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Transgender

'Transgender' is an umbrella term used for people who do not, or do not fully, identify with the sex observed at their birth. The term is broad and covers widely diverging experiences — from people with persistent gender dysphoria who seek medical treatment, to people who make only a social or linguistic adjustment. That breadth is a point of concern: what is a life-defining medical problem for one person is an identity choice for another.

What does the term mean?

In contemporary discourse, transgender is usually defined as a 'discrepancy' between an inwardly experienced gender identity and the sex recorded at birth. It matters that 'gender identity' is a theoretical concept: it cannot be measured objectively and rests entirely on self-report. Moreover, sex is not 'assigned' at birth — it is observed on the basis of the body.

There is no medical test that can establish whether someone is transgender. The diagnosis of gender dysphoria describes a persistent discomfort with one's own body or the assigned social role; that diagnosis requires clinical distress and duration. The broader term 'transgender' is nowadays also used by people without dysphoria, which blurs the distinction between a medical condition and an identity.

Related terms and direction of transition

Within the transgender spectrum, distinctions are made by direction of transition. Transmasculine and FTM (female-to-male) refer to persons of female birth sex (AFAB) who move in a masculine direction. Transfeminine and MTF (male-to-female) refer to persons of male birth sex (AMAB) who move in a feminine direction. The counterpart of transgender is cisgender.

Rise in identifications

The number of people identifying as transgender has risen sharply since around 2010, particularly among teenage girls and young women. That is a striking shift compared with the classical pattern, which involved a small group, predominantly adult men with early and persistent dysphoria. Researchers such as Lisa Littman (2018) introduced in this context the concept of rapid-onset gender dysphoria. Social media, peer influence and broader cultural factors are named in the literature as possible explanations.

Medical transition and the scientific debate

A medical transition usually involves hormone therapy and, for some, surgical procedures. In the Netherlands this care follows a specialised pathway, historically known as the Dutch Protocol. This originally Dutch model — puberty blockers followed by cross-sex hormones — was long presented internationally as the gold standard, but is now under heavy fire. Criticism concerns, among other things, the weak long-term data, selection bias and the absence of control groups.

The British Cass Review (2024) concluded that the evidence base underpinning puberty blockers and hormone treatment in minors is 'remarkably weak'. Sweden, Finland, Norway and Denmark have substantially revised their practice: treatment of minors is sharply restricted and offered only in a research setting.

For adults, hormones and surgery are far-reaching and partly irreversible: they affect fertility, sexual function and lifelong medication. A well-considered decision requires full information about these consequences.

Psychosocial well-being

Transgender persons have higher rates of psychiatric complaints than the general population. The mainstream frame attributes this primarily to 'minority stress' and social rejection, and presents medical treatment as the solution. The picture is, however, more complicated. The Swedish long-term study by Dhejne et al. (2011) found that psychiatric morbidity and mortality remained elevated even after medical transition.

Legal position in the Netherlands

Since the Transgender Act of 2023, a person in the Netherlands can change their registered sex through a declaration at the civil registry, without medical conditions. Critics point out that self-identification without any review creates tensions with sex-based provisions — women's sport, prisons, shelters and medical care.