In late June, the Health Council of the Netherlands, an independent scientific advisory body, issued controversial guidance in support of the so-called “Dutch Protocol,” which provides hormonal interventions to children suffering from gender dysphoria. The protocol, pioneered in the Netherlands in the late 1990s, has been exported around the Western world through clinical practice guidelines developed by the controversial World Professional Association for Transgender Health (WPATH).
“Research shows that hormone treatments physically achieve their intended function and appear to improve mental health,” reads the Health Council’s press release. The council’s conclusion, however, clashes with the findings of several systematic reviews. These reviews have prompted medical-practice reversals by early adopters of the Dutch protocol like Finland and Sweden, as well as demands for an independent evaluation by the Dutch House of Representatives.
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That the Health Council rubberstamped the protocol is a signal example of the problem of regulatory capture in the field of youth gender medicine. Such capture occurs when a regulatory body becomes so dependent on the sector it regulates for specialized expertise and policy guidance that it ends up functionally serving that sector’s interests. Journalist Bernard Lane’s incisive summary of the situation could apply to any number of decisions by regulators of pediatric gender medicine: “A Dutch committee recites the reasons to rethink the gender medicalization of minors, then sees no reason to act.”
The capture starts with the Health Council itself. Six of the twelve members of its Advisory Committee were either directly or indirectly involved with providing endocrinological interventions to dysphoric minors. While two of these advisors lacked voting rights, they still possessed the ability to shape the nature of the conversation. The heavy representation of gender medicine practitioners on the committee, Dutch law professor Lodewijk Smeehuijzen argued, effectively amounts to asking the field’s practitioners to evaluate both their own work and that of their friends and colleagues. That may even amount to a violation of the Health Council’s formal policies for avoiding conflicts of interest.
The potential conflicts of interest should be obvious. The developers of youth gender medicine, the Netherlands’ University Medical Centers, which are represented among the council’s advisors, risk tremendous reputational fallout. Practitioners, also represented, have vested professional and personal interests in maintaining the status quo. A finding that the Dutch protocol clashes with the requirements of the Netherlands’s health-law framework could threaten their medical practices and subject them to liability for malpractice in future civil and disciplinary proceedings.
It is not surprising, then, that these gender clinicians continue to endorse the clinical merits of “affirming care,” even in the face of only “low quality” supporting evidence, ethical concerns over “informed consent,” and a general confusion about exactly what condition they’re treating in the first place.
The Netherlands is not alone. Such regulatory capture is the rule, not the exception, in youth gender medicine.
Similar issues have plagued, for example, the World Health Organization’s controversial guideline-development process for gender medicine. The panel responsible for developing those guidelines was stacked with members who have unresolved conflicts of interest in favor of preserving “affirming care,” including multiple members of WPATH. The WHO, critics argued, was effectively working backward from a predetermined policy objective: expanding access to treatment. The pushback was enough to make the WHO announce that it would limit its guidelines to adults and concede that the evidence for child and adolescent transition is “limited.”
Similarly, gender medicine endorsements by U.S. medical associations like the Texas Medical Association and the American Academy of Pediatrics are often shaped by members specifically selected because they are also members of groups devoted to “LGBTQIA” issues, or because of their specific expertise in “affirming care.” A single “affirming” pediatrician, Jason Rafferty, drafted AAP’s controversial position statement on pediatric gender medicine. The organization renewed the statement in 2023 despite growing concerns abroad about the evidence.
You might not agree with the critics of youth gender medicine. But if those critics rely on the principles of evidence-based medicine, you can at least check their work. By contrast, when professional organizations prioritize “affirming” practice or therapeutic alignment over evidence, they fail to educate people about what’s best for them and their children.