In a landmark two-year review, the Health Council of the Netherlands—the country’s highest scientific advisory body—has delivered its verdict on gender affirming care for transgender youth. The council’s conclusions were universally positive for gender-affirming care: it endorsed the treatments as careful, lawful, and effective, framed quick access as a matter of the right to health, warned that “doing nothing” is harmful, cast aside the Cass Review as not applicable to Dutch care, reported zero cases of regret among trans youth patients, and called the reduction of the country’s years-long wait times “morally urgent.” In doing so, the Netherlands becomes the latest in a series of European countries to reaffirm and strengthen care for transgender youth, refuting a right-wing talking point in the United States that Europe is “pulling back.”
The review was commissioned in May 2024 in the wake of the Cass Review. The Health Council’s committee ran systematic literature searches and consulted outside clinical experts chosen for their differing perspectives on the care—a list that included Hilary Cass herself. The panel was chaired by Olaf Dekkers, a Leiden University Medical Center professor of internal medicine whose academic specialty is research methodology, and seated professors of health law and medical ethics alongside practicing physicians and psychiatrists. From that foundation, the committee dismantled the argument at the center of the American campaign against this care—that the evidence is too weak to justify treatment—answering that the evidence quality for trans youth care is in line with the norm across pediatric medicine, and that doing nothing carries documented harms of its own, pointing specifically to harms produced by America’s own care bans.
The committee concluded that the care is lawful and careful, and that it works as intended, stating in its summary: "The committee concludes that somatic treatment for young people with gender dysphoria fits within the health law framework. It further finds that scientific research shows the intended physical effects are achieved, that there are indications of some improvement in mental outcomes, and that the number of cases of regret is low. In the committee's view, the current data on unintended physical and mental effects are not cause for concern."
The advisory also rejected the framing that treating transgender youth is a risky intervention while not treating them is a neutral default. Delaying care, the review found, carries its own harms: youth develop unwanted and often irreversible physical changes—some of which can only be undone later with surgery—while mental health suffers in the meantime, and some young people locked out of careful care turn to unregulated hormones on their own. The committee's answer, in a passage aimed directly at that framing, calls the reduction of wait times a moral imperative: "Non-treatment is therefore not a neutral option. In the public debate, treating is often presented as intervening, while waiting is treated as self-evident. From the perspective of autonomy it becomes clear that delaying or withholding care also has consequences for young people's lives and their developmental possibilities—and that those consequences are morally relevant. From that perspective, shortening the waiting times is morally urgent."
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