The Dutch Protocol for Juvenile Transsexuals: Origins and Evidence

Michael Biggs (2022) The Dutch Protocol for Juvenile Transsexuals: Origins and Evidence, Journal of Sex & Marital Therapy, DOI: 10.1080/0092623X.2022.2121238

Abstract

It has been a quarter of a century since Dutch clinicians proposed puberty suppression as an intervention for “juvenile transsexuals,” which became the international standard for treating gender dysphoria. This paper reviews the history of this intervention and scrutinizes the evidence adduced to support it. The intervention was justified by claims that it was reversible and that it was a tool for diagnosis, but these claims are increasingly implausible. The main evidence for the Dutch protocol came from a longitudinal study of 70 adolescents who had been subjected to puberty suppression followed by cross-sex hormones and surgery. Their outcomes shortly after surgery appeared positive, except for the one patient who died, but these findings rested on a small number of observations and incommensurable measures of gender dysphoria. A replication study conducted in Britain found no improvement. While some effects of puberty suppression have be

Reconsidering Informed Consent for Trans-Identified Children, Adolescents, and Young Adults

Stephen B. Levine, E. Abbruzzese & Julia W. Mason (2022) Reconsidering Informed Consent for Trans-Identified Children, Adolescents, and Young Adults, Journal of Sex & Marital Therapy, 48:7, 706-727, DOI: 10.1080/0092623X.2022.2046221

Abstract

In less than a decade, the western world has witnessed an unprecedented rise in the numbers of children and adolescents seeking gender transition. Despite the precedent of years of gender-affirmative care, the social, medical and surgical interventions are still based on very low-quality evidence. The many risks of these interventions, including medicalizing a temporary adolescent identity, have come into a clearer focus through an awareness of detransitioners. The risks of gender-affirmative care are ethically managed through a properly conducted informed consent process. Its elements—deliberate sharing of the hoped-for benefits, known risks and long-term outcomes, and alternative treatments—must be delivered in a manner that promotes comprehension. The process is limited by: erroneous professional assumptions; poor quality of the initial evaluations; and inaccurate and incomplete information shared with patients and their parents. We discuss data on suicide and present the limitations of the Dutch studies that have been the basis for interventions….

The Distortions in Jack Turban’s Psychology Today Article on ‘Gender Affirming Care’

Study 1 & 2

Reality’s Last Stand – Leor Sapir – 8 Oct 2022

According to Turban, the 2011 study showed “improvements in depression and global functioning following treatment,” but not in “feelings of anxiety and anger, gender dysphoria, and body satisfaction.” The 2014 study “found that psychological functioning steadily improved over the course of the study and by adulthood these now young adults had global functioning scores similar to or better than age-matched peers in the general population.”

Both articles are reports from the famous Dutch study. That study, however, suffers from serious internal difficulties, and even if these are ignored, its findings are almost certainly inapplicable to the majority of cases presenting at gender clinics nowadays. For good treatments of the problems on both fronts, I recommend this peer-reviewed article by Levine et al, who first categorized the Dutch study’s weaknesses, and this one by Michael Biggs, which explores the problematic origins of the practice. Because the Dutch study is still regarded as the gold standard in this area of medical research, it is worth describing some these problems in greater detail.

Regarding the study’s internal limitations, I will mention five…