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Annelou L. C. de Vries is a Dutch child psychiatrist and academic at the Levvel Centre, Amsterdam UMC [1] [2] As one of the principal architects of the Dutch Protocol, her work had a major influence on the global understanding and treatment of gender dysphoria in children and adolescents.
The idea of using puberty blockers originated in the Netherlands and was developed by de Vries, Professor of Pediatrics Peggy Cohen-Kettenis, pediatric endocrinologist Henriette Delemarre, [2] and health psychologist Thomas D. Steensma. The first patient received these drugs in 1987. [3] Cohen-Kettenis collaborated with endocrinologists in Amsterdam, one of whom had experience prescribing gonadotropin-releasing hormone analogs, which were relatively new at the time. At the time, gender dysphoric teenagers had to wait until they were of age for cross-sex hormones, but the team proposed that earlier interventions might benefit carefully selected minors.[ citation needed ]
De Vries et al. (2011) published a cohort study of the first 140 adolescents who received puberty blockers and/or gender affirming hormones between 2000 and 2008. [4] The study group consisted of the first 70 adolescents who received puberty blockers: 33 born boys and 37 born girls. [4] All participants had experienced gender dysphoria since childhood, were supported by their environment, had no comorbidities that could influence the diagnosis, and had reached at least Tanner stage 2 or 3. [4]
The group was examined twice: shortly before starting puberty blockers and shortly before starting cross-sex hormones. [4] Various questionnaires were used to measure IQ, emotional and behavioral problems, depressive symptoms, the intensity of anxiety and anger, general psychological functioning, gender dysphoria, and body satisfaction. [4] Comparing the two measurement points showed that adolescents had significantly fewer emotional and behavioral problems shortly before starting gender-affirming hormones than before starting puberty blockers. [4] The participants also had significantly fewer depressive symptoms and improved their general psychological functioning. [4] No significant improvement in anger, anxiety, or gender dysphoria was measured. [4] Because puberty suppression reduces the associated stress of gender dysphoria, De Vries et al. (2011) concluded that it offers a valuable opportunity to give adolescents time to consider their gender identity and any subsequent medical steps. [4]
De Vries became known in the media for her working method through her appearance on the television program De Wereld Draait Door (DWDD) with Valentijn de Hingh, who was a teenager in transition at the time. [5] A year later she appeared again on DWDD, this time with three girls who wanted to transition to male. [6]
For the participants of the first cohort studies, the minimum age of twelve years was maintained. However, there was now discussion whether this was desirable. [7] [8] For example, de Vries et al. (2014) indicated that the age of twelve years could not be desirable for born girls, in whom puberty often begins before that age. [7] In 2017, the Endocrine Society published its recommendations for the clinical management of gender dysphoric individuals. [9] They abandoned the minimum age and recommend the use of puberty blockers from Tanner stage M2 or G2 in the development of sexual characteristics. [9] This recommendation was adopted in the Netherlands by 2018 at the latest. [10]