The “Dutch protocol” has long been heralded as the gold standard in youth gender transitioning by proponents of “gender-affirming care.” A new scientific paper, published last week in the Journal of Sex & Marital Therapy, discussed the origins of pubertal suppression in children with gender dysphoria and reviewed what we know and don’t yet know about the controversial practice.
The protocol was first proposed in the mid-1990s. Puberty blockers could be prescribed at the beginning of Tanner Stage 2, a developmental stage that is accompanied by the first signs of pubic hair growth, as well as breast budding in girls or testicle growth in boys.
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var _bp = _bp||[]; _bp.push({ "div": "Brid_64205652", "obj": {"id":"27789","width":"16","height":"9","video":"1105672"} }); ","_id":"00000183-7a63-d948-a3b3-fe7b416e0000","_type":"2f5a8339-a89a-3738-9cd2-3ddf0c8da574"}”>Video EmbedCross-sex hormones were previously unavailable to a child until the child was granted a referral to an adult gender clinic. This usually happened between the ages of 16 and 18, and these referrals were rare. Surgeries were not performed before the age of 18. Over time, the recommended minimum ages have gotten younger, and they were altogether removed in the latest iteration of the WPATH guidelines.
Puberty blockers halt the bodily changes associated with puberty temporarily so that a child can decide which gender they want to live as.
However, over 95% of those who choose to block their puberty will continue on to cross-sex hormones. Research has shown that puberty blockage is associated with lower bone density. Animal models have documented differences in spatial memory and stress response. We don’t yet know the long-term effects on sexual desire or functioning. A newer application has emerged more recently that consists of suppressing puberty indefinitely to facilitate a “nonbinary” appearance.
When we consider global trends, the United Kingdom and Europe have been moving in a different direction, exercising greater caution and skepticism in their approach to treating children with gender dysphoria. North America, on the other hand, continues bulldozing the other way. Parents need to know they are justified in their concerns despite the browbeating and bullying they may encounter from professionals in the field, the media, and wider society.
I believe that many of those facilitating this approach believe that they are doing the right thing for these children. Treatment, especially for vulnerable populations, should always be informed by scientific evidence, even if it runs contrary to a patient’s requests. Any treatment approach that fails to do so will not lead to good outcomes for anyone.
Dr. Debra Soh is a sex neuroscientist, the host of The Dr. Debra Soh Podcast, and the author of The End of Gender: Debunking the Myths About Sex and Identity in Our Society.
