Explosive growth in referrals
The number of referrals to Dutch gender clinics has risen sharply since around 2010, with a striking shift among young people: whereas boys used to make up the larger share, referrals now mainly involve teenage girls, some of whom have no history of gender variance in childhood. This pattern, described in the international literature as rapid-onset gender dysphoria (Littman, 2018), is still primarily explained in the Netherlands as “greater visibility,” but internationally it fits into a broader picture involving social and media-driven factors.
What the Radboud study found
In 2023, Radboud University, together with Radboudumc, published the report My Gender, Whose Care? on the growing demand for transgender healthcare. The study was commissioned by ZonMw and the Ministry of Health, Welfare and Sport. The researchers found that demand for care has grown sharply and that waiting lists are long, even though the supply of care has expanded considerably. Based on the available figures, they could not determine whether there are actually more transgender people than in the past. Media sociologist Peter Vasterman compiled the figures; see the articles on the growth of transgender healthcare since 2012 and on the number of young people who identify as trans or gender-diverse.
The visibility explanation
The report points to increased visibility. At the presentation on 10 May 2023, Professor of Communication Enny Das said that transgender people are making themselves seen and heard more, and that there is greater attention to and recognition of their place in society. As a result, others recognise themselves in their experiences and feel more able to express themselves. The researchers also mention minority stress: the mental burden of living in an environment that does not accept gender diversity. According to them, this demand for help is now ending up in specialist care, which was not designed to handle it.
The social influence explanation
Opposing this interpretation is the hypothesis put forward by American researcher Lisa Littman. In 2018, she described in the journal PLOS ONE young people whose gender dysphoria, according to their parents, had emerged suddenly around puberty, and suggested that peers and the internet might play a role. The study was based on parents’ accounts, not on research involving the young people themselves. Following criticism, the journal reassessed the article, and a corrected version was published in March 2019. Finnish professor of psychiatry Riittakerttu Kaltiala described a sharp increase in the number of girls presenting at her clinic, often with a history of mental health problems.
Why the composition of the group matters
The Dutch Protocol was studied in a small, carefully selected group. In the October 2023 Zembla broadcast, foreign doctors argued that the young people now seeking care differ from that group, meaning that the earlier findings cannot automatically be applied to them. Clinicians at Amsterdam UMC respond that, in the Netherlands, every step is preceded by extensive diagnostic assessment. More about this age group can be found on the page about young people.
Consequences for healthcare
The increase is affecting waiting times. According to Radboud University, in 2022 people seeking help with gender-related questions waited an average of two years before an indication for medical care could be established. Since early 2025, Amsterdam UMC has temporarily stopped scheduling intake appointments for new adult patients; see the archive article about the Amsterdam UMC gender clinic. How the healthcare system is responding is discussed in the article on waiting times and the healthcare system. An overview of the increase and the shift towards young girls can be found on transbeleid.nl, in the article about the increase in referrals.