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European rollout

Between 2010 and 2020, Europe largely followed the gender-affirmative model — until Scandinavia and the UK applied the brakes based on their own evidence reviews. In the Netherlands, the Health Council advised in June 2026 on transgender care for young people (source).

Rollout 2010–2020

The Netherlands led the way with the VUmc protocol (see Dutch rollout ); according to the Cass Review, the Dutch Protocol was subsequently adopted in the United Kingdom and internationally (source).

The Scandinavian Turnaround (2020–2024)

Sweden was first. The Statens beredning för medicinsk och social utvärdering ( SBU ) published a systematic review in 2022 which concluded that the evidence is insufficient to assess the effects of puberty blockers and hormones on gender dysphoria and psychosocial wellbeing (source). In December 2022, the Swedish National Board of Health and Welfare (Socialstyrelsen) issued guidance recommending medical treatment of minors only within a research protocol or in exceptional cases (source).

Finland (guideline, 2020) advises extreme caution with puberty blockers under 18 according to the Cass Review (source), and the Norwegian commission Ukom recommended in March 2023 that puberty blockers and hormonal and surgical treatment be defined as "utprøvende behandling" (experimental treatment; Ukom 2023; source). According to the Cass Review, the Finnish and Swedish guidelines are the only international guidelines that could be recommended for use in practice (source).

The UK: Cass Review (2024) and Tavistock closure

The United Kingdom closed the Tavistock GIDS clinic on 31 March 2024 (source) (see Tavistock closure ). The Cass Review recommended a holistic assessment, standard evidence-based psychological treatment of the associated distress and co-occurring conditions, and puberty blockers only within a research protocol (source). According to the Cass Review, the evidence base for puberty blockers and hormones in young people is weak (source; see the specific page). NICE (2020) had already laid the foundation; its review of puberty blockers rated all results as very low certainty (source).

The Netherlands and Germany

In the Netherlands, minister Dijkstra wrote to the House of Representatives on 4 June 2024 that the situation in the United Kingdom is not directly comparable to that in the Netherlands and that the conclusions of the Cass Review, where relevant, will be taken into account in the revision of the quality standard (source). In June 2026 the Health Council concluded that somatic treatment of young people with gender dysphoria fits within the legal framework for healthcare, but also wrote that the strength of evidence is low to very low and that long-term data are lacking (source). In 2024 Germany adopted the Selbstbestimmungsgesetz, under which the gender entry can be changed by declaration since 1 November 2024; the law does not regulate medical treatment (source).

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