Psychological Support
Psychological support is formally a central part of the Dutch gender care pathway. In practice, however, its clinical depth has declined sharply in recent years. The emphasis has shifted from careful differential diagnosis to an affirmative role in which self-reported gender identity is accepted as the starting point. The Cass Review (2024) described this shift as problematic.
What psychological support should be
Multiple factors often play a role in gender-related concerns: autism, trauma, depression, eating disorders, a gay or bisexual orientation that feels unsafe in the person’s environment, social influences, or a phase of adolescent identity development. Good psychological support explores these factors broadly and over time, without predetermining the outcome. This is known as exploratory psychotherapy and was considered the standard approach until recently. Therapy First and Genspect are divided over how it should be implemented.
Affirmative model: care follows the desired outcome
The affirmative model assumes that clients themselves know best what their gender identity is, and that the practitioner’s role is to affirm that identity and facilitate the desired medical steps. In this model, differential diagnosis is framed as “gatekeeping.” In the Netherlands, this model has become dominant in specialist centres. Its empirical basis is weak: there is no randomised research demonstrating that affirmative support produces better outcomes than exploratory support.
The international shift
In the United Kingdom, Sweden, Finland and Norway, psychotherapy has once again become the primary form of support for young people with gender dysphoria, with medical interventions offered only in research settings or in highly selected cases. The Cass Review explicitly concluded that a holistic, exploratory psychological approach is the appropriate first step, and that withholding psychotherapy in favour of a rapid medical pathway is not supported by the evidence. See also Cass Review and Critical perspectives.
Comorbidity is undertreated
Data from specialist centres show that a substantial proportion of referred young people have autistic traits, depressive symptoms, anxiety disorders, eating-related problems or trauma. A 2026 cohort study found that autism is strongly overrepresented among gender-diverse children. How autism and gender dysphoria are distinguished from each other is explained at genderautisme.nl. When gender-related concerns are immediately affirmed and medically facilitated, underlying problems remain untreated. Detransitioners regularly report that their true distress lay in a different area from the one for which medical transition appeared to offer a solution. See also Detransition and Psychological effects of detransition.
Support after a medical pathway
People who have undergone hormone treatment or surgery and subsequently develop doubts, regret or psychological problems still have limited access to specialised aftercare in the Netherlands; see support after detransition. The healthcare infrastructure is geared towards facilitating transition, not towards supporting detransition or addressing complex aftercare needs.
Waiting times and alternative providers
Waiting times for specialist centres are long. This has led to growth in the number of independent psychologists and commercial clinics that provide support outside the official pathways or even prescribe hormones through a less stringent “informed consent” pathway. The quality and thoroughness of these providers vary widely. An overview of psychologists and psychiatrists working in gender care can be found at genderexperts.nl. See also Waiting times and care pathway.