Summary
The Cass Review v The Netherlands: Why the Netherlands is Continuing Youth Gender-Affirming Healthcare.
The Cass Review v The Netherlands: Why the Netherlands is Continuing Youth Gender-Affirming Healthcare.
At a time when healthcare for transgender youth in the United Kingdom faces severe restrictions, an authoritative report from the Health Council of the Netherlands provides a vital, evidence-based roadmap. While not naming the Cass Review specifically, it is clear there is a conflict.
Both reports grapple with the same core problem – thin long-term evidence, particularly on cognition and fertility – but reach different policy conclusions. NHS England’s Cass Review, published in April 2024, judged that the evidence was too weak to justify continued routine prescribing, and recommended restricting puberty blockers to clinical trials and using hormones only with “extreme caution” under 18. The Dutch Health Council, weighing similar evidence gaps, concluded they are “no cause for immediate concern” and do not justify restricting or withdrawing care.
Commissioned by the Dutch Minister of Health following parliamentary motions regarding adolescent medical care (partially in response to Cass), the independent advisory body published its findings in June 2026.
Their central conclusion is clear, grounded, and deeply reassuring: gender-affirming medical care for adolescents – including puberty blockers (GnRH agonists) and gender-affirming hormones, is lawful, clinically effective, and will continue to be provided across the Netherlands.
Reaffirming Efficacy, Safety, and Legality
The Dutch Health Council’s committee on Transgender Care for Adolescents evaluated the legal, physical, and psychological dimensions of healthcare for under-18s. The committee concluded unequivocally that gender-affirming medical treatment for adolescents with gender dysphoria aligns fully with Dutch healthcare legislation.
The report’s clinical conclusions strongly reinforce the international medical consensus:
- Efficacy: Scientific research demonstrates that hormonal treatments successfully achieve their intended physical effects, alongside clear indications of improvements in adolescent mental health.
- Safety Profile: Current scientific data on unintended physical and mental health side effects do not warrant immediate concern. The report emphasises that some long‑term outcomes (particularly cognition and fertility) require further study, and that these uncertainties must be discussed openly with families as part of informed consent. Crucially, the Council determined that these gaps do not justify restricting or withdrawing care.
- Low Discontinuation Rates: Dutch studies show that only 0% to 3.5% of individuals who commenced hormone therapy as adolescents subsequently discontinued treatment. Within these studied cohorts, no cases of regret were identified.
- The Harm of Denying Care: While acknowledging that long-term outcomes regarding cognition and fertility require further study, the committee explicitly determined that these uncertainties do not provide sufficient grounds to alter or restrict the care pathway. Crucially, the council emphasised that denying care carries severe risks, as withholding medical support can actively harm a young person’s mental health.
Contrast Between Dutch Continuity and the UK Landscape
For trans young people and advocates in Britain, the Health Council’s conclusions present a striking contrast to domestic policy. While NHS England has moved to restrict puberty blockers and gender-affirming hormones exclusively to clinical research trials, the Netherlands (the birthplace of the original “Dutch Protocol”) has chosen to maintain patient access through its existing structured pathway, rather than pausing care pending further research.
The Health Council explicitly compared its model with international practice. While noting that England and Sweden have restricted care to research protocols, it highlighted that their other European neighbours (including Germany, Austria, Switzerland, Poland, and France) have firmly embedded gender-affirming treatments within their national healthcare guidelines. Rather than dismantling services, the Dutch model focuses on strengthening its carefully structured pathway. This pathway prioritises step-by-step gender exploration, psychological support, multidisciplinary team assessments, and voluntary informed consent.
TransLucent had concerns about Cass immediately after it was published, and our CEO at the time (Steph Richards) commissioned our own review, appointing seasoned gender and medical professionals who took several months to report -” Responding to the Cass Review – A Solution Focused” refers.
We are pleased to see the Dutch report confirm several of our findings.
Strengthening Care Without Depriving Patients
Rather than withdrawing medical interventions, the Dutch report outlines constructive recommendations to enhance care quality across the health service:
- Primary Care Training: Expanding education for general practitioners and local mental health services, enabling them to support exploratory gender questions early, prevent unnecessary pathologisation, and alleviate waiting lists at specialist gender clinics.
- Refining Care Standards: Clarifying diagnostic protocols and decision-making competence within revised standards of care (Kwaliteitsstandaard Transgenderzorg – Somatisch), with explicit attention given to co-occurring psychosocial needs.
- Outcome Tracking: Establishing standardised nationwide monitoring across gender clinics to gather robust, long-term data into adulthood regarding cognitive development, fertility, and quality of life.
- Compassionate Care for Discontinuation: Explicitly separating treatment discontinuation from regret, recognising that stopping treatment can reflect a natural exploratory journey rather than a clinical failure, and ensuring supportive care without stigma.
- Promoting Societal Acceptance: Acknowledging that medical care alone cannot resolve distress driven by prejudice and calling on society to foster acceptance of gender diversity and tackle social exclusion.
What This Means for the UK
The Dutch Health Council’s findings deliver a powerful message to healthcare leaders in the UK: evidence-based medicine prioritises patient well-being, clinical expertise, and individual autonomy over political restrictions.
- Trans youth in Britain deserve the same high standard of holistic, evidence-led healthcare as young people in the Netherlands.
- TransLucent calls on the government, the NHS, medical royal colleges, and health policymakers to look closely at this decisive report.
- It is time to abandon restrictive mandates, listen to rigorous international evidence, and restore compassionate, accessible healthcare for trans young people in the UK.
