Waiting Times and Care Pathway

Gender-affirming care in the Netherlands has faced rising waiting times for years. This is a problem for people experiencing persistent dysphoria, but also a reason to take a critical look at capacity, eligibility assessment and the growing demand. 'Faster care' is not automatically the same as 'better care', especially if this shortens the diagnostic process.

Related topics can be found under Waiting Times and the Healthcare System and Five Years Waiting for the First Appointment: The Reality of the Dutch Gender-Affirming Care Waiting List.

What does the care pathway look like?

Referral starts with the family doctor, who refers the patient to a specialised gender team, usually at Amsterdam UMC or Radboudumc. After the initial assessment, a diagnostic process follows, consisting of several consultations with psychologists and psychiatrists. These are aimed at ruling out differential diagnoses, assessing comorbidities and determining whether medical treatment is appropriate.

For adults, hormone treatment can often be started relatively soon after diagnosis. For minors, an — formally — more extensive and phased pathway applies under the Dutch Protocol, although its implementation is also under pressure.

Waiting times

Waiting times for an initial assessment are two to four years or longer in several places. The cause is a combination of capacity problems and a sharp rise in the number of referrals — particularly among adolescent girls — since around 2013. According to media sociologist Vasterman, gender-affirming care has grown by 1,728 percent since 2012. Comparable increases have been observed internationally and are an important argument in the debate about social and cultural factors behind the rise in gender dysphoria. What happens during the waiting period is explained step by step at gendermolen.nl.

Alternatives and risks

Long waiting times push people towards three alternatives, each with its own problems:

• Family-doctor-led hormone therapy: faster, but with considerably less diagnostic preparation. Knowledge and monitoring vary widely between practices.
• Care abroad: in Belgium or through private online clinics. Access is easy, and in some models ('informed consent') the threshold for being prescribed hormones is very low.
• Self-medication via the internet: medically risky, with no laboratory monitoring and uncertain product quality.

The combination of 'long waiting times + easily accessible alternatives' effectively shifts the diagnostic process outside specialised care, at a time when the international evidence debate is calling for more careful diagnostics, not less.

Policy context

Advocacy organisations are calling for expanded capacity and faster access. The Dutch Parliament's handling of the issue is covered under parliamentary attention. At the same time, the Cass Review (2024) and evaluations in Sweden, Finland, Denmark and Norway emphasise the importance of thorough diagnostics, treatment of comorbidities and ruling out differential diagnoses (autism, trauma and internalising disorders) before medical intervention. A solution focused solely on expanding capacity, without taking a critical look at the care model, is not aligned with the international policy shift.