The so-called Dutch Protocol, first developed in the Netherlands in the 1990s, has been the foundation for prescribing puberty blockers to children diagnosed with gender dysphoria. For years, it was promoted internationally as a model of “best practice.” But the global picture today tells a very different story: one of growing restrictions, suspensions, and outright bans.
A Global Rollback
Countries that once adopted or tolerated the Dutch approach are now abandoning puberty blockers for minors after evidence reviews revealed poor outcomes, high risks, and low certainty of benefit.
- Sweden, Finland, Denmark, Norway, Belgium, Hungary, and the UK have restricted or banned puberty blockers outside of clinical trials.
- Russia, Chile, and Argentina have also halted or banned paediatric gender medicine.
- In Australia, Queensland has placed puberty blockers on pause pending review, and the National Health and Medical Research Council is conducting a federal review.
- New Zealand is also reviewing its policies.
- Even in the Netherlands, birthplace of the Dutch Protocol, officials have signalled a move away from this model.
Meanwhile, the United States has seen a wave of state-level bans, with over 20 states restricting puberty blockers for minors, and more legislation under consideration.
The Silent Majority: Countries That Never Allowed
It is important to remember that outside the small group of Western nations where the Dutch Protocol took hold, the vast majority of countries worldwide never adopted puberty blockers for children.
- Most of Asia (outside a few exceptions like Thailand, Japan, South Korea):
- In countries such as China, India, Indonesia, Malaysia, Philippines, Pakistan, Vietnam, etc., puberty blockers have never been licensed for use in gender dysphoria in children.
- Legal frameworks and cultural/political contexts do not permit paediatric gender transition.
- Eastern Europe and the Balkans:
- Poland, Hungary, Romania, Bulgaria, Serbia, Croatia and similar jurisdictions have not approved or provided puberty blockers for minors with gender dysphoria.
- In fact, several of these governments have enacted explicit restrictions on LGBT or trans medical interventions for minors.
- Middle East and North Africa (MENA):
- Countries including Saudi Arabia, UAE, Qatar, Egypt, Morocco, Algeria, Jordan, Lebanon have not authorised puberty blockers for gender dysphoria in minors.
- In many of these jurisdictions, homosexuality and transgender identities are criminalised, making gender-affirming care impossible.
- Most of Africa (except South Africa):
- South Africa is the only African country with some history of gender-affirming health services.
- Elsewhere (e.g. Nigeria, Kenya, Uganda, Tanzania), puberty blockers for gender dysphoria have never been part of healthcare services.
- Latin America:
- Some countries (e.g. Argentina, Brazil, Uruguay, Chile) have gender identity laws and gender-affirming care frameworks, including puberty blockers in certain clinics.
- But the majority (e.g. Mexico outside Mexico City, Peru, Colombia) either do not provide them, or never introduced them for minors.
- Russia & CIS countries:
- Russia, Belarus, Kazakhstan and other post-Soviet states have never permitted puberty blockers for gender dysphoria in minors.
- In fact, Russia recently banned “gender-affirming care” altogether for all ages.
Why the Protocol Was Never Necessary
The rationale for puberty blockers was always weak. Evidence now shows:
- Most children with gender distress (around 80–85%) naturally resolve their distress if supported through adolescence without medical intervention.
- Puberty blockers interfere with normal development of bone, brain, and fertility, with lifelong health consequences.
- The Dutch studies themselves were based on tiny, highly selected samples that cannot justify widespread medicalisation of children.
- No study can ever prove what a child “would have been” if left to normal puberty — meaning the science behind puberty suppression was always speculative.
Conclusion
The retreat from the Dutch Protocol is global and accelerating. Countries that once pioneered or embraced puberty blockers for children are now stepping back, while most of the world never allowed it in the first place.
Children do not need experimental drugs to halt their healthy development. What they need is compassion, psychological support, and time to grow into themselves without irreversible medical interventions.
The Dutch Protocol should not be celebrated as a medical breakthrough — it should be remembered as a cautionary tale.
References:
Journal of Sex & Marital Therapy (2023). The Myth of “Reliable Research” in Pediatric Gender Medicine: A critical evaluation of the Dutch Studies—and research that has followed. https://www.tandfonline.com/doi/full/10.1080/0092623X.2022.2150346#abstract
Cass Review (UK, 2024). Final Report. NHS England Independent Review of Gender Identity Services for Children and Young People. https://webarchive.nationalarchives.gov.uk/ukgwa/20250310143933/https://cass.independent-review.uk/home/publications/final-report
Sweden (2022). National Board of Health and Welfare. Guidance on care of children and adolescents with gender dysphoria. https://segm.org/Swedish-2022-trans-guidelines-youth-experimental
Finland (2020). Council for Choices in Health Care (COHERE). Recommendation on gender dysphoria treatments for minors. https://segm.org/sites/default/files/Finnish_Guidelines_2020_Minors_Unofficial%20Translation.pdf
Norway (2023). Norwegian Healthcare Investigation Board (Ukom). Healthcare for children and adolescents with gender incongruence.https://pmc.ncbi.nlm.nih.gov/articles/PMC11976144
Forbes (2023). “Increasing Number of European Nations Adopt a More Cautious Approach to Gender-Affirming Care Among Minors.” https://www.forbes.com/sites/joshuacohen/2023/06/06/increasing-number-of-european-nations-adopt-a-more-cautious-approach-to-gender-affirming-care-among-minors
Bioethics Observatory (2024). “European policies regarding minors with gender dysphoria: A comparative analysis.”