Dutch committee acknowledges effects of gender drugs for minors while doubling down

A committee in the Netherlands has admitted that providing puberty blockers and cross-sex hormones to trans-identified youth can sometimes cause adverse medical and physical effects but declined to abandon the procedures despite international concerns about their long-term impact.

The Health Council of the Netherlands submitted a report to the Netherlands’ Minister of Health, Welfare and Sport titled “Transgender care for young people” on June 30. The report examines the impact of so-called gender transition procedures on minors with gender dysphoria, focusing primarily on puberty blockers and cross-sex hormones.

The report’s release comes amid international concern about the long-term impact of providing life-altering procedures to trans-identified youth, a practice pioneered in the Netherlands.

The document defends the Dutch Protocol, saying it relies on “a step-by-step exploration of gender identity with a broad psychological exploration phase, a multidisciplinary assessment, psychosocial support and consent, under guidance of a multidisciplinary team.”

The report suggests the Dutch Protocol did not work as well in England, where the National Health Service-commissioned Cass Review prompted a pause in prescribing puberty blockers and cross-sex hormones to minors, saying that the “reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress.”

Commenting on the Cass Review, the Dutch report claimed: “there often appeared to be no multidisciplinary care and insufficient attention was paid to any other causes of suffering.”

“The care provided there, therefore, didn’t correspond with the Dutch approach,” the researchers said. 

The report acknowledges research showing the adverse effects of gender interventions on the physical and mental health of trans-identified youth, while suggesting the negative consequences may stem from other factors as well.

It states that “Bone mineral density decreases during treatment” with puberty-blocking drugs and “recovery occurs after starting” cross-sex hormones but “does not always seem to be complete” in trans-identified males.

“There are also indications that the bone mineral density in this group also decreases independently of hormone treatment, possibly as a result of lifestyle factors,” the report added. “The long-term effects on osteoporosis and fracture risks are uncertain.”

Examining the impact of puberty blockers and cross-sex hormones on the height of trans-identified youth, the report notes a decreased growth rate following use of puberty blockers, while maintaining that “this largely seems to be overtaken” once cross-sex hormones are introduced.

“Some studies find no difference in the final height difference between treated and untreated adolescents,” the researchers wrote. “Other studies show that in treated adolescents the final equal height is more fitting with gender identity.”

Another adverse effect of puberty blockers identified in the report is an increase in fat mass.

However, the report contends that cross-sex hormones make an individual’s “body composition … more suited to gender identity,” as trans-identified males who take estrogen see their fat mass decrease, while trans-identified females who take testosterone see the opposite effect.

The report finds “no adverse effect” of puberty blockers on fertility, while admitting “there is still much to learn about the effects of the treatments on fertility.”

The committee describes research on “mental outcomes after treatment” with cross-sex hormones as “very limited” and credits puberty blockers with giving youth with gender dysphoria “better mental health.”

It cited studies finding “either no effect or a small negative effect” on the cognitive functioning of trans-identified youth following the use of puberty blockers and cross-sex hormones.

After asserting that “a lack of evidence should, of course, not be a license to completely recommending unproven treatments,” the committee said it does not intend to “recommend reorganizing healthcare” by abandoning the Dutch Protocol, claiming that “denying care is also harmful.” The report also expressed concern that “regret and detransition are being used to” restrict access to puberty blockers and cross-sex hormones.

The report comes as 27 states in the U.S. have banned some or all types of gender transition procedures for trans-identified youth, citing concerns about their long-term impact: Alabama, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia and Wyoming.

The American College of Pediatricians has warned that puberty blockers can cause “osteoporosis, mood disorders, seizures, cognitive impairment and, when combined with cross-sex hormones, sterility,” while listing potential side effects of cross-sex hormones as giving youth “an increased risk of heart attacks, stroke, diabetes, blood clots and cancers across their lifespan.”

The U.S. Department of Health and Human Services issued a 400-page report last year warning that gender interventions for minors “carry risk of significant harms including infertility/sterility, sexual dysfunction, impaired bone density accrual, adverse cognitive impacts, cardiovascular disease and metabolic disorders, psychiatric disorders, surgical complications, and regret.”

“Meanwhile, systematic reviews of the evidence have revealed deep uncertainty about the purported benefits of these interventions,” the HHS report stated.