The clinical lesson 'Youth with gender incongruence' by Dutch gender clinicians aims to describe Dutch adolescent gender care and its dilemma's. This commentary discusses five serious objections. First, the lesson fails to draw the implications from its acknowledgement of the paucity of evidence: puberty blockers and cross-sex hormones most likely do not meet the requirements for standard care. Second, it does not make the crucial distinction between childhood and adolescent onset gender dysphoria. Third, its claim that from those children that continue from GnRHa to cross-sex hormones '98% continues to use these hormones in the long term' is unfounded. Fourth, it does not acknowledge the dilemma that puberty blockers may impede, rather than facilitate, time for reflection. Fifth, it inaccurately represents the literature on the potential detrimental effects of GnRHa on brain development. The commentary concludes with a call to reform Dutch gender care, following the examples of Sweden and Finland.