It will be the “summer of trans anger” if it is up to the organizers of the demonstration for better transgender care last Saturday. “We call on you to organize angry actions,” it sounds between the offices on the Zuidas in Amsterdam. “To let you know that we are ready. Done with the waiting lists. Done with the diagnoses. Done with the abuse of power!”
Cheers rise from George Gershwin Square, where hundreds of colorful activists have gathered. There are many rainbow colors, dyed hairstyles and black boxes on the feet. Transgender flags serve as a cape. In addition to LGBTI organizations, there are representatives from BIJ1 and the youth party Rood – which the SP would break with that day because of communist ideas.
The demonstration was organized by activists in response to the Instagram account @VuGenderMistreatment. For more than a month, mostly anonymous stories have been shared from (former) patients of the gender outpatient clinic of Amsterdam UMC (formerly VUmc). They have received “hundreds” of stories, says an administrator of the account on stage. “In five weeks, eh.” cheers.
The account contains stories from years ago, but also recent ones. About that Amsterdam UMC would be reluctant to treat non-binary people who do not feel (entirely) male or female. About letters from the outpatient department that say ‘sir’ or ‘madam’, while that doesn’t match someone’s identity.
Between two fires
Transgender care is under fire from both sides. An important demand from the demonstrators is a smaller role for the psychologist in the treatment. They find it “dehumanizing” to have to prove that they are transgender in order to be eligible for hormone treatments and possible surgeries.
A counter-movement, which has gained a foothold in the United States and the United Kingdom in particular, argues for a stricter selection at the gate. Mainly out of fear that children may regret irreversible treatments – incidentally, only half a percent of Amsterdam UMC patients between 1972 and 2015 regret.
Media sociologist Peter Vasterman warned last month in NRC for the “sudden emergence of gender dysphoria”, the medical term for transgender feelings, among children who apply. This number has risen sharply since 2012, especially among those who feel like a boy but have a girl’s body. Amsterdam UMC contradicted that. “We see no evidence of a lack of gender dysphoria in the new group,” said researcher Thomas Steensma, who attributes the increase to increased social acceptance.
Waiting lists for years
The activists focus mainly on Amsterdam UMC, which is said to have an “unofficial monopoly” on transgender care. Not literally: Amsterdam UMC, which in the 1970s became the first academic hospital in the world to provide transgender care, in 2020 treated only a fifth (650) of the total number of patients in the psychological phase, and a third (425) in the endocrinological phase. phase (hormone treatments). “You can only go to Amsterdam only for very complex cases, for example with associated mental or physical complaints,” says Michiel Verkoulen of consultancy firm Careful Advice, which has been asked by the ministry to unleash transgender care. But with his ‘protocols’ other healthcare providers would dictate how they should provide that care, namely: with an extensive psychological trajectory. Only after the diagnosis of ‘gender dysphoria’ is someone allowed to undergo medical procedures.
“When you are eighteen you can tattoo your entire body or have a breast augmentation,” says Jaimy Boelen (18), sitting on a bench prior to the demonstration. „At least, if you cis [niet trans] are. But for trans people, physical adaptations are made so difficult.” He himself has been on the waiting list for a year and a half.
With its protocol, Amsterdam UMC would encourage waiting lists. They have been extremely long for years. It is now scheduling intake interviews from people who signed up in July 2019. That waiting creates extra mental pressure, care providers notice, sometimes resulting in suicidality. At the demonstration, a story is shared about a boy who couldn’t stand the wait anymore.
At the end of 2018, the Ministry of Health appointed a ‘quartermaster’ to create more care provision for transgender people and to shorten waiting times. This was partly successful: compared to 2019, the capacity in mental health care for trans people increased by 58 percent and in endocrinological care by even 133 percent. But demand is rising even faster. The number of people waiting increased from 2,820 in 2019 to 4,729 at the beginning of this year. The corona pressure in the hospitals reinforced this.
“We do not want to be the largest or one of the few providers,” says the head of the Amsterdam gender center, Annelijn Wensing-Kruger. “The waiting lists are really inhumane.” The hospital helped set up gender centers in Radboudumc (2020) and Zaans Medical Center (2021).
‘There is no protocol, no template’
“There is actually no protocol,” says Wensing-Kruger. “There is no mold that everyone goes through.” There are care standards that good transgender care must meet. But these were drawn up in consultation with the entire sector, including patient organization Transvisie.
These standards of care oblige the diagnosis hated by the activists. “A psychologist now has the power to make decisions about your body,” says Vreer Verkerke (58), party representative at BIJ1 Amsterdam, and spokesperson for the demonstrators, in the middle of the crowd.
The activists want more self-determination. “Anarchism is also about self-determination and autonomy,” says the Vrije Bond when asked why the anarchist organization is present at the demonstration. They advocate a system of informed consent: as long as the patient is well informed about the impact of a treatment, he or she should be able to make his own decision.
To some extent, that system is already there, says Wensing-Kruger. But it depends on what you mean by that. “Not that you sign with the surgeon at the cross, for example.” According to her, the psychological interviews “are not designed to test whether someone is gender disfavoured – people who report to us quickly meet the criteria. The conversations are aimed at understanding the feelings, to see how someone is doing, how much support they receive from the environment and to discuss expectations.” In addition, according to health care providers, it should be examined whether someone has a trauma or autism that can influence the sense of identity.
Some feel that they are not taken seriously. “I have friends who are autistic and therefore have to put in more effort to prove that they want to transition,” says Noah from Leiden, who has a sign with ‘Not Trans Enough? Vuck off!’ holds. “You know your own identity best,” says Bo Salomons, next to Noah.
In some countries the psychologist already has more of the role of a counselor. Also the latest version of the international transgender healthcare standard WPATH no longer requires an extensive psychological evaluation. In Malta, Denmark and Iceland this may no longer even be a condition.
The Dutch healthcare standard drawn up by the sector. offers limited space for this. Still. Evaluation discussions about the standard will start after the summer, with a shorter diagnostic process in particular on the agenda. People without other mental or physical problems could potentially progress more quickly, the quartermaster noted in April.
The growth in the number of non-binary persons is also an important development. According to some healthcare providers, a third of their patients do not feel male or female. According to the activists, there is little room for them at Amsterdam UMC. “They doubted whether my daughter was trans enough because she doesn’t dress ‘girly’ enough,” reads a statement from a parent on @VuGenderMistreatment about the period 2017 to now. “Since then, my daughter has been wearing much more ‘feminine’ clothes than usual when we have to go to the VUmc again.”
Wensing-Kruger calls that image obsolete. “A significant proportion of the people who come to us are non-binary. For example, some want a breast removal, but no hormones. That is quite possible.” Not only non-binary people need differentiation. For example, a majority of transgender men and women do not want genital surgery, according to a 2019 study by the quartermaster and Transvisie.
Yet it sometimes still seems as if the Amsterdam UMC has two ‘flavors’. On a still-used questionnaire from 2008 that NRC saw, it says: ‘Did your father look male before?’, ‘Did your mother behave feminine?’ and ‘As a child (0-12 years old) did you behave like a real boy?’ “Good point,” says Wensing-Kruger. “We are working hard to ensure that the questions are not very binary.”
It is also true that patients sometimes receive letters at home with ‘sir’ or ‘madam’, while they do not identify themselves as such. “In the electronic patient file there was no option to write to someone without a Mr or Mrs., but that is of course not part of an expertise center.”
If more trans people are part of the gender team, the activists say, the treatment of the patients will improve. They demand an “active search” for staff who are trans themselves. And they believe trans people should be involved as advisors, trainers, managers and supervisors.
“Professional expertise is at least as important to us as experiential expertise,” says Wensing-Kruger. Amsterdam UMC itself has a ‘Gender Council’ of experts by experience who can give solicited and unsolicited advice. At the beginning of this year, a support center for gender questions was set up, where experts by experience can answer questions. They also visit courses to get students excited about transgender care. But there are no trans people on the psychologist team. It is true that recruitment texts state that experiential expertise is an advantage, “but it has never been successful”, admits Wensing-Kruger.
Youth care and adult mental health care are also struggling with a major staff shortage. “This problem is bigger than transgender care,” says quartermaster Michiel Verkoulen of VWS. But that is not what the activists have to say on Saturday. “Fuck the VU. Trans Care Now!” they shout as they pass the hospital. Dozens of middle fingers go up in the air.
You can talk about suicide at the national helpline 113 Suicide Prevention. Phone 0800-0113 or www.113.nl