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Gender care in Belgium

Belgium largely follows the gender-affirmative model that has come under pressure in neighbouring countries. The university centres in Ghent, Leuven and Brussels apply the WPATH guidelines, while Belgian legislation has for years been among the most liberal in Europe. The international recalibration — the Cass Review in the UK, the SBU report in Sweden, the COHERE guideline in Finland — has reached the Belgian debate, but so far has not led to a formal change of course.

Care provision and centres

Specialised gender care in Belgium is concentrated at the university hospitals UZ Gent (the oldest and largest centre), UZ Leuven and UZ Brussel. In addition there are independent psychiatrists and psychologists who carry out diagnostics. Medical treatment — hormones and surgery — takes place almost exclusively within the university centres. Waiting times have grown considerably in recent years, in parallel with the explosive rise of presentations.

Legislation: liberal self-identification

In 2017 Belgium introduced a progressive gender law that makes legal sex change possible via a simple administrative procedure, without medical requirements. In 2019 the Constitutional Court ruled that the law had to make additional room for non-binary registration, a point that has been worked out legislatively since. In 2018 the law was extended: minors too can since then, with the consent of parents and a family judge, change their sex registration. Since its introduction the number of applications has risen sharply — an increase also observed in other countries with self-identification.

Medical treatment of minors

The Belgian centres largely follow the WPATH Standards of Care (SOC8), but this guideline has been under heavy international criticism since the WPATH Files. Leaked internal documents showed that WPATH suppressed its own systematic literature reviews at Johns Hopkins when the outcomes turned out unwelcome. Belgian doctors who apply SOC8 are therefore basing themselves on a guideline whose scientific basis is now expressly contested by the Cass Review and the Swedish SBU.

In April 2024 VRT NWS reported on the Belgian discussion around medical treatment of trans teenagers. Parents, former patients and some clinicians voiced concerns about the speed with which pathways are started, about superficial diagnostics and about long-term effects. A number of Belgian academics have publicly called for an independent evaluation along English lines; to date there has been no follow-up. Puberty suppression is available in Belgium, with a diagnostic pathway that varies per centre.

Co-morbidity and patient population

As in the Netherlands, the UK and Scandinavia, the patient population in Belgium has shifted in the past decade: substantially more adolescent girls, often with co-morbid problems such as autism, anxiety, depression or an eating disorder. International researchers explicitly link this shift to social and media dynamics; see rapid onset gender dysphoria.

Reimbursement and accessibility

Gender-affirming treatments for adults are partly reimbursed by the health insurance (RIZIV). For minors reimbursement depends on the treatment, age and diagnosis. Hormone therapy is usually reimbursed; surgical interventions have age- and type-bound conditions. Detransition care is barely organised in Belgium yet, a gap that is also noted in other countries; see detransition.