Thomas Steensma

Thomas D. Steensma is a Dutch health psychologist with experience in counseling individuals with gender incongruence and supporting them in their medical transition.^[1] As one of the principal architects of the Dutch Protocol, his work has 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 Steensma, Professor of Pediatrics Peggy Cohen-Kettenis, pediatric endocrinologist Henriette Delemarre, and child psychiatrist Annelou de Vries.^[2] 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.

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]

In 2014, a follow-up study was conducted on some of the participants as well as new adolescents.^{[5] [Note 1]} After treatment with sex hormones and surgery, the same variables were measured as in 2011, as well as the subjective and objective well-being of the participants.^[5] The results showed that both the intensity of gender dysphoria and of anxiety and anger had decreased significantly at the end of the study.^[5] The subjective and objective well-being of the participants was comparable to that of their peers without gender dysphoria.^[5] Their measured well-being based on environment (i.e., support from parents, friends, access to health care, etc.) was even significantly better than that of the average Dutch adolescent.^[5] Based on the results of these two studies, De Vries et al. (2014) concluded that the protocol-based use of puberty blockers, followed by hormone treatment and gender reassignment surgery, improves the psychological functioning of transgender adolescents.^[5]