Navigating Trans Care Referrals in the Netherlands: A Guide for Expats

In the Netherlands, accessing transgender‐related care is a two‐step process—and can be very different from other places where it is possible to approach an LGBTQ+‐friendly clinic or endocrinologist directly. Below is a simple, step-by-step overview of how trans care referrals work in Dutch practice, followed by a comparison to a more familiar U.S. model.

1. Why You Still Start with Your Huisarts (GP)

Other models’ approach (often):

- Many clinics allow you to fill out an intake form online or call an LGBTQ+ clinic directly. You might meet with a nurse or counselor who does an initial assessment and, if you qualify, you can see an endocrinologist for hormone therapy or a mental health provider for documentation to support your medical transition.

- In some health plans, you can get “informed‐consent” hormone prescriptions without ever needing a formal doctor’s referral—so long as you meet certain criteria (age, initial lab work, etc.).

Dutch approach:

- In the Netherlands, every medical path starts with your huisarts (GP), even for trans care. You cannot simply search for a gender clinic and walk in.

- Your huisarts will do an initial discussion: asking about your gender identity history, mental health, physical health, and making sure there are no medical contraindications.

- If your huisarts believes that gender care is appropriate, they will write a formal verwijzing (referral) to a recognized gender identity clinic (gendercentrum) or transgender specialist.

2. Registering with a Huisarts and Initial Conversation

1. Find and register with a huisarts in your neighborhood (many practices advertise “LGBT‐friendly” or “English spoken”).

2. Schedule a double consult (20 minutes) or longer right away, because discussing gender identity can’t fit into the standard 10-minute slot.

3. During that visit, you’ll discuss:

   - Your gender history (when you first felt incongruent, any prior counseling).

   - Your overall physical health (current medications, chronic conditions).

   - Your mental health status (any anxiety, depression, or other diagnoses).

4. The huisarts may also order basic labs (bloodwork, liver function, hormone levels) to rule out any underlying issues before a gender care plan starts.

Key point: You cannot bypass the huisarts—even if you already know you want hormone therapy, you must first get that referral letter.

3. Referral to a Gender Identity Clinic (Gendercentrum)

Once your huisarts feels it’s appropriate:

1. They will write a formal verwijzing to one of the Netherlands’ recognized gender identity clinics. The main centers are located at:

   - Amsterdam UMC (formerly VUmc) Gender Team

   - VU Amsterdam Vrije Universiteit Gender Clinic

   - UMC Groningen Transgender Care Center

   - Erasmus MC Rotterdam Gender Identity Clinic

2. Your referral goes to the chosen clinic’s intake coordinator who will contact you—often within 2–4 weeks—to schedule a first intake appointment.

3. First intake appointment at the gender clinic typically includes:

   - A meeting with a gender specialist (often a psychiatrist or psychologist with specialized training). They explore your history, expectations, and readiness.

   - Additional mental health screening (to ensure co-existing conditions are addressed first).

   - Discussion of treatment options: social transition support, hormone therapy, voice therapy, and potential surgical referral pathways.

4. If accepted by the gender team, you enter the diagnostic phase, which often takes 3–6 months, as they need to confirm a persistent history of gender incongruence, your informed consent, and your understanding of long-term risks/benefits.

4. Starting Hormone Therapy (HRT)

Once the clinic completes their assessment:

1. The gender clinic psychiatrist/psychologist writes a recommendation (advies) to start hormone therapy.

2. Your huisarts receives this recommendation and will prescribe and monitor your HRT depending on your goals, or whether you were previously on medication prior to your arrival.

3. The huisarts schedules regular follow-up lab checks:

   - Every 3 months during the first year (liver enzymes, lipid panels, hormone levels).

   - Every 6–12 months afterward, if stable.

Insurance coverage:

- The basic health insurance (basisverzekering) covers the mental health assessments at the gender clinic, the cost of hormones, and most routine bloodwork—after you pay your annual €385 deductible (eigen risico).

- Surgical procedures (e.g., top surgery, hysterectomy/oophorectomy, orchiectomy, vaginoplasty) are also covered by basic insurance, but there are stricter criteria: typically 12 months of continuous HRT, documented consultations, and approval from the gender team.

- Some patients choose a small supplementary plan (aanvullende verzekering) to cover extra counseling sessions or ancillary therapies (speech therapy, hair removal, etc.), which may not be fully covered.

5. Surgical Referrals (If Desired)

If you pursue any gender-affirming surgery:

1. At least 12 months of continuous hormone therapy is required by the Dutch guidelines before you can apply for surgery coverage.

2. The gender clinic coordinates referrals to certified surgeons—often in the same university hospitals. You’ll meet with a surgeon, undergo pre-surgical evaluations, and complete a surgical readiness assessment.

3. Once approved, the surgery costs are billed to your basic insurance; you only pay any applicable deductible out of pocket (again, typically the portion beyond your €385 deductible if that has not yet been met).

6. Emergency or Urgent Concerns

- If you ever find yourself in a mental-health crisis due to gender dysphoria(severe anxiety, suicidal thoughts), you do not need another referral: you can call 112 or the regional GGZ crisis line (e.g., 0800-1540 in Amsterdam). They are trained to handle gender-related emergencies.

- For urgent medical issues (e.g., clotting concerns on estrogen) you would go to your nearest Spoedeisende Hulp (Emergency Department) and can seek LGBTQ+-friendly hospitals when possible (Amsterdam UMC, UMC Utrecht, etc.).

How This Compares to the US Model:

Practical Tips for Expats Seeking Trans Care in the Netherlands

1. Find a Supportive Huisarts Early: 

   - Use online expat groups (Facebook “Expats in Amsterdam” or Expatica forums) to ask for GPs experienced with trans care. 

   - Once you register, schedule a “double consult” and explain your trans-related health goals up front.

2. Be Prepared for a Waiting Period: 

   - Expect a 2–4 week wait for your first intake at a gender clinic, then an additional 3–6 months of assessment before you start hormones.

3. Keep Your Medical Records Handy: 

   - Bring any letters, mental health diagnoses, or lab results from the U.S. These help the gender team confirm your history and may shorten evaluation time.

4. Normalize Follow-Up Labs: 

   - Whether you start estrogen or testosterone, your huisarts will do labs every 3 months. Remember that these are standard Dutch lab panels—they will check liver function, lipids, hematocrit, etc.

5. Consider Supplementary Coverage if Needed: 

   - If you want speech therapy or more psychotherapy sessions than the basic insurance covers, a small aanvullende verzekering (e.g., “alternatieve” or “therapie” rider) is worthwhile.

6. Know Your Crisis Numbers: 

   - For any urgent mental health crisis, call 112, or the regional GGZ crisis line (Amsterdam: 0800-1540).