of children were sacrificed. What’s even worse, is that the Dutch clinicians who created this child transition treatment protocol, themselves advised against the early full social transition of a child prior to the early stages of puberty.

A Story That Subverted Our Common Sense

[ Jazz instilling his childhood passion of creating mermaid tails into another little boy whose parents are raising him as a girl ]

Jazz’s story was compelling because he was photogenic and looked feminine: he had long hair, princess dresses, a love for Disney songs and mermaids. His mother even speculated that Jazz’s love of mermaids was related to their lack of genitalia—a theory she picked up from other parents of gender-nonconforming boys on internet forums. But many kids, both boys and girls, in the early 2000s loved mermaids because of The Little Mermaid. It wasn’t because of a pathology. It was a trend.

This shows a broader trend of how the parents of “trans kids” have a tendency of scrutinizing their child’s every behavior as evidence of some problem just itching to be solved. They are superimposing their own adult analysis onto a child’s behaviors, in order to derive meaning from them. 

An adult who has tons of kids and is working multiple jobs to support them wouldn’t fixate so much on which fictitious character their child is obsessed with– nor would they have the time to construct an elaborate fairytale about why the kid wants to become that thing. But if you’re like Jazz’s parents, who are wealthy enough to have four kids living in a big house, who were really on the cutting edge of child-centered parenting, and who happened to have a kid who was very gender non-conforming– you’ve got yourself a perfect storm to find yourself as the parent of a “trans kid.”

Many young boys go through phases of dressing up as princesses. In Jazz’s case, what might have been a passing interest, or one that evolved into a career in dance, theater or fashion design— became a diagnosis. His parents, like many of those who now champion their young “trans kids,” were not initially ideologues. Most began as concerned, bewildered, or overwhelmed—struggling to soothe their distressed child and feeling inadequate in the face of it.

In today’s climate, these parents are swiftly ushered into the world of gender medicine. Pediatricians refer them to gender clinics, where experts frame early social transition as harmless and reversible. The same experts falsely claim that puberty blockers are reversible interventions which “pause” development so a child can consider whether they wish to proceed to cross-sex hormones, and that blocking healthy puberty in its early stages is something which must be done urgently, as a form of suicide prevention. Out of love and fear, parents hand the reins to medical professionals—believing they’re doing what’s best for their child. Importantly, all of these life-changing psychosocial and medical interventions are framed as neutral, harmless opportunities for self-exploration. Even as a child’s puberty is being actively suppressed, parents are lead to believe that no permanent, life-altering decisions have been made yet. They are given a false illusion of having ‘more time’ to decide upon the future opportunities which will be available to their child, not understanding one basic truth:

The first permanent decision regarding a child’s gender transition is often made much earlier than parents realize. Social transition in early childhood initiates a path that almost always leads to medicalization. Puberty blockers interrupt natural developmental processes necessary for resolving gender distress. By the time cross-sex hormones are introduced, the child’s trajectory has already been firmly set for years.

How the Dutch Protocol Created the Market for Trans Children

[ Jazz Jennings and the doctors who removed his genitals ]

The widespread belief that pediatric transition was a response to an existing and urgent medical need ignores a crucial reality: the existence of medical interventions for children with gender dysphoria has itself created the demand for those very interventions. The Dutch Protocol, which introduced the use of puberty blockers followed by cross-sex hormones in carefully selected adolescent patients, did not emerge in response to a large population of children begging for medical transition. Rather, it introduced an entirely new treatment pathway that shaped how gender dysphoria was understood and managed—one that was soon exported across the Western world.

Developed in the Netherlands in the early 1990s, the Dutch Protocol was initially presented as a compassionate innovation for a small group of carefully screened adolescents whose gender dysphoria was severe, persistent, and began in early childhood. These adolescents were described as psychologically stable, supported by their families, and free of major comorbid mental health issues. The protocol’s authors claimed that, for these specific patients, early medical intervention could reduce distress and improve quality of life. Mostly, these clinicians seemed concerned with the ability of these young (mostly) boys to “pass” as women in adulthood, as a way to correct for the difficulties faced by adult transsexuals who attributed their mental health and life difficulties following transition— to their inability to pass as the opposite sex in adulthood.

But the Dutch studies that laid the foundation for this protocol were small, lacked control groups, followed participants for only a few years, failed to keep rates of loss to follow up within a clinically negligible level and were deeply methodologically flawed. Despite this, the model was rapidly adopted internationally as the gold standard for pediatric gender care. Before any outcomes were published on the Dutch kids, the practice of transitioning kids was adopted with full confidence in countries like the United States, where the cautious gatekeeping of the original protocol was largely abandoned. Screening criteria were loosened, psychological evaluations were fast-tracked, and transition timelines were compressed. What began as a narrowly defined intervention for a rare group of patients became a mass treatment pathway for any child who expressed discomfort with their sex.

As more clinics adopted the protocol, more children were referred for treatment. As more children were referred, more clinicians trained to meet the need. As medical infrastructure for youth transition expanded, so did public awareness—and with it, parental anxiety that they may not be doing ‘enough’ to ‘help’ their gender non-conforming children, by simply allowing them to grow up without psychosocial or medical intervention. Suddenly, any child questioning their gender could be perceived as a ticking time bomb. The narrative of “better a trans kid than a dead kid” spread, not because the risk of suicide had been proven to be high in non-transitioned children, but because it had become a rhetorical tool to justify medicalization.

In this way, the existence of a medical treatment pathway for gender dysphoric youth created the perception of a crisis of “trans kids not getting the healthcare they needed.” The “trans child” was no longer an anomaly but a potential reality for any child who failed to conform to gender norms, and then– a reality for any kid no matter how gender-conforming they were in childhood, to declare themselves as trans in adolescence, and to find themselves on an operating table where a surgeon carves away at their healthy bodies in a futile attempt to create for their patients, a new metaphysical reality. 

Where once clinicians waited for children with intractable dysphoria to emerge from adolescence before prescribing interventions, they now trained parents, educators and pediatricians, to look for signs of gender nonconformity in children—converting ordinary developmental exploration into medical red flags.

Jazz Jennings became the poster child of this new paradigm. His transition was held up as proof that early medical intervention could be a success story. But what was never mentioned was that Jazz’s transition was not done by the criteria of even the Dutch Protocol. He was socially transitioned in early childhood, long before the onset of puberty, and he began puberty blockers at age 11. Because his male genitals never developed, surgeons later struggled to construct even a functional approximation of female anatomy. Jazz’s experience exposed the flaws in the protocol’s logic: puberty suppression might prevent unwanted physical changes, but it also stunts the very development needed for later surgeries. In trying to erase male puberty, clinicians created new medical challenges—ones Jazz paid the price for.

Almost a decade before Jazz had his penile inversion procedure, the Dutch clinicians already knew that boys with suppressed pubertal development would need a more invasive procedure involving tissue from the colon to make up for the lack of genital development. Yet, for some reason, it doesn’t seem that any of the clinicians treating him were aware of these findings, nor did they make him or his parents, or the public whom they were actively propagandizing to, aware that a more complicated surgery is the inevitable, well-known outcome of early pubertal suppression in juvenile males.

Today, the Dutch Protocol is being re-evaluated even in the country where it began. Dutch clinicians have acknowledged that their original research cannot justify the global expansion of pediatric gender medicine as it has come to exist. Will that stop them from justifying their protocol on other grounds? No. Definitely not. But, systematic reviews in Europe have found that the evidence base for youth transition is weak, and that the risks may outweigh the benefits. The world is beginning to wake up to the harm inflicted upon children in the name of ‘compassion’ and ‘mercy.’

Pediatric social and medical transition protocols were not a response to rising rates of gender dysphoria, nor an ‘uncovering’ of a dysphoric population of kids who always existed but were finally receiving the “‘life-saving” treatment they deserve—it just created lifelong medical patients out of healthy children. Gender medicine, both for kids and for adults, offered solutions that promised to resolve complex psychological distress through medical means, while failing to address the root causes of that distress. And it created an illusion of necessity, when in truth, what had changed was not the metaphysical nature of the children, but the treatments made available to them.

Norman Spack & Ken Zucker: Two Different Treatment Protocols

[ Norman Spack describes “salivating” at the pediatric transition protocols of the Netherlands ]

The rapid shift toward medicalizing childhood gender distress did not happen spontaneously—it had architects. One of the most pivotal was Dr. Norman Spack, a pediatric endocrinologist at Boston Children’s Hospital, who helped bring the Dutch Protocol to North America. After learning of the work being done in the Netherlands, Spack was reportedly so eager to adopt puberty suppression protocols for children that he later described himself as having “salivated” at the idea of blocking puberty in gender dysphoric youth.

Spack opened the first major pediatric gender clinic in the United States in 2007, the same year Jazz Jennings’s story went public. He was not alone in his enthusiasm. By the time Jazz was a toddler, his parents were already being told that puberty blockers would be available to prevent their son from developing into a man. This promise was made long before Jazz reached puberty, long before he had even learned to tie his shoes, and more importantly, long before there was any robust, long-term evidence showing that the Dutch cohort fared better than their non-medicalized peers. The idea that “doing nothing” was cruel—and that intervening medically was compassionate—had already taken root.

[ Ken Zucker— the man, the myth, the legend. ]

This marked a dramatic departure from the predominant therapeutic model of the prior decades, as practiced by clinicians like Dr. Ken Zucker. Zucker, a psychologist at Toronto’s Centre for Addiction and Mental Health (CAMH), focused on helping children explore and potentially resolve their gender distress without affirming them as the opposite sex. His approach—common throughout the 1990s and the 2000s after being practiced in earlier decades—emphasized watchful waiting, play therapy and parenting strategies aimed at reconciling the child with his biological sex—rather than socially transitioning or medically affirming the gender distressed child. Zucker recognized that the vast majority of gender-dysphoric children would ultimately reconcile with their natal sex if left alone, and his research showed this to be true.

His approach was grounded in the simple fact that, at the time, there was no medical intervention to offer these children. Puberty blockers and cross-sex hormones for minors were not yet part of mainstream medical practice. This therapeutic orientation existed not only because it was cautious, but because it was all that existed. Because medical transition was off the table, clinicians were forced to understand gender dysphoria as something that could evolve—and often resolve—over time.

The emergence of puberty blockers as a tool for interrupting development radically altered that framework. Once medical interventions were available, the question was no longer, “How should we help the child learn to accept their body?” but “When do we start altering the body to match the child’s stated identity?” The very presence of a medical option redefined the ethical terrain—and subtly, but powerfully, redefined what was seen as “affirming,” “progressive,” or even “life-saving.”

This shift did not occur because new evidence demanded it, but because a new possibility existed. And it was this possibility—not a genuine explosion in a new strain of particularly intractable childhood gender dysphoria—that drove the ballooning rates of pediatric transition. Once clinicians could prescribe blockers, more parents began to seek them. Once parents began seeking them, more clinics opened. Once clinics opened, more children were diagnosed. And once children were diagnosed, the cycle reinforced itself—bolstered by an uncritical media, ideological activism, and a medical community eager to innovate before fully understanding the consequences of the past experiments done on earlier cohorts of adolescents and adults.

Jazz Jennings was swept into this current at the very beginning. His journey, far from being an organic expression of his inborn “gender identity,” was shaped at every turn by the availability of interventions that had only recently entered the medical arena, and by the burgeoning American obsession with reality TV shows centered around extreme variations within different parenting styles. By the time Jazz’s trajectory was cemented with an early social transition, he no longer fit neatly within the original Dutch Protocol criteria. The practice of early childhood social transition showcased a new ethos– not that many of these kids would naturally grow out of their distress, and that caution is required, but that these children were doomed to never outgrow it. That is, at least, the bold-faced lie which Jazz’s parents allege was told to them by the therapist who diagnosed their toddler with Gender Identity Disorder in 2003.

He had not even reached puberty when the path of medical transition was laid out before him. He never had to contend with the fact that someday he would become a man. By the time he was five, he was fully convinced that his (or his mother’s) childhood fantasy could continue forever.

The story of the “transgender child” is not a story of new, emerging science responding to a medical need that has always existed. It is the story of medicine creating a new patient population—and a society that eagerly embraced it, blind to the harm it might cause– because the “experts” who stood to gain so much in profit by recommending intervention over non-intervention, would begin to develop a bias in the way they approach medicine: to prioritize the short term happiness of a child over his long-term well-being.

Reflections

As I look into Jazz’s story, with an understanding of the way that medical interventions for pediatric gender dysphoria spurred a cultural shift in how we understand the nature of children, I am left with so many more questions.

What really did Jazz Jennings’s parents know about the pathway they were signing their son up for? I know that the Jennings’s were aware of how experimental these interventions are. But, I often wonder whether they even knew that this treatment protocol they were signing their son up for, was pioneered by clinicians in the Netherlands, who had been doing these treatments for less than a decade by that point. I wonder if they were even aware that there were non-medicalized models for treating pediatric gender dysphoria which showed promise, and had been practiced for far longer than the medicalized ones. Were they even made aware that they had options other than “a dead son or a living daughter?”

What exactly did their toddler’s gender therapist tell them about the nature of their son’s condition? I wonder why Jazz’s parents were told by the gender therapist who diagnosed their toddler son with Gender Identity Disorder in 2003, that it was unlikely that their son would outgrow his distress and reconcile with his sex— when everything in the literature of that time suggested the opposite. If this was what the therapist indeed said, this isn’t just a spiritual belief in a gendered soul passed off as medical advice— this is a clinical pathway sold to parents of a toddler on the basis of a bold-faced lie. The dogma that “kids know who they are” would not emerge into popular culture until after Jazz’s social transition as a kindergartener had commenced. Something about this arc of the story is fishy.

Were Jazz’s parents not told that early gender non-conformity is more indicative of a later homosexual outcome than a transsexual one?

Did Jazz Jennings’s endocrinologists not know that early pubertal suppression in juvenile males stunts genital growth and necessitates an even riskier “gender reassignment” surgery? Because the Dutch clinicians who had been suppressing boys’ puberties for about 20 years by the time Jazz got his puberty blocker implanted— certainly did. This ‘side effect’ of pubertal blockade was reported on in a Dutch newspaper. Did no one think to communicate this to…. anyone???

==

James Crisp, EUROPE EDITOR 13 April 2024

Dr Hilary Cass said children who think they are transgender should not be given any hormone drugs at all until at least 18 CREDIT: Yui Mok

Belgium and the Netherlands have become the latest countries to question the use of puberty blockers on children after the Cass Review warned of a lack of research on the gender treatment’s long-term effects.

Britain has become the fifth European nation to restrict the use of the drug to those under 18 after initially making them part of their gender treatments.

Their use was based on the “Dutch protocol” - the term used for the practice pioneered in the Netherlands in 1998 and copied around the world, of treating gender dysphoric youth using puberty blockers.

The NHS stopped prescribing the drug, which is meant to curb the trauma of a body maturing into a gender that the patient does not identify with this month.

In Belgium, doctors have called for gender treatment rules to be changed.

I am currently reading Time to Think which details the trans medical scandal at the Tavistock. I have been following this for awhile and am still shocked at the details that are emerging.

One lie I am tired of hearing is that the Dutch Protocol and Pediatric transition were immaculately researched and have a strong evidence base. This book shows how poor the evidence base was, how the research was funded by pharmaceutical companies, how the pressure to transition children was driven by activist groups such as Mermaids, and how poor funding for children’s mental health services all contributed to this perfect storm of putting children on a medicalized pathway that leaves them at risk of being anorgasmic, infertile, and whose consequences to brain development we do not yet understand. 

Warning: contains descriptions of chemically neutering homosexuals.

By: Bernard Lane

By: Mar 5, 2024

The gist

The puberty blocker-driven “Dutch protocol” of medicalised gender change—administered to ever more teenagers around the world—appears more likely to come under serious scrutiny in its home country.

The parliament of the Netherlands has now passed two motions this year calling for a closer look.

On February 27, with a majority of 101 out of 150 votes, the parliament approved a motion asking the government to commission research.

This would compare the outcomes of the Dutch protocol with the results of new, more cautious treatment policies in other European countries, such as Sweden, where non-invasive psychosocial techniques are now favoured as first-line responses to gender distress.

On January 25, the parliament approved a motion—proposed by Diederik van Dijk of the conservative Calvinist Reformed Political Party (SGP)—that the government seek advice from the independent Health Council on the medico-legal implications of medicalised gender change for minors.

Both motions were opposed by the temporary Health Minister of the Dutch administration in caretaker mode, but cabinet negotiations are under way and expected to produce a new, more responsive government reflecting the success of centre-right and populist-right parties in last November’s elections.

“I think this [second motion] will exert extra pressure on the new minister of health to initiate a review of the puberty blockers in one way or another, be it the Health Council or another institution,” said media sociologist Dr Peter Vasterman, who has been calling for independent evaluation of gender medicine in the Netherlands before any expansion of capacity.

“We don’t have a new government yet, but it will probably be a right-wing variant. So, there is a good chance that this topic will finally be put on the agenda and a review will be conducted of current trans care.”

--

The detail

Parties supporting the February 27 motion included the centre-right New Social Contract (NSC) party of Peter Omtzigt, the right-wing populist Party For Freedom (PVV) of Geert Wilders and the populist-right Farmer-Citizen Movement (BBB) of Caroline van der Plas. The motion was spon.sored by NSC member Dr Rosanne Hertzberger.

Among those opposed to the motion were GreenLeft-Labor (GL-PvdA), the social-liberal party D66, the Socialist Party (SP) and the Christian Democratic Appeal party (CDA).

The objections raised by Health Minister Pia Dijkstra, of the D66 party, included privacy risk, the difficulty of the research proposed, the redundant nature of the research proposed, and the ethics of using randomised clinical trials (something not proposed by anyone).

Dr Hanneke Kouwenberg, a Dutch radiologist and nuclear physician who has followed the gender clinic debate, said she was angry at the denial and hypocrisy of parties seeking to block the motion.

“As often happens, opponents of a more fundamental scientific approach in this debate do not substantiate their position with arguments, but rather with emotional blackmail,” she told GCN.

“It is deeply disturbing that research aiming to examine whether Dutch gender care has better outcomes than other countries, which indeed might substantiate the claim of successful selection of treatment candidates, is being vilified by parties perceived as ‘progressive’ and ‘left wing,’ whilst the minister goes so far as to call such research ‘unethical’—which is especially bizarre since no intervention is needed in the proposed research.

“It once again shows how much the parties resisting [inquiries] do not have the interests of minors, nor quality of care, in mind, but consciously and repeatedly close their eyes to a practice whose benefits have never been substantiated but whose drawbacks are increasingly coming to light.” 

“More and more teenage girls are choosing to change their gender around the world. In Quebec, the health system responds very quickly to their requests for medical transition by prescribing blockers, testosterone and mastectomies. These young girls often present with several mental health problems and many wonder if we give ourselves the time to evaluate everything that is going on in their heads. Is it normal for a 14-year-old girl to get a testosterone prescription within minutes? And what happens when they change their minds?”—Documentary, the French-language arm of Canada’s CBC public broadcaster, 29 February 2024

Watch the ethics

A spokeswoman for the group Genderpunt, which advocates for more open debate about gender medicalisation, said the Dr Hertzberger’s February motion with its focus on comparative outcomes might seem more palatable to government, although she suggested that if the job were given to Dutch gender researchers it might be undermined by “gender-affirming” groupthink.

She said it was possible that the ethical and medico-legal analysis called for by Mr van Dijk’s January motion would prove “far more interesting.”

“Is it ethically justified to take the risk that a minor will, in the long-term, regret gender-affirming care and have to deal with the consequences for the rest of his life? How is this child protected by national and international law (like the Convention on the Rights of the Child).”

Science: egalitarian or authoritarian?

Before her recent election to parliament Dr Hertzberger was a microbiologist studying the little understood bacterial makeup of the human vagina, a field with implications for the reproductive and sexual health of women.

“For instance, it is unclear why humans are the only apes with this high acidity and dominance of Lactobacillus whereas these characteristics are absent in other primates. Why is the human vagina such a good host for these specific bacteria?” she says on her website.

She carried out her research thanks to the hospitality of a lab at the VU University Amsterdam, which is also home to the gender centre whose Dutch protocol for “juvenile transsexuals” culminates for males in castration and the surgical creation of a pseudo vagina.

Dr Hertzberger has practised “citizen science” with the rationale of engaging ordinary women in research to develop a probiotic to modify the vaginal microbiome. She is also an advocate for “open science” whereby all findings, even negative results, are made public.

“The general aim is to increase scientific efficiency by sharing as much information as possible with other scientists and the general public,” she says.

She has also reflected on the role of science in society, publishing an essay with the title The great nothing: Why we have too much faith in science. Her thesis is that science is muscling into the moral vacuum left by organised religion.

“I see a new generation of Western secular policymakers, politicians, administrators, thinkers, writers, entrepreneurs and leaders who no longer see science as a tool for generating knowledge, but as a new infallible authority; an all-knowing judge who decides what is good and what is evil,” she writes.

Video: Dutch MPs debate gender clinics

Vision necessary

Dr Hertzberger’s motion was put in the context of the international scientific debate over youth gender dysphoria and reports to the Dutch parliament acknowledging missing data and a “lack of visibility” into local gender patients.

A familiar narrative in the Netherlands has been that the pioneering Dutch protocol was a source of pride and that any concerns arose from its less careful application in other countries. However, the rigour and ethics of the key Dutch studies establishing the protocol have recently come under much sharper scrutiny both in the Netherlands and internationally.

During the February 15 debate of motions proposed by her and other MPs, Dr Hertzberger said: “The decision to treat these children with puberty inhibitors is taken at an early age, 14 to 15 years on average, during a period of major hormonal, physical and mental changes, based on symptoms that are not objectively quantifiable.”

“We have seen in recent years how other European countries have become more reluctant to treat minors according to the so-called ‘Dutch protocol’. More importantly, the reports before us today show a lack of visibility [into Dutch gender patients].

“We see in Sweden, for example, that they have temporarily really stopped puberty inhibitors altogether and only allowed them in experimental settings. We are very curious to see what happens to that cohort of patients in the end and how their wellbeing goes.

“This [shift to more cautious treatment] comes not only from politics and not only from society, but also from healthcare itself and from science.”

“The Endocrine Society (ES) is updating its clinical practice guidelines on ‘gender-affirming care.’ ES, however, appears to be putting its thumb on the scale in favor of medical interventions by appointing experts with serious conflicts of interest to its guideline-development group, ignoring its own standards for how to write trustworthy medical recommendations, and trying to keep the process hidden from the public.”—Leor Sapir, news article, City Journal, 27 February 2024

“It’s noteworthy that most of the authors of ES’s 2017 clinical practice guidelines were also big names at WPATH [the World Professional Association for Transgender Health]. Two—Peggy Cohen-Kettenis and Louis Gooren—were Dutch pioneers of pediatric gender medicine. Despite the perception that ES and WPATH are separate entities, and that recommendations on behalf of ‘gender-affirming care’ are not just made by trans advocacy groups but also by run-of-the-mill U.S. medical groups, the truth is that WPATH members used ES as a guise for embedding hormonal interventions as an accepted standard of care in the United States.”

Why the data drama?

Aside from her successful motion, Dr Hertzberger put up another which did not go forward. This sought data to compare people diagnosed and treated in Dutch gender clinics with those on waiting lists.

She noted that the patient group seen today—dominated by teenage females—was different from the past group of mostly males with gender distress stretching back to early childhood.

“I am really puzzled by this [resistance of some MPs to requests for more data], because there is a report [to parliament] that says there is too little visibility into this group [of patients] and the medicalisation of this growing group of children and adults,” she said.

“We are particularly interested in the children. We see major changes in recent years in European countries that have changed their standard of care [Finland was first in 2020, followed by Sweden in 2022 and England issued a new, cautious draft treatment policy in 2023—GCN.]

“Surely that is a goldmine of data which, by the way, we can easily collect in anonymised and aggregated form, as we so often do.

“I really want to ask [Health Minister Dijkstra] why she does not want more data on this important development [in gender dysphoria], which also has medical-ethical consequences,” Dr Hertzberger said.

Dr Vasterman told GCN that it was quite reasonable to request current data on patient registrations, diagnoses and treatment at Dutch gender clinics.

“It is unacceptable that no new data has been provided for years now, which makes it very difficult to evaluate current trends, such as the shift in sex ratio [of patients] and the rise of non-binary identity among young girls.

“These developments have huge impact on the needs for trans care but without data it is difficult to develop new a policy.”

“Despite claims that blocking puberty gives time for decision-making, no one can answer the obvious: How is it possible for a child to discover ‘This isn’t as bad as I feared,’ when they are blocked from experiencing it? Fears are resolved by confronting them, not avoiding them.”—Sexual behaviour scientist Dr James M Cantor, tweet, 3 March 2024

Not our problem

Dr Kouwenberg said that “Dutch politics has long acted as if there were no problem with the Dutch protocol,” despite last October’s breakthrough Zembla documentary on the flawed design of key studies, critiques in international journals and the shift to caution of progressive European countries.

“And if there were a problem, it was invariably stated that the problems abroad were due to a poor selection of candidates for puberty blockers, that in the Netherlands, work was being done very carefully, and only children who were actually ‘trans’ [those whose gender dysphoria would not desist with the passage of time] would be treated with puberty blockers. The concerns of critics were always dismissed as moral panic and fear-mongering,” Dr Kouwenberg told GCN.

“It comes as no surprise that there is actually no test, let alone a validated one, to distinguish desisters from persisters prospectively, and Dutch medicine does not possess crystal balls to predict the future. Nevertheless, the gender clinic in Amsterdam [which developed the Dutch protocol] and the politics associated with it have long been able to stave off further investigation with statements like these.” 

By: SEGM

Published: Jan 13, 2022

A version of this article was originally published on the Society for Evidence-based Gender Medicine’s website on January 11, 2023.

A common sentiment among those involved in the push-back against the excesses of pediatric gender medicine is to wax nostalgic about the so-called “Dutch protocol.” This protocol is frequently referred to as the “gold standard” model of care, and is often portrayed as an eminently reasonable, cautious, and conservative approach to treating gender confused youth that has been abandoned in recent years for an extreme “affirmative” model that ahbors medical gatekeeping and immediately (and unquestioningly) accepts a patient’s self-reported cross-sex identity.

But while the Dutch protocol is certainly a better and more cautious approach than the affirmative model, “better” and “more cautious” are relativistic terms that do not equate to “good” and “reasonable.” In fact, the Dutch protocol only appears good and reasonable when juxtaposed with the medically reckless affirmative model. In reality, any sober and objective evaluation of the original studies that form the basis of the Dutch protocol would reveal that they are fatally flawed and wholly inapplicable to the current clinical landscape.

A new open-access publication, “The Myth of Reliable Research in Pediatric Gender Medicine,” focuses on the two Dutch studies that gave rise to “gender-affirmative” care for youth worldwide. The authors convincingly demonstrate that rather than “solid prospective research” or even the “gold standard” in research, as these studies are frequently described by the proponents of “gender-affirmative care,” the Dutch research suffers from profound, previously unrecognized problems. These problems range from erroneously concluding that gender dysphoria disappeared as a result of “gender-affirmative treatment,” to reporting only the best-case scenario outcomes and failing to properly examine the risks, despite the fact that a significant proportion of the treated sample experienced adverse effects.

The authors note that the Dutch studies, while of unacceptably low quality by today’s standards, were commensurate with the clinical and research practices during the era of expert opinion-led medicine widely practiced before the 1990s. The term “evidence-based medicine” and its focus on quality comparative clinical research to determine optimal treatment only emerged in the 1990s. The Dutch researchers began to medically transition gender dysphoric adolescents in the late 1980s and early 1990s—just as medicine was starting to undergo this major paradigm shift.

The authors assert that had the Dutch studies been published today for the first time, the “innovative practice” of using hormones and surgery to gender-transition children and young adults would never have been permitted to enter general medical settings due to the very low quality of the research, and problematic outcomes experienced by several of the young people.

Unfortunately, since the publication of the final Dutch study in 2014, the practice of youth gender transitions underwent what’s known as “runaway diffusion”— a problematic but not uncommon phenomenon whereby the medical community mistakes a small innovative experiment as a proven practice, and a potentially non-beneficial or harmful practice “escapes the lab,” rapidly spreading to general practice settings.

The authors note that the only way to curb the damage of ongoing “runaway diffusion” is to conduct systematic reviews of evidence, update treatment guidelines to reflect the lack of evidence, and then “de-implement” unproven or harmful practices—a process known as “practice reversal.” They observe that such practice reversals of “gender-affirming” interventions for youth are already underway in Finland, Sweden, England, and most recently the state of Florida.

The authors also address the plethora of new studies since the Dutch research. They note that these newer studies, which purport to have definitively proven that puberty blockers and cross sex hormones are “as benign as aspirin, as well-studied as penicillin and statins, and as essential to survival as insulin for childhood diabetes” are even more flawed than the original Dutch research. To demonstrate the lack of rigor in more recent research, the authors focus on three recent studies, including the most recent study by Tordoff et al. That study made headlines for purportedly demonstrating that following 12 months of “treatment” with puberty blockers and cross-sex hormones, depression in gender-dysphoric youth all but disappeared. The authors demonstrate that this finding is both implausible and indefensible. They conclude that far from having perfected previously flawed research methods, these newer studies continue to suffer from serious problems but that researchers have indeed perfected the art of spin—misrepresenting weak, uncertain, or even negative findings as strong and positive.

The authors note that the question, “Just because we can, should we?” is not unique to pediatric gender medicine. What makes this area exceptional is the radical, irreversible nature of “gender-affirming” medical and surgical interventions desired by the exponentially growing numbers of youth in the Western world. New changes to the ICD-11 “gender incongruence” diagnosis, endorsed by WPATH “Standards of Care 8” as the diagnostic category that should guide treatment decisions, have resulted in a situation whereby virtually any body modification desired by a young person, including unlimited possibilities for “nonbinary” procedures, can be considered “medically necessary.” They also note the gender-clinicians’ relentless political activism. Rather than engaging in reflection and improving research methods, many gender-clinicians-turned-advocates are instead trying to quell the ongoing scientific debate by calling it “science denialism” motivated by ignorance, religious zeal, and transphobia.

The authors observe, “The key problem in pediatric gender medicine is not the lack of research rigor in the past—it is the field’s present-day denial of the profound problems in the existing research, and an unwillingness to engage in high quality research requisite in evidence-based medicine.” They caution that harm at scale will ensue if the gender medicine establishment does not acknowledge the problems with the research it relies on and continues to produce studies favoring spin over rigor. The authors remind readers that medicine is a double-edged sword with potential to help but also to harm, and that the history of medicine is replete with examples of “cures” that turned out to be far worse than the “diseases” they purported to treat.

This new publication represents an inflection point in the field of pediatric gender medicine. It is requisite reading for anyone following the ongoing scientific debate in the field of youth gender medicine. For those looking for highlights, below is a summary of the key points.

The Dutch Studies of Youth Gender Transitions are Deeply Flawed

Critics and proponents of youth gender transition agree that to date, the Dutch studies represent the best available evidence for pediatric gender transition, and indeed the entire model of “gender-affirming” care is based on the Dutch experience. The seminal importance of the Dutch studies is evidenced by the fact that the Endocrine Society Guidelines, and WPATH “Standards of Care 7” under which the practice proliferated, refer only to the Dutch experience as proof of “benefits” of the practice.

The Dutch studies found that puberty blockers, cross-sex hormones, and surgery effectively transformed young bodies, leaving patients satisfied with their appearance shortly after the final surgery. However, the studies failed to show that these physical changes resulted in any clinically meaningful or reliable psychological benefits sufficient to justify the serious adverse effects that emerged.

Besides the small sample size, lack of control group, and only short-term follow-up—well-known issues with the Dutch research—the authors identify several serious methodological problems that have been overlooked.

1. Only best-case scenario outcomes were included in the studies’ results

The Dutch studies reported only the best-case scenarios at each stage of treatment: puberty blockers, cross-sex-hormones, and surgery. Those who did not fare as well, or experienced problems, where not included in the research results.

The first of the two Dutch studies, which focused specifically on the effects of puberty blockers, selected its 70 cases from a larger pool of treated cases focusing only those who successfully completed puberty blockade and were ready to start cross-sex hormones. The authors argue: “Using the start date of the next phase of treatment (cross-sex hormones) as the defining inclusion criterion for the study of the prior phase of the treatment (puberty blockers) introduced serious bias.” Those who developed problems while on puberty blockers and/or discontinued them would not have made it into the “first 70” cases. This methodology also assured that the cases are most physically and mentally mature, as it favored older subjects.

The second and final study suffers from the same problem, but it is more visible, since the subjects were followed from the first into the second study. The 70 cases dropped down to 55. Those who developed medical problems (including 3 cases obesity and diabetes and 1 death) were reclassified as “nonparticipants,” eliminating their negative outcomes from the studies’ final results.

The Dutch studies’ unusual subject recruitment and retention methods disqualify the research from the “quality longitudinal prospective cohort study” designation. Rather, the Dutch studies are best described as a “case series”—the lowest and least reliable level of evidence.

2. The conclusion that gender dysphoria disappeared after “affirmative” treatment is wrong

The linchpin finding of the final 2014 Dutch study (and only clinically significant improvement) was the reported “disappearance” of gender dysphoria post-surgery. However, this finding is compromised by misuse of the UGDS “gender dysphoria” measurement scale. Not only did the wording of the gender dysphoria scale questions switch from female to male (and vice versa) before and after treatment, but the entire scoring mechanism was effectively reversed. As a result, a gender-incongruent patient answering the same question in the same way would register an instant “drop” of “gender dysphoria scores” as soon as the scale version was switched—independent of any treatment. They explain:

The following hypothetical scenario clearly demonstrates the problem. A severely gender dysphoric, cross-sex identified female patient is asked to answer two of the UGDS questions: “Every time someone treats me like a girl I feel hurt” and “Every time someone treats me like a boy I feel hurt” (Items 2 on the “female” and the “male” versions of the UGDS scale, respectively).It is likely that the patient would strongly agree with the first statement, and strongly disagree with the second. The first answer would lead to the score of “5” on the UGDS gender dysphoria scale, indicating the highest possible level of gender dysphoria. The second answer— which is effectively the same answer—would result in the score of “1” indicating the lowest possible gender dysphoria. This is because unlike the first question, which belongs to the “female” battery of questions, the second question belongs to the “male” battery of questions and effectively assumes the subject to be male—hence, the lack of distress of being associated with “maleness” receives the minimum “gender dysphoria” score.

If we now consider that only the “female” scale was used for gender dysphoric females at baseline but was then switched to the “male” scale after the final surgery (and vice-versa for male subjects), it becomes clear that the remarkable drop in “gender dysphoria” the UGDS scale registered after surgery entirely results from switching the scale.

The authors note that it is vitally important to recognize that inversion of the UGDS scale after gender reassignment was not merely “not ideal” as lead author, Dr. de Vries acknowledged—but that it entirely invalidated the final Dutch study’s main finding. They explain:

When defending the choice to reverse the UGDS scale (de Vries, 2022), de Vries pointed out—and we agree—that it would make no sense to ask postoperative natal males to answer a question such as “I dislike having erections” (Table 1, UGDS-M, item 11), since they no longer have penises. We empathize with the Dutch researchers’ plight, as they found themselves without a valid tool to measure the construct of “gender dysphoria” after treatment. It is equally nonsensical, however, to ask natal males to answer questions such as, “I hate menstruating because it makes me feel like a girl” (Table 1, UGDS-F, item 10)—and it makes even less sense to report “resolution of gender dysphoria” because they don’t “hate menstruating.”

The problem with the claim of “disappearance of gender dysphoria” which relies on reversing the scale was evident in the Dutch team’s presentation at the WPATH Symposium in late 2022. Presenting long-term follow-up data on male-to-female transitioners, the Dutch team acknowledged that while subjects continued to score low on “gender dysphoria,” over half reported genital shame, and nearly a quarter continued to feel inadequate about their bodies, which they still deemed too masculine.

3. Psychotherapy was offered to all subjects making it impossible to determine which intervention “worked”

Contrary to the notion that psychotherapy to explore the causes of gender dysphoria or to ameliorate it non-invasively is akin to “conversion therapy,” the Dutch protocol required ongoing psychotherapy and the studies appropriately acknowledged that psychotherapy may have contributed to the high postoperative functioning of the treated youth. However, commingling psychotherapy with hormones and surgery made it impossible to determine whether medical and surgical interventions, psychotherapy, or simply the passage of time allowed these already high-functioning youth to retain their high function 1.5 years after surgery.

4. The studies only focused on potential benefits and failed to evaluate risks

Despite their longstanding hypothesis that hormones impair bone and brain development, the Dutch researchers did not evaluate these risks. The failure to consider all relevant outcomes—including physical health effects—is a key methodological flaw in the Dutch research. Even without setting out to evaluate physical health risks, the Dutch studies revealed that up to 7 percent of subjects suffered severe morbidity and mortality: several subjects developed diabetes and obesity during treatment, one died, and 100 percent became sterile since the protocol required removal of reproductive organs.

Many risks and uncertainties associated with puberty blockers and cross-sex hormones have emerged in more recent research. Long-term follow-up data presented at the WPATH Symposium suggest that reproductive regret and significant problems with sexual function affected a significant proportion of those transitioned in the Dutch clinic as adolescents. The authors observe: “Patients and their families cannot make informed decisions about a treatment when the physical health risks are assumed to be minimal and not reported, and only the potential psychological benefits are considered.”

5. The results are not generalizable to most currently presenting cases of gender-dysphoric youth

Currently, most youth with gender dysphoria suffer from post-pubertal onset of gender dysphoria, significant mental illness, and increasingly present with non-binary gender identities—clinical presentations the Dutch explicitly disqualified from their studies. Today, the Dutch protocol is administered to the very youth who would have been disqualified from this foundational research. This is alarming since up to 1 in 10-20 youth in the US (with similar trends in the rest of the Western world) currently claim a transgender identity, placing them at risk for treatment with a protocol explicitly contraindicated for them.

6. Conducting research with the preconceived notion of the superiority of medical gender reassignment

Equipoise, a key concept in clinical research, requires that investigators maintain a genuine sense of uncertainty and curiosity about which interventions are most effective. This allows design of studies that do not favor one intervention over another but instead generate reliable evidence about which intervention is most likely to provide benefits while minimizing risks. The Dutch researchers started with the preconceived but untested notion that the only way to help youth with early childhood onset of gender dysphoria that worsened in adolescence was to transition them using hormones and surgery.

The danger and inaccuracy of assuming that nothing but hormones and surgery “works” is highlighted by findings from an earlier, often overlooked study from the same Dutch gender clinic that reported the outcomes of gender-dysphoric youth who were rejected from gender reassignment in adolescence. Remarkably, 80 percent of these youth were no longer interested in gender transition as adults and found other ways to address their gender dysphoria. This calls into question the assumption that gender dysphoric adolescents will invariably want to live as transgender-identified adults.

7. The availability of the Dutch protocol may have created the crisis of growing demand for youth gender reassignment in the absence of objective medical necessity criteria or quality research

The authors point to an earlier study of Dutch youth conducted before the advent of the Dutch protocol. This prospective population study of 879 Dutch children reported that 6 percent of the young children were considered “gender variant,” but 24 years later none had chosen to undergo medical transition despite being eligible for gender reassignment as mature adults.

These “gender-variant” children were coming of age just a few years before the Dutch protocol was created, and before the Dutch clinicians devised the notion of “juvenile transsexuals”—which today we term “transgender youth.” Thus, these children were able to experience identity development without the pressure of labels and importantly, without puberty blockers and cross-sex hormones.

Proponents of treating youth with hormones and surgery assert that these interventions are essential for “those who need it.” The authors pose two key questions: “First, has the availability of the Dutch protocol create this ‘need?’ Second, absent clear criteria to separate a young person’s ‘wish’ from a ‘need,’ will rigorous research be required to demonstrate that the benefits outweigh the risks?”

8. It is time to conduct a re-evaluation of the Dutch experience using rigorous research methodologies

In view of the thousands of referrals to the Amsterdam gender clinic since the practice of gender-transition of youth was launched, the authors urge the Dutch research team to use quality methodologies to re-analyze the quarter-century of outcomes of youth gender reassignment. The authors issue specific recommendations about how to begin: by accessing health registries and reviewing the records of all patients diagnosed with gender dysphoria, regardless of the treatment chosen. They encourage the Dutch to design studies that compare various subgroups, and to pay attention to objective long-term mental health and physical outcomes, analyzing them separately for each type of intervention and by sex at birth.

Importantly, the authors note that the primary outcome of youth gender reassignment must be clearly articulated and justified. At first, the Dutch researchers stated that the goal of transition was to improve psychological functioning. However, when studies failed to show convincing benefits of improved psychological functioning, the goal was redefined; the Dutch researchers most recent assertion is that psychological outcomes are not the correct outcomes to measure, the preferred outcomes are quality of life and satisfaction with treatment.

Outcomes should not be changed based on what the researchers see “works” after the treatment, because such methodology introduces a serious risk of finding an association by chance. Rather, the outcomes should be clearly articulated in advance and consistently tracked and reported for all “intent-to-treat” subjects, regardless of whether their conditions improve, worsen, or are unchanged.

The Research that Followed the Dutch Studies is Even More Flawed

Newer studies purportedly proving the benefits of gender transition suffer from even more significant limitations than do the Dutch studies. The authors illustrate this deficit by analyzing three recent studies that have been widely cited by proponents of youth gender reassignment as proof that early gender transition is beneficial, illustrating how the studies’ weak or even negative findings are spun into favorable results.

A striking recent example is the study by Tordoff et al., which has been touted as proof that the benefits of gender reassignment rapidly appear during the first year of treatment and lead to dramatic reductions in depression. In fact, the rates of depression in the treated group remained unchanged before and after treatment. The optimistic conclusion of benefits came from the fact that the untreated group worsened, and this finding was incorrectly perceived as a signal that treatments must have helped the “treated” group remain stable and avoid deterioration. However, Tordoff et al. failed to notice that they lost a whopping 80 percent of “untreated” participants by the end of the study, and that this dropout rate entirely invalidated the study’s methodology and conclusions:

However, by basing their conclusion about the relative success of the “treated” on the finding of lack of success among the “untreated” cases, the researchers failed to consider that they lost an astounding 80% of their “untreated” cohort by the end of the study (28 of 35); in contrast, over 80% of the “treated” cohort (57 of 69) remained enrolled. The high dropout rate in “untreated” subjects makes intuitive sense: the study took place in a gender clinic setting, the primary purpose of which is provision of gender transition services. Youth whose distress was ameliorated without the use of hormones would have little reason to stay enrolled in the clinic and participate in the ongoing research. However, what this also suggests is that the highest functioning “untreated” youth dropped out of the study. Thus, the entire conclusion that because “untreated” cases faired so poorly on measures of depression, anxiety, or suicidality, it must be that hormones given to the “treated” cases “worked,” is invalid. There are other problems in the study, including the fact that the use of psychiatric medications was not accounted for in the analysis. The university was aware of the problems with this research but chose to remain silent because the study’s optimistic conclusions were so well received by national news media outlets (Rantz, 2022).

Much research conducted by gender clinics suffers from similar problems, and few front-line clinicians responsible for recommending treatments have the time and skill to critically evaluate methodologies of these deeply flawed studies, which somehow make it past peer-reviewers in even the most prestigious journals.

Final Thoughts

“The Myth of Reliable Research in Pediatric Gender Medicine” mounts a formidable challenge to the claim that the Dutch studies’ conclusion that psychosocial benefits arise from “solid prospective research.” It not only challenges the notion that the rapidly growing numbers of gender dysphoric youths can be safely and effectively treated with hormones and surgery but also questions whether even those with childhood-onset are best served with hormones and surgery. The article demands urgent attention from the medical community.

The authors highlight how far the field of gender-medicine has drifted from the core principles of evidence-based medicine. They advocate enlisting methodology experts without intellectual or other conflicts of interest in any new research, rather than continuing to rely on research from online surveys or the gender clinics themselves, which, fighting for the survival of their practices, have increasingly assumed a politicized and activist stance.

Insistence by the gender medicine community that questioning science and demanding rigor in research is akin to “science denialism” or “transphobia” places the field at risk of becoming one of the biggest medical epidemics of harm. As the authors point out, currently as many as 1 in 10-20 high school and college youth in the U.S. self-identify as transgender. This self-identification, “affirmed” by healthcare professionals, puts them at risk for what has been demonstrated to be a largely irreversible “gender-affirming” medical treatment pathway which results in irreversible changes and is expected to lead to infertility or sterility.

Thousands of harmed young detransitioners are already speaking out, and recent studies indicate medical detransition rates of up to 30 percent. Not all of these individuals identify as “detransitioners” and not all will conceptualize their experiences as “regret,” but many have, and many more likely will. Prior research suggests there is roughly an 8-11 year gap between gender reassignment and the emergence of long term regret and markedly increased morbidity and mortality.

Medical societies and scientific journals that suppress debate in gender medicine, while uncritically promoting the fallacious “settled science” narrative by publishing deeply flawed studies, are contributing to this crisis. The gender medicine field has a limited time to self-correct before public health authorities, and increasingly, elected officials who do not understand medicine but do understand the risks of harm to youth, step in to curb the damage.

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Did you know that a kid died as a result of undergoing surgery as a result of the original Dutch study and this was withheld from the results? And that there are numerous methodological flaws in the Dutch study.