Dutch Clinical Interest in Gender Dysphoria Skyrocketed in 2014

Rare Diagnosis and Intervention Accelerated When Children < 10 Years were Targeted

By Peter A. McCullough, MD, MPH

I am commonly asked by concerned parents about the relatively sudden interest in gender dysphoria and the desire to change from one gender to another. While this is a complex subject that will take many issues of Courageous Discourse to cover, I wanted to start with a simple trend from a bona fide research group in the Netherlands.

van der Loos et al, recently published data from a retrospective cohort of 1766 children and adolescents in the Amsterdam Cohort of Gender Dysphoria. The authors give a brief history of the field: “In the Netherlands, gender-affirming medical treatment was already available for transgender adults aged >18 years since 1972. Nevertheless, children and adolescents experiencing GD were devoid of treatment options until 1987, when psychologist Peggy T. Cohen-Kettenis noticed an increasing number of transgender teenagers requesting medical intervention. After careful deliberation, gender affirming hormone (GAH) treatment was made available for thoroughly screened well-functioning young people between 16 and 18 years of age—after first-stage treatment with antiandrogens for assigned males at birth (AMAB) and progesterone for assigned females at birth (AFAB). Thenceforth, a modest number of adolescents were treated with GAH. Around the same time, pediatric endocrinologist Henriette A. Delemarre-van de Waal treated an adolescent diagnosed with GD with a gonadotropin-releasing hormone agonist (GnRHa) to halt puberty. After following the then current diagnostic protocol, she added GAH treatment a few years later. Internationally, this approach of diagnostic procedure and combined treatment of GnRHa and subsequent GAH came to be known as the Dutch Protocol. Few studies have assessed the prevalence of GD in children and adolescents. Based on the current literature, 1.3% to 2.7% of schoolchildren self-identify as transgender or gender nonconforming people. Nevertheless, ever since the implementation of the Dutch Protocol, a rise in the number of adolescents requesting this treatment has been seen. The protocol has become common practice in gender identity clinics throughout the Western world and has been incorporated into the Endocrine Society’s guideline for the medical treatment of GD from the earliest edition and into the standards of care by the World Professional Association for Transgender Health since 1998. However, the approach is not endorsed worldwide. For example, in Sweden the eligibility for treatment with puberty suppression in adolescents has recently been restricted.”

van der Loos MATC, Klink DT, Hannema SE, Bruinsma S, Steensma TD, Kreukels BPC, Cohen-Kettenis PT, de Vries ALC, den Heijer M, Wiepjes CM. Children and adolescents in the Amsterdam Cohort of Gender Dysphoria: trends in diagnostic- and treatment trajectories during the first 20 years of the Dutch Protocol. J Sex Med. 2023 Feb 27;20(3):398-409. doi: 10.1093/jsxmed/qdac029. PMID: 36763938.

Dutch law changed in 2014 to allow treatment of gender dysphoria without gonadectomy. This appeared to be an accelerant allowing more parents to bring young children (< 10 years) forward for puberty halting treatment in order to intentionally give gender influencing (female or male) hormonal therapy.

In summary, the relatively sudden interest in Dutch transgender medicine in occurred not because of a secular change in a psychiatric disease, but rather was driven by laws and clinical protocols with public interest that followed in changing from one gender to another and the program has been off to the races ever since.

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van der Loos MATC, Klink DT, Hannema SE, Bruinsma S, Steensma TD, Kreukels BPC, Cohen-Kettenis PT, de Vries ALC, den Heijer M, Wiepjes CM. Children and adolescents in the Amsterdam Cohort of Gender Dysphoria: trends in diagnostic- and treatment trajectories during the first 20 years of the Dutch Protocol. J Sex Med. 2023 Feb 27;20(3):398-409. doi: 10.1093/jsxmed/qdac029. PMID: 36763938.