Investigating the Netherlands Gender Affirming Care Policy (GACP) to Improve Transgender Youth Health Outcomes in the U.S.

Project Summary

This grant was awarded through E4A’s special Call for Proposals: Approaches to Advance Gender Equity From Around the Globe. The project team is investigating core components of the Netherlands’ (NL) Gender Affirming Care Policy (GACP) to determine which components might be best adapted for and implemented in U.S. settings.

Research Question(s)

  • How does the presence or absence of GACP components predict Transgender/Gender Minority (T/GM) youth health trajectories in the United States (U.S.) as compared to the Netherlands (NL)?
  • Which GACP components may be the most applicable/impactful for the U.S.?
  • How can these components be adapted for U.S. policy/care systems?


  • Produce an initial roadmap of policy and future research recommendations for adopting/adapting components of the GACP in the U.S. and a meaningful cross-cultural contribution to the evidence-base for T/GM youth policy and care.


Transgender/gender minority mental health related to: gender affirmation (i.e., the ability to affirm one’s gender identity, which may include social and time-dependent medical transition), and (2) environmental affirmation which depends on policies and practices that respect the gender identities of T/GM youth and afford social protections (e.g., in family, civic, legal, and educational settings).


The investigators are using a multi-method longitudinal approach, with parallel participation of T/GM youth and their families in the NL (N=60) and U.S. (N=60), as well as care and policy experts from both countries. A 3-stage Delphi consensus process with a NL and U.S. Expert Stakeholder Panel (N=14) is being employed to identify core components of the GACP for the U.S. Study findings will be presented to the Expert Stakeholder Panel who will complete a second Delphi process to identify consensus policy recommendations for the U.S.

Transgender flag draped over the back of a person at a pride festival
Grantee and Partner organizations

Children’s National Research Institute at Children's National Hospital
VU University Medical Center, Amsterdam, the Netherlands

Grant status
In Progress
Principal investigators
John Strang, PsyD
Anna van der Miesen, MD
Start date
Award amount
30 months
Stage of adaptation

Identification of the intervention’s core components & test transferability to the U.S.

Country of origin
The Netherlands
Translatable to
U.S. healthcare systems

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