“I bet being trans in The Netherlands is like living in the future”: Could The Netherlands serve as an imperfect “gold standard” comparator for transgender youth research in the United States?

Background: In available comparative studies, Dutch transgender youth have consistently shown better psychosocial well-being compared to those in other countries. Therefore, the Netherlands (N.L.) could be considered a gold-standard—though imperfect—comparator for transgender youth research. The United States (U.S.) is heterogeneous in its policies and practices impacting transgender youth, and policies are in flux. This study examines similarities and differences between U.S. and Dutch policies, practices, and contexts relevant to the well-being of transgender adolescents. Methods: A three-stage Delphi procedure was conducted with expert panels in the N.L. and U.S. Results: This process identified candidate mechanisms driving differences in outcomes for transgender youth between the countries, including: (1) training provided to Dutch students and schools to promote acceptance and understanding of gender diversity; (2) availability of gender specialists for Dutch youth; (3) insurance coverage of broad gender-related services in the N.L., compared to inconsistent coverage in the U.S. and numerous state care bans; and (4) a Dutch public that is largely accepting of gender diversity, with historical roots of acceptance dating back three decades. Discussion: Study findings indicate intersectional racial inequities remain inadequately addressed in both countries. Primary ongoing needs in each country and novel approaches to improve outcomes are discussed.