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Waiting times and care pathway
Dutch gender care has seen rising waiting times for years. That is a problem for people with persistent dysphoria, but also a reason to look critically at capacity, indication and rising demand. 'Faster care' is not automatically the same as 'better care', particularly if diagnostics are shortened as a result.
What does the care pathway look like?
Referral runs via the GP to a specialised gender team, usually Amsterdam UMC or Radboudumc. After intake comes a diagnostic process of several conversations with psychologists and psychiatrists, aimed at ruling out differential diagnoses, assessing comorbidity and checking whether medical treatment is appropriate.
In adults, hormones can be started relatively quickly after diagnosis. In minors a — formally — more extensive and phased pathway applies under the Dutch Protocol, although its implementation too is under pressure.
Waiting times
Waiting times for an initial intake are at multiple locations two to four years or more. The cause is a combination of capacity problems and a sharply increased number of referrals — particularly among adolescent girls — since around 2013. Comparable rises are seen internationally and are an important argument in the debate over social and cultural factors in the increase of gender dysphoria.
Alternatives and risks
Long waiting times drive people to three alternatives, each with its own problems:
- GP-led hormone therapy: faster, but with considerably less diagnostic preparation. Knowledge and monitoring vary widely per practice.
- Care abroad: in Belgium or via private online clinics. The threshold is low, the bar for being prescribed hormones is very limited in some models ('informed consent').
- Self-medication via the internet: medically risky, no lab checks, unclear product quality.
The combination 'long waiting times + low-threshold alternatives' de facto shifts the diagnostic process outside specialised care, at precisely the moment when the international evidence discussion argues for more careful diagnostics, not less.
Policy context
Advocacy organisations call for capacity expansion and quicker access. At the same time, the Cass Review (2024) and the evaluations in Sweden, Finland, Denmark and Norway emphasise the importance of thorough diagnostics, treatment of comorbidity and ruling out differential diagnoses (autism, trauma, internalising disorders) before medical intervention. A solely capacity-expanding solution without a critical look at the care model does not align with the international policy shift.