Gender care takes root at VU Amsterdam

Around 1975, care for transgender people was established at the Vrije Universiteit hospital in Amsterdam. Endocrinologist Louis Gooren became the public face of the team. This outpatient clinic grew into Amsterdam UMC’s current Knowledge and Care Centre for Gender Dysphoria.

The years before

From the 1950s onward, several Dutch doctors quietly helped patients with hormones and surgery. Following public controversy over an operation, this practice virtually came to a standstill in 1966. In 1972, a small group of healthcare providers founded the Stichting Nederlands Gender Centrum, the first institution in the Netherlands dedicated to this type of care. The Amsterdam cohort, in which all patients were registered, therefore begins in 1972.

The gender team

In the mid-1970s, the VU became involved as an institution. The team worked in a multidisciplinary way: psychologists and psychiatrists made the diagnosis, endocrinologists provided hormones, and surgeons performed the surgeries. In the late 1980s, Gooren became a professor of transgender medicine, a chair that did not exist anywhere else.

Research and influence

The team published extensive scientific research, which earned it international authority. Between 1972 and 2015, nearly seven thousand people registered at the clinic. In 2002, care for children and adolescents, which had begun in Utrecht in 1987, also moved to Amsterdam; see the start of gender care for young people.

How treatment was structured

Treatment followed a set sequence of stages. It began with a diagnostic phase involving consultations with a psychologist or psychiatrist. Hormone treatment then started, alongside the so-called real-life phase: the patient lived entirely in their desired role for at least one year. Only after that would surgery be considered. The team made decisions collectively at every stage. This approach was in line with the international Standards of Care. In 2014, the mandatory real-life phase was removed from the Amsterdam protocol, creating room for people who do not identify as men or women.

The figures from the Amsterdam cohort

Because almost all Dutch patients were treated in Amsterdam for a long time, the centre has an exceptionally comprehensive registry. In 2018, researchers published data on 6,793 people who had registered between 1972 and 2015. During that period, the number of new registrations per year increased approximately twentyfold: from a few dozen around 1980 to nearly seven hundred in 2015. Of the adults who had undergone surgery on their sex glands, fewer than one percent later reported regret. Critics point out that these figures concern people who were treated as adults and after a lengthy process, and that regret generally only becomes apparent years later.

Other centres

Amsterdam was not the only city to offer gender care; the university hospital in Groningen had also been providing it for many years. In 2020, Radboudumc in Nijmegen opened its own centre of expertise, partly to reduce the long waiting lists. Since around 2015, an increasing number of smaller providers outside the university centres have also emerged, particularly for psychological support and hormone treatment.

Significance

The fact that the Netherlands later became known as the country of the Dutch Protocol is connected to this early start. There was an experienced team, a hospital that supported the care, and coverage through health insurance. The history of transgender healthcare in the Netherlands, including today’s waiting lists, is summarised on transtijd.nl under The Netherlands and gender care. More about the current situation can be found on the page about gender care in the Netherlands.