Nearly 1 in 5 young people referred to Amsterdam UMC never started medical treatment

On 9 March 2026, the Centre of Expertise on Gender Dysphoria at Amsterdam UMC (VUmc location) published a study in the Journal of Sex & Marital Therapy that followed 1,470 young people consecutively referred to the clinic between 2009 and 2019. The researchers — Frédérique de Rooy, Femke Dekkers, Thomas Steensma, Arne Popma, Baudewijntje Kreukels and Annelou de Vries — wanted to find out which of these young people ultimately did not start gender-affirming medical treatment (puberty blockers or hormones), and why.

264 of the 1,470 young people stopped before treatment began

Of the 1,470 young people referred, 264 — 18% — never proceeded to medical treatment. The main reason, accounting for 38.3% of this group, was that further assessment did not confirm gender dysphoria. In another 27.7%, gender dysphoric feelings were present, but a diagnostic process proved unfeasible — for example, because other issues required attention first or because the young person dropped out. This means that almost two-thirds of the untreated group left the pathway for diagnostic or practical reasons, not because the clinic deliberately turned them away.

Less gender dysphoria, but more mental health problems

A striking picture emerges when the two groups are compared at intake. Young people who ultimately did not start medical treatment reported less severe gender dysphoria and a less negative body image at the outset than those who did begin puberty blockers or hormones. At the same time, the untreated young people scored higher on problems relating to overall psychological functioning. In other words, those who did not enter a medical pathway were not simply "healthier" — their broader psychological difficulties were actually more severe, while their specific gender dysphoria symptoms were less pronounced.

What this adds to the Dutch debate

In June 2026, the Dutch Health Council concluded that transgender care for young people in the Netherlands is "carefully structured", with extensive diagnostic assessment before every medical step. This VUmc study adds a concrete figure: of every five young people who enter the clinic, approximately one leaves the pathway without ever receiving puberty blockers or hormones, usually because the diagnosis of gender dysphoria did not hold up. This contradicts the image of a well-oiled process in which every referral automatically leads to medical treatment.

At the same time, the study shows that the group that drops out cannot simply be dismissed as a "false alarm": their broader psychological difficulties were actually more severe than those of the group that did receive treatment. This raises the question of what happens to these young people after their gender-related care ends, and whether the care they receive following dropout is tailored to them just as well as the gender-affirming care provided to those who continue through the pathway. The study itself does not answer that question, but it does provide the first detailed account of the size and profile of this group.