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Transgender Network
Atlantisplein 1
Room 2.14
1093 NE Amsterdam
+31 20 205 0915
info@transgendernetwerk.nl
www.transgendernetwerk.nl

At:

the General Manager of BNNVARA, Lonneke van der Zee

the Chairman of the Board of Directors of the NPO, Frederieke Leeflang
the Ombudsman for Public Broadcasting, Margo Smit

Copy to:
the Zembla editor-in-chief, Manon Blaas

Re:

Urgent letter regarding the upcoming Zembla episode about transgender care, scheduled for October 26

October 24, 2023

Dear Lonneke van der Zee, Frederieke Leeflang and Margo Smit,

“We envision a world with equal opportunities for everyone.” That is stated in the mission of BNNVARA. We as the
Transgender Network can only agree with this. Unfortunately, we are increasingly seeing threats to equal opportunities
becoming mainstream for transgender people. We regret to note that various media also play an active role in this.

We are sending you this urgent letter because we fear that an upcoming broadcast of the investigative
journalism program Zembla will also (possibly unintentionally) contribute to this.

Of course we hope that the editors of Zembla will follow the journalistic codes1 and Guidelines2 and that one-sided
reporting on transgender care will not be an issue. The signals we receive from
However, some interviewees have raised serious concerns for us. Moreover, we know Zembla as the program that in
December 2018 amplified the personal story3 of one person with regrets about a medical transition - which does not rule
out the possibility that mistakes were made in the care provided - to generate suggestions about the quality of the entire
transgender care4 .

By means of this letter we would like to call on you as NPO, BNNVARA and the ombudsman to critically assess the
broadcast and to provide you with information for a balanced assessment of this broadcast. In addition, we urgently appeal
to the public broadcaster not to do so

1
CodeofBordeaux
2
Guideline2022
3
Zembla – Transgendermetregret,19-12-2018
4
Transgender Network, Response to Zembla broadcast about regret among transgender people (2018)

The Transgender Network Netherlands Foundation is committed to an inclusive society in which gender-diverse people can live
freely and safely and in which everyone is given the space to differ.
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to become a negative influence in a culture battle for the right to exist and the right to access care of
transgender adults and young people.

Assessment of the facts

Before the broadcast in the Netherlands, Zembla spoke with Transvisie5 and Sabine Hannema and Annelou
de Vries from the Amsterdam UMC. We understand from them that the editors of Zembla have also interviewed
people in England, Sweden and Finland about transgender care for minors.
These three countries were not chosen at random: they also regularly appear in the House of Representatives
in questions about transgender care from parties such as SGP and JA21, because in these countries the
guidelines and advice for transgender care for minors have recently been tightened. In addition, both Sweden and
England are characterized as countries where the media is extremely negative, even stigmatizing, about
transgender care for minors.

By (pending) tightening of their guidelines or advice, all three of these countries deviate from the international
standard for transgender care established by the international professional organization of professionals
in transgender care (WPATH)6 . We understand that this trend may raise questions about Dutch practice that
does follow the international standard.
At the same time, the tightening of guidelines and advice from these three countries could also be critically
examined. Our experience shows that the latter often does not happen or does not happen sufficiently, and the
background and context of the retreating movement with regard to transgender care in these countries is not
highlighted by the media. Instead, pointing out these three countries in the media seems to be used solely as
criticism of the Dutch approach ('Dutch protocol').
This only makes those countries instrumental in stirring up a fuss and sowing doubt about transgender care in
the Netherlands, instead of attempting to provide a thorough explanation of all developments surrounding
this care.

You as broadcasters and ombudsman are most likely not experts on this subject.
That is why we take you through what transgender care is all about, what is known about
puberty blockers and the developments in the three countries mentioned above. We will address a number
of misconceptions that are circulating and correct them immediately.

Gender incongruence

1. First, it is important to realize that gender incongruence cannot be objectively determined

set. Whether someone is transgender, including a child, is always up to the person to be aware of

5
Transvisie is the national patient organization for transgender people within transgender healthcare, it
organizes contact groups for various target groups and promotes collective interests in the field of healthcare.

6
WPATHStandardsofCare11

The Transgender Network Netherlands Foundation is committed to an inclusive society in which gender-diverse people
can live freely and safely and in which everyone is given the space to differ.
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to become. As for gender dysphoria, which concerns psychological suffering due to the
incongruence between physical sex and gender identity, its characteristics can be determined through
questionnaires or psychological research.
2. Gender incongruence and gender dysphoria in themselves are not reasons to treat someone medically.
This is only possible based on an individual treatment wish, also for minors7 .
In accordance with the Medical Treatment Agreement Act (WGBO), the patient must be fully informed
about the treatment options before decisions can be made. The Dutch quality standard for somatic
transgender care imposes an additional criteria that someone must be assessed by a psychologist or
psychiatrist and discussed in a multidisciplinary team. Moreover, as with any other medical specialty,
diagnostics and treatment in transgender care and the development of medication are closely monitored and
adjusted where necessary, precisely on the basis of scientific insights and consideration of possible
negative and positive consequences of treatment.

Puberty blockers

3. The primary aim of puberty blockers in children with gender incongruence is to reduce puberty
prevent the development of secondary sexual characteristics (such as breasts, low voice, facial hair) that do
not match gender identity. Various (overview) studies show that it also has positive effects on psychological
well-being. This is an intended effect because it removes the worsening of gender dysphoria and the fear of
developing unwanted sexual characteristics. Puberty blockers are obviously not the only factor that has an
effect on the well-being of transgender young people. Gender-affirming care, hormones (from age 16) and
operations (from age 18) are known to clearly improve mental well-being by clearly reducing gender dysphoria.
8 9 10 11 12 13 14

4. Like any medicine, puberty blockers can cause side effects, which is why there are guidelines
for health monitoring. There has been several decades of experience with the use of puberty blockers in
children with premature puberty and these medications

7
Up to the age of 12, parents/guardians (those who have parental authority) decide. From 12 to 16 years (from 15 to 15
years), permission from both young people and parents/guardians is required. From the age of 16, the young person
decides and parental consent is not legally required.
8
Holt,MK,Parodi,KB,Elgar,FJ etal. npjMentalHealth, 2,10 (2023)Res
9
VanderMiesenetal. Journalofadol;escenthealth (2020)66(6):699-704
10
Kuperet al. Pediatrics (2020) 145 (4): e20193006
11
Chenetal. NewEnglandJournalofMedicine (2023)92023,388(3):240-250
12
DeVriesetal. Pediatrics (2014)134(4):696-704
13
Becker-Heblyetal. European Child & Adolescent Psychiatry (2021) 30(11):1755-1767
14
Achilleetal. Int.Journal of PediatricEndocrinolology (2020);2020:8

The Transgender Network Netherlands Foundation is committed to an inclusive society in which gender-diverse people
can live freely and safely and in which everyone is given the space to differ.
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are generally considered safe15. Negative health consequences are reversed by (adequate monitoring
of health and) the onset of the body's own puberty or puberty induced by cross-sex hormones16.

Counseling regarding medical preservation of fertility is mandatory before starting puberty blockers.

5. The call for research into the effects of puberty blockers from the highest
quality rating by critics of transgender care for minors is not only met with the observation that this is
considered unethical. The fact that no double-blind placebo-controlled randomized trials have been
done does not mean that there are none
evidence for the treatment or whether it should not be offered. Such trials have not been done for a wide
range of other care either. It speaks of a double standard and thus points to non-scientific motives for
holding transgender care to account for this.17

Sweden, Finland and England

6. Countries such as Sweden and Finland have long been characterized as reluctant to provide transgender
care, and their apparent deviation from the 'Dutch protocol' cannot therefore be taken as a benchmark
for the state of affairs in transgender care. For example, both countries only started medical
transgender care for puberty children more than two decades after the Netherlands. The removal
of major obstacles to access to care naturally led to an explainable increase in registrations in both
countries over the past ten years.
Just like in the Netherlands, there is no data in those countries about the extent of the need for
transgender care to remove those obstacles.
7. Restricting transgender care for adolescents in England cannot be seen separately from the poor state of
youth transgender care, with waiting lists of three years and poor internal relations at the only clinic in
England (GIDS Tavistock), and a political climate in which transgender rights and care are under
an extremely negative magnifying glass.18

8. No new evidence has been presented in any of the countries, nor outside these countries, that
puberty blockers are so harmful that prescribing them is irresponsible. Only a reverse burden of proof
is used, which is not standard for other types of care.

15
BangaloreKrishnaetal. HormoneResearchinPaediatrics. (2019)91(6): 357-372
16
Claahsenetal. Dutch Journal of Medicine (2023)167
17
McNamaraetal. ACriticalReviewoftheJune2022FloridaMedicaidReportontheMedicalTreatmentof
Gender Dysphoria (2022)
18
J.Rigby,R.Respaut,C.Terhune(2022) England'stransteens,lostinlimbo,facemountingbarrierstocare, Reuters

The Transgender Network Netherlands Foundation is committed to an inclusive society in which gender-diverse people
can live freely and safely and in which everyone is given the space to differ.
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We want to exclude every risk whereby the risk of damage due to failure to provide care is ignored or
minimized.
9. The Cass Report from England relies on the NICE review to assess the evidence
for use of puberty blockers. The conclusion that no policy recommendation can be made based on
that evidence does not correspond with the assessment of the WPATH (World Professional
Association of Transgender Health). Moreover, it is not known which 'experts' conducted the review
and it cannot therefore be ruled out that political or ideological considerations played a role in the
design and analysis of the review.19

Increase

10. The increase in the demand for care from young people can most likely be explained by the removal
of barriers through reduced stigma and better access to care. The so-called 'sex ratio' is
generally balanced among trans people. This also applies to transgender care as a whole.
The fact that the times at which transgender girls enter care differ from transgender boys is an indication
of distinguishing factors that influence access to care20 21. There is no question of a so-called
explosion of trans boys, according to the WPATH in its new Standards of Care.22

Creating a controversy

Anyone with knowledge of the origins of the criticism of transgender care for minors knows that this has little to
do with science. Our experience is that journalists say that they do not want to give a platform to extreme,
ideologically motivated actors, but that in practice this rarely happens or succeeds. This may have several
reasons, but an important reason is that people are insufficiently aware of the motivations of the 'critical'
actors and how they present themselves as reasonable and expert under the name of science.

An example of someone who, according to our information, also appears in the Zembla broadcast is Dr.
Riittakerttu Kaltiala-Heino. This Finnish psychiatrist at Tampere University is an outspoken opponent
of gender-affirming care for minors. She is internationally known as a scientist who associates herself with well-
known conversion therapy advocates (such as

19
EJEckert(2021)
ConclusionsNotSoNICE:ACriticalAnalysisoftheNICEEvidencereviewofpubertyblockersforchildrenandadolescentswithgenderdysphoria
20
F. Ashley(2019)TheJournalofSexualMedicine, 16(6): 948–949
21
J.Serano(2022) ExplainingAssignedSexRatioShiftsinTransChildren
22
WPATH (2022) StandardsofCarefortheHealthofTransgenderandGenderDiversePeople,Version8

The Transgender Network Netherlands Foundation is committed to an inclusive society in which gender-diverse people
can live freely and safely and in which everyone is given the space to differ.
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Stella O'Malley of Genspect23) and the pseudo-scientific SEGM2425 , which, together with well-known
hate groups in the United States, are driving the ban and criminalization of transgender care for minors. In a
hearing before the Florida Board of Medicine, Kaltiala-Heino also personally recommends conversion therapy
for transgender minors26. She cannot prove that this psychotherapy is an alternative to puberty blockers.
Nevertheless, the Board severely limited access to transgender care. Florida is now one of the most radicalized
states in terms of transgender care and families and adult trans people are fleeing to other states
for their care and their own safety.

The United States has a long tradition of anti-LGBT groups masquerading as scientific organizations.
Members of, for example, SEGM and ACPeds27 28 29 are actively creating doubt about this care in
their ideologically and religiously motivated struggle against transgender care. Criticism of transgender care for
minors would not be so widespread in politics and the media if these organizations had not existed. In countries
where there is already a conservative movement regarding transgender care or transgender people (in society,
politics, media or science), such as England30, Sweden31 and Finland32 , they find supporters and a breeding
ground for spreading their apparently 'serious' doubts about puberty blockers. Neighboring countries
can then be pointed out where stricter guidelines and advice on puberty blockers are published.
Republican politicians in the US camouflage their ideological motives for banning transgender care for minors by
finally pointing to the once liberal European countries that have now 'repented'33.

We are concerned that Zembla editors may not see through this and, based on the controversy over puberty
blockers, think that something is really going on in the quality of that care. We would therefore like to urgently
point out that this 'controversy' has a political nature that is now gaining momentum

23
E.Piper(2023) EXCLUSIVE:'Focusrelentlesslyonunder25':Leakedchatsrevealinfluentialgender-critical
group's plantousechildrentopushforbansontransitioning, DailyDot
24
ScientistsforEvidence-basedGenderMedicine.
25
A.Caraballo(2023) Theanti-transgendermedical-expertindustry, CambridgeUniversityPress L.
26
LeveilleandQ.McLamore (2022) LivecoverageofFloridaBoardofMedicine28October2022anti-
transrulemakingmeeting, GenderAnalysis
27
ACPed is an abbreviation of American College of Pediatrics
28
M.Pauly(2023) InsidetheSecretWorkingGroupThatHelpedPushAnti-TransLawsAcrosstheCountry.
MotherJones
29
SouthernPovertyLawCenter(SPLC), AmericanCollegeofPediatricians
30
T.John(2021) Anti-transrhetoricisrifeintheBritishmedia.Littleisbeingdonetoextinguishtheflames, CNN
31
R.Orange(2020) TeenagetransgenderrowsplitsSwedenasdysphoriadiagnosessoarby1,500%, TheGuardian
32
JHonkasalo(2018) JournalofInternationalWomen'sStudies, 20:40-52
33
K.Klapsa(2023) TherealstoryonEurope'stransgenderdebate, Politico

The Transgender Network Netherlands Foundation is committed to an inclusive society in which gender-diverse people
can live freely and safely and in which everyone is given the space to differ.
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gains momentum from media attention. For example, the Bell v. Tavistock case in England led to the
sudden decision by Sweden's Karolinska Hospital to stop caring for transgender children. The decision in
the lawsuit, which was reversed on appeal, relied heavily on the expert claims of Paul Hruz34, a diabetes
specialist who has no expertise in transgender care.
He is, however, affiliated with the National Catholic Bioethics Center35, a Christian organization that spreads
pseudoscience. This came amid the fuss caused in Sweden by the docu-series of the public broadcaster
SVT, called Trans tåget. Socialstyrelsen's recommendation that the benefits outweighed the risks subsequently
did not materialize in 2021, but advice with reverse reasoning followed in 202236. Moreover, the advice was
based on research into social contagion (Rapid onset gender dysphoria), which does not hold up37, and of
which the researcher also associates himself with leading figures in the conversion therapy agenda38 39. The
makers of the successor to Trans tåget, Transbarnen, praised themselves for this decision by
Socialstyrelsen. The development in Sweden is an example of how not science but bad faith actors such as
Hruz and journalists who see controversy negatively influence transgender care.

So even though the Zembla editorial team does not want to give a platform to extreme voices40
against transgender care, such as those that are politically rampant in the United States, it can only
be concluded that this policy still trickles down to media makers and influences reporting. For example,
the media have helped create barriers to accessing necessary care for transgender children in England,
Sweden and Finland. We as the Transgender Network want to ensure that this also has consequences for
healthcare in the Netherlands. An evaluation of the Dutch quality standard for somatic transgender care is
now in the final phase and an update for a new standard will start this year. Due to the above, influencing
this necessary improvement in quality standards through controversy stirred up in the media is not in the interest
of tackling the real problems in transgender care. Such as the long waiting lists, the unnecessary medicalization
of transgender people and the lack of expert support for trans people outside the medical specialist field.

We therefore call on BNNVARA and the NPO to learn from the mistakes made elsewhere and to discuss the
pitfalls associated with reporting on transgender issues with experienced experts from the transgender
community. Should the Zembla

34
TransSafetyNetwork(2020)QuestionableexpertiseatBellvTavistock https://
35
www.ncbcenter.org/our-fellows
36
HealthLiberationNow!(2022) Fact-check:AboutSocialstyrelsen'sDecisionandTransCareinSweden
37
T.Broderick(2023) EvidenceUndermines'RapidOnsetGenderDysphoria'Claims, ScientificAmerican
38
HealthLiberationNow (2023) Anti-transconversiontherapymapofinfluence
39
https://icgdr.org/about/
40
Orally learned from contactperson atAmsterdamUMC

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broadcast gives rise to an official complaint, we will certainly do so, just as the RFSU in Sweden41 was recently
forced to file a complaint against the public broadcaster's (SVT) latest attack on transgender care.
Regardless of whether there is a complaint, we hope for introspection at the NPO and BNNVARA
about the handling of controversies regarding transgender rights and care. If you wish to respond
to this letter, we would certainly appreciate it and will share your response publicly, just like this one.

Yours sincerely,

Aafke Owlhorn
Board member of Care & Welfare

Elise van Alphen

Director

Sophie Schers
Policy advisor

41
RFSU:DärföranmälerviSVT:s “Transkriget”tillgranskningsnämnden (2023)

The Transgender Network Netherlands Foundation is committed to an inclusive society in which gender-diverse people
can live freely and safely and in which everyone is given the space to differ.