Gender Healthcare in Belgium
Belgium largely follows the gender-affirmative model that has come under pressure in neighboring countries. The university centers in Ghent, Leuven, and Brussels follow the WPATH guidelines, while Belgian legislation has ranked among the most liberal in Europe for years. The international reassessment — the Cass Review in the UK, the SBU report in Sweden, and the COHERE guideline in Finland — has reached the Belgian debate but has not yet led to a formal change in direction.
Healthcare provision and centers
Specialized gender healthcare in Belgium is concentrated at the university hospitals UZ Ghent (the oldest and largest center), UZ Leuven, and UZ Brussels. There are also independent psychiatrists and psychologists who provide diagnostic assessments. Medical treatment — hormones and surgery — takes place almost exclusively within the university centers. Waiting times have risen sharply in recent years, in parallel with the explosive increase in referrals.
Legislation: liberal self-identification
In 2017, Belgium introduced progressive gender legislation allowing legal gender change through a simple administrative procedure, without medical requirements. In 2019, the Constitutional Court ruled that the law must also provide room for non-binary registration, an issue that has been developed legislatively since then. The law has been in force since January 1, 2018, and also applies to minors from the age of sixteen: they need their parents' assistance and a statement from a child and adolescent psychiatrist confirming that they have sufficient capacity for discernment. 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 centers largely follow the WPATH Standards of Care (SOC8), but this guideline has faced severe international criticism since the WPATH Files. Documents made public in a US court case in 2024 showed that WPATH suppressed its own systematic literature reviews at Johns Hopkins when the findings were unfavorable. Belgian doctors who follow SOC8 are therefore relying on a guideline whose scientific basis is now explicitly being challenged by the Cass Review and Sweden's SBU.
In April 2024, VRT NWS reported on the Belgian debate surrounding medical treatment for trans teenagers. Parents, former patients, and some clinicians expressed concerns about the speed with which treatment pathways are initiated, the superficial nature of the diagnostic process, and the long-term effects. Concerned parents connect, among other places, through the Belgian organization Cry for Recognition. The link overview contained on that organization's website can be found at cryforrecognition.be in the archive. UZ Ghent also came under fire following criticism of a rapid referral for a mastectomy. A number of Belgian academics have publicly called for an independent review modeled on the English example; so far, this has not been acted upon. Opinion pieces on gender and gender dysphoria also appear in the Humanist Association, a Flemish sociocultural organization. Puberty suppression is available in Belgium, with a diagnostic pathway that varies by center. A chapter-by-chapter critical review of SOC8 can be found at wpath.nl.
Comorbidity and patient population
As in the Netherlands, the UK, and Scandinavia, the patient population in Belgium has shifted over the past ten years: there are considerably more adolescent girls, often with comorbid conditions 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 partially reimbursed by health insurance (RIZIV). For minors, reimbursement depends on the treatment, age, and diagnosis. Hormone therapy is generally reimbursed; surgical procedures are subject to age- and procedure-specific conditions. Detransition care is still barely organized in Belgium, a gap also noted in other countries; see detransition.