Long waiting list at gender clinic Amsterdam UMC leads to patient freeze
The gender clinic at the Amsterdam UMC is struggling with overload and is therefore no longer accepting new adults for treatment. ‘In a rich country like the Netherlands, we should be able to provide gender care without these excessive waiting lists,’ says Sarah Bracke, professor of Sociology of Gender.
The demand for gender care is considerably higher than the gender clinic at the Amsterdam University Medical Centre (UMC) can currently handle. Only a fraction of the people currently on the UMC's waiting list are called for an intake interview; annually, this involves some 450 adults and 250 children/adolescents out of a total of 4,500 and 1,000 waiters, respectively.
To illustrate: an adult referred by a doctor in November 2020 is not eligible for an initial interview until April 2025, according to a public document from the UMC. So that person will have spent four years and five months on the waiting list. Once in treatment, the wait is by no means over. Then comes an interview with a psychologist, but due to a shortage of psychologists in the Netherlands, that course for adults takes about a year and a half.
In order not to increase the waiting time after an initial interview, the gender clinic at the UMC has decided not to take in any more new adults for treatment. Children and adolescents will still be called for an intake interview. Referrals from GPs and other healthcare providers to the gender clinic are also still possible, but, the UMC warns, those people must then ‘take into account years of waiting times’.
Multiple factors
Other medical institutions that offer gender care similarly struggle with long waiting times. Why the number of referrals to gender clinics is increasing so much across the board, the UMC does not know. ‘It may be that familiarity around the subject plays a role here, but possibly other factors are also influential,’ the UMC writes.
Indeed, according to Sarah Bracke, UvA professor of sociology of gender and sexuality, there are several reasons behind the increased demand for gender care. ‘First, the increase cannot be separated from the increase in technical options.’ Interventions such as breast augmentation and reduction, vaginal rejuvenation surgery, menopausal hormone therapy, hair implantations and the use of anabolic steroids for muscle development have become widespread quite rapidly over the past decades, Bracke argues. These are all examples of procedures that can support or confirm a person's gender identity, and are also seen by many as gender-affirming care.
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Critics, such as US physician Lisa Littman, argue that individuals are more often choosing to change gender on a whim, due to ‘peer pressure and social contagion’. In some cases, this would even lead to transition regret - a definition that recently caused uproar among the trans community when it was nominated by the Van Dale for the election Word of the Year 2024. In response, the dictionary decided to cancel the election.
Unnecessary suffering
But according to Bracke, arousals have nothing to do with this, instead she points to the ‘already decades-long crumbling of rigid gender roles under the influence of various emancipation movements, which have given individuals more opportunity and freedom to shape their social gender identity. In addition, the expansion of what gender can be does not escape the workings of the market, according to Bracke: ‘Gender identity is undoubtedly also a market for companies. And the fact that we so often have to check a m/f checkbox when making online purchases adds to the feeling that we are constantly being challenged about our gender identity and therefore have to do something with it.' The popularity of ‘preferring neither’ can therefore be partly understood as resistance to this, Bracke said.
The difficult accessibility of gender care due to long waiting lists leads to unnecessary suffering, according to Bracke: ‘From a more general feeling of interrupted lives to potentially heavy tolls on the mental health of those who spend years on waiting lists. In a rich country like the Netherlands, and in a context where many forms of gender-affirming care are widely available, we should be able to provide gender care without these excessive waiting lists.' According to Bracke, this calls for ‘investment in the growth of facilities, as well as public education to counter political pressure on this particular form of gender-affirming care.
