Introductory note: Trans In Eigen Hand is pleased that more research is being conducted into transgender care and how it can be improved; we also appreciate the work done to create the published studies. However, we do have a number of reservations regarding the publications, which are outlined in the message below.
Consultancy firm SiRM - Strategies in Regulated Markets and Radboud University Nijmegen released a report this week on the future of transgender care. The reports rightly conclude that expansion of specialist transgender care is necessary, but strange predictions and pathologization in the reports could lead to wrong policy choices. This could cause the already poor state of transgender care to plummet further, warn transgender organizations Principle 17, Trans in Eigen Hand, Trans Healthcare Network, Trans Radical Resource Exchange (T-RREx), Trans Zorg Nu, and TZN Nijmegen.
Strange predictions
Researcher Fons Strijbos from SiRM concludes that significant catch-up capacity is needed and that transgender care based on informed consent will lead to a decrease in the need for psychological care. Furthermore, he recommends better guidance by GPs and (for young people) in schools. The transgender organizations wholeheartedly agree with these conclusions.
But they have major questions about other conclusions. In all scenarios, the demand for transgender care does not increase further after five years. The only reason for this seems to be that the prediction model stops after 5 years. The report also makes strange predictions, such as the idea that greater acceptance of trans people would lead to a decrease in the demand for surgeries. TransZorgNu activist Eelke: "This seems based on the assumption that we adjust our bodies for others, but we do that for ourselves. The reality is that social acceptance has led to an increase in the demand for transgender care! Things went wrong with this reasoning before: the Transgender Care Quartermaster established that waiting times increased by 50%, where a 50% decrease was expected."
Minority stress
Researchers Chris Verhaak from Radboudumc and Enny Das from Radboud University conclude that transgender people suffer from minority stress, which can only be solved by society. The transgender organizations also share this conclusion.
What is incomprehensible is the logical leap the researchers then make: that people would end up on the waiting list not because of an internal wish, but because of minority stress. Also, people with other care needs would end up in a 'medical-specialist trap.' These claims are nowhere truly substantiated in the report. On the contrary, the sounding board group study shows that most trans people have a very clear care request at the time of intake. Eelke: "Trans people indeed have care needs for which they can go nowhere else, but there is no evidence at all that they are reporting to gender teams incorrectly because of this. This reasoning reeks of pathologization. In fact, they are saying: 'You don't know what you want. You are letting yourselves be led by social pressure.'"
Dangerous interpretations
During the presentation, it immediately became clear that both reports leave room for dangerous interpretations. Not only can the demand for care be underestimated again, but there was also immediate speculation in the room about a triage of waiting lists. That would primarily mean: even more unnecessary screening and an artificial shortening of the waiting list by sidelining people. EenVandaag2 even suggested, following the studies, that it would be better not to refer trans children to gender teams. This is not stated anywhere in the reports and is particularly dangerous: the long waiting time is already causing enormous suffering among transgender youth, while their bodies change in the wrong direction.
Urgency is missing
What is missing in both studies is the great urgency felt by the 7,000 people waiting for transgender care. The researchers talk about the need for more research, but completely ignore the fact that current waiting times are costing lives. Trans youth Sam (15): “I have been on the waiting list for puberty blockers for two years now. At school they do their best, but my breasts keep growing. As a result, I have attempted suicide five times out of despair.”
It is also remarkable that they did not look at bottlenecks in transgender care, such as the evaluating psychologist. The researchers continue to stick to the current gatekeeping system: the gender teams make people wait three years for an intake, force them into conversations with an evaluating psychologist, give a heavy psychiatric diagnosis, and only then offer the physical care for which the person came. That is scandalous. In fact, this is a violation of human rights—but the researchers don't mention that.
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1https://www.zonmw.nl/nl/artikel/loslaten-van-binair-denken-kan-druk-op-transgenderzorg-verlagen and https://www.zonmw.nl/nl/artikel/extra-zorgcapaciteit-transgenderzorg-nodig-om-wachtlijsten-terug-te-dringen