How Dutch TV Appearances Normalized Gender Care Without Evidence

"We got a wave of patients who, because of the first television broadcasts, thought: that's me." That's what Jos Megens, then coordinator of the VU gender clinic in Amsterdam, said looking back on the late 1970s. He and endocrinologist Louis Gooren first appeared on Dutch talk shows such as Sonja Barend's and on Rondom Tien. Megens: the day after such a broadcast, the hospital's phone lines were "red hot". This account doesn't come from critics, but from the documentary Transgender Pioniers from the NPO program Andere Tijden, based on the broadcaster's own archive.

A clinical practice that sold itself on TV

It's an uncomfortable fact that rarely resurfaces in the official historiography of Dutch gender care: the flow of patients to the VU clinic did not grow primarily because general practitioners referred patients based on clinical criteria, but because people recognized themselves in what they saw on television. Megens himself calls it a "wave" — a word that fits public interest more than a carefully screened patient population. American investigative journalist Mia Hughes describes this mechanism in a recent essay for Genspect as a form of "iatrogenic" growth: the treatment practice itself generated the demand it subsequently answered. That is Hughes's interpretation, not an established fact — but the underlying events she describes can be independently found in the Dutch public broadcasting archive.

The backstory: Otto de Vaal and the Arnhem case

The roots go back even further. Amsterdam physician Otto de Vaal (1916–1993) had already publicly opposed the idea that transsexuality was a mental disorder from the 1950s onward, following a high-profile treatment case in Arnhem in 1959. According to Amsterdam UMC's own anniversary history, De Vaal founded the Stichting Genderfonds in 1972 together with plastic surgeon Philip Lamaker — the forerunner of the later VU gender clinic, where Gooren and later Peggy Cohen-Kettenis further built up the treatment practice that in 1998 culminated in the publication that became internationally known as the Dutch Protocol.

What's striking is what Amsterdam UMC's own retrospective does and doesn't tell. The piece describes international symposia and knowledge exchange between doctors as the driving force behind the clinic's growth, but leaves the domestic TV appearances — and their effect on patient influx — entirely unmentioned. The medical self-image is one of scientific development; the picture from the broadcaster's own archive is one of public recognition via the screen. Both sources concern the same period and the same people, but tell a different story.

What was never reassessed

Hughes points out in her essay that the medical-ethical approval the VU gave in 1976 for sex-change surgery was never fundamentally reconsidered afterward, not even when the clinic grew from a small-scale adult practice into a child and youth department with international reach. That is a strong claim that we have not been able to independently verify in an official committee report — the minutes of such decisions are not public — but the pattern fits what our own dossier on the Dutch Protocol shows: a treatment model that kept growing for decades as clinical practice before foreign oversight bodies — from the Cass Review to Sweden's SBU — began systematically scrutinizing the underlying evidence base.

That difference is relevant for the Dutch public, which has rarely stopped to consider exactly how societal acceptance of gender care came about here. Not through a step-by-step build-up of research evidence followed by public information — but through public information that ran ahead of the research evidence, with the practice itself subsequently read as proof of societal support.

Why this is more than history

This is not a story of bad intentions. Megens and Gooren acted from the conviction that they were helping people who had nowhere else to turn, and for some viewers, recognition on TV was undoubtedly the first step toward appropriate help. But the distinction between "many people recognize themselves in this" and "this treatment is scientifically substantiated" is precisely the distinction that, decades later, still had to be made at the Cass Review and Sweden's reassessment. Anyone wanting to understand why that happened so late must look not only at the clinical literature but also at the living room: at what was shown on Dutch television in the 1970s and 1980s, and what was accepted from it without further scrutiny. The archive of historical Dutch sources on this site deliberately places those two layers — the medical and the societal — side by side.

For those who want to follow the clinical next steps of this history — how the VU practice, after the 1980s, was further formalized into the protocol that gained worldwide adoption — an extensive reconstruction can be found at dutchprotocol.nl, covering the role of Cohen-Kettenis, Delemarre-van de Waal and Gooren in the period 1980–1990.

Sources

Andere Tijden (NPO), "Transgender Pioniers", episode 90. anderetijden.nl/aflevering/90/Transgender-Pioniers

Amsterdam UMC, "Hoe pioniers experts werden: 50 jaar transgenderzorg in Amsterdam UMC", 2026. amsterdamumc.org

Mia Hughes, "How the Dutch Normalized Medical Madness", Genspect, October 1, 2026. genspect.substack.com/p/how-the-dutch-normalized-medical

NTvG, "De eerste geslachtsveranderende operatie van vrouw naar man in Nederland", 1959/60. ntvg.nl