Michael Biggs reviews history of the Dutch Protocol

The Department's Associate Professor Michael Biggs has reviewed the history of the Dutch Protocol: a proposition by Dutch clinicians to use puberty suppression as an intervention for “juvenile transsexuals”, a practice which has now become the international standard for treating gender dysphoria.

The article was published in the Journal of Sex & Marital Therapy, a leading journal in the field of human sexuality.

Dr Biggs analyses the history of this intervention and investigates the evidence cited to support it. The paper argues that the Dutch Protocol was originally justified by claims that it was reversible and that it was a tool for diagnosis, however, recent evidence challenges this. 

The main evidence for this practice came from a longitudinal study of 70 Dutch adolescents who had undergone puberty suppression followed by cross-sex hormones and surgery. Their outcomes shortly after surgery appeared mostly positive: an improved psychological function and reduced gender dysphoria. However, these findings rested on a small number of observations (much fewer than 70) and incommensurable measures of gender dysphoria. A replication study conducted in Britain found no such improvement in gender dysphoria or psychological functioning.

The paper also evaluates the side effects of puberty suppression. While some effects have been carefully studied, such as on bone density, others have been ignored. There is now increasing evidence for negative effects on cognitive and emotional development and on sexual functioning.

The full article can be read here.

A magnifying glass resting on top of graphs and a laptop


Original Publication

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