Navigating Trans Care Referrals in the Netherlands: A Guide for Expats
Accessing transgender‐related care in the Netherlands can be very different from other places where it is possible to approach an LGBTQIA+ 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.
Updated March 2026 | Written by Ramon Julian Pesigan
The state of things in 2026
The wait for trans care in the Netherlands is bad, and getting worse. Transgender Netwerk reports waits of up to six years for an initial intake, and has called the situation a crisis that has "gotten completely out of hand." NL Times Amsterdam UMC — historically the biggest gender clinic — has stopped accepting new adult patients entirely.
That said, the system is not the only option. This guide covers how the official route works, what has changed, and what practical alternatives actually exist.
1. It still starts with your huisarts (GP)
Every medical path in the Netherlands runs through your huisarts, including trans care. You cannot self-refer to a gender clinic. Your GP will have an initial conversation about your gender history, general health, and any medical contraindications, and if appropriate will write a formal referral (verwijzing) to a gender clinic.
A few things worth knowing upfront:
Book a double consult (20 minutes) from the start. A 10-minute slot isn't enough.
Bring documentation from home. Prior diagnosis letters, lab results, and HRT prescriptions from abroad won't automatically fast-track you, as waiting lists often don't distinguish between those who have already received some gender-affirming care and those who haven't DutchReview — but they do give your GP and eventual care team important context.
A GP cannot legally refuse you for being trans. Refusing a new patient on that basis violates Article 1 of the Constitution. If this happens, it can be reported to Transgender Netwerk Nederland. Trans In Eigen Hand
Use rozeinwit.nl or the Transgender Wegwijzer at transgenderwegwijzer.nl to find trans-friendly GPs in your area.
2. The referral and gender clinic system
Once your GP writes a referral, it goes to the clinic's intake coordinator. The main recognized centers are:
Amsterdam UMC (VUmc) — Closed to new adult patients. Has been redirecting the longest-waiting patients to Gender Clinic (Bosch en Duin) on a case-by-case basis.
UMCG Groningen — Still accepting referrals. Check current wait times at umcg.nl (updated monthly).
Radboud UMC Nijmegen — Also has a waiting list, and was last reported calling patients from mid-2022 registrations.
Erasmus MC Rotterdam — Active; check current times directly.
Genderhealthcare (Utrecht, private) — As of March 2026, their wait is 873 days (~2.5 years), with 507 people in the queue. Genderhealthcare
Gender Clinic (Bosch en Duin, private) — Currently only accessible to patients who have been on Amsterdam UMC's waiting list the longest and have been personally contacted by Amsterdam UMC.
You can register on multiple waiting lists simultaneously Trans In Eigen Hand — do this from day one. The live overview of wait times across all providers is at transineigenhand.nl/wachttijden.
Once you're accepted by a gender team, you enter a diagnostic phase lasting roughly 3–6 months, covering your gender history, informed consent, and readiness for treatment.
3. Starting HRT
After the diagnostic phase, the clinic sends a recommendation (advies) to your GP, who then prescribes and monitors your hormones.
While GPs can technically prescribe HRT without a formal gender dysphoria diagnosis, in practice that diagnosis is necessary for virtually every step — accessing HRT through a clinic, getting surgery approved, and supporting a legal gender marker change. DutchReview
Monitoring schedule: Every 3 months in year one (hormone levels, liver enzymes, lipid panel), then every 6–12 months once stable.
Note on formulations: Injectable estrogen is not commonly available in the Netherlands — Dutch guidelines point toward tablets, gels, and patches. Transworldexpress If you've been on injectables elsewhere, raise this with your prescribing doctor.
4. Insurance in 2026
Choosing the right Dutch insurer matters as much as choosing your clinic. The restitutiepolis (reimbursement policy), previously recommended for trans care, was scrapped in 2025. The current advice is to take out a combinatiepolis, which gives the most freedom to choose among contracted providers. DutchReview
Since 2025, no Dutch policy provides 100% reimbursement for mental healthcare providers that aren't contracted with your insurer Trans In Eigen Hand — and this includes most gender dysphoria diagnostic services. Before enrolling in any plan, contact the insurer directly and ask specifically which gender clinics they have contracts with and what percentage of non-contracted care they reimburse. International insurance plans and student policies tend to offer the least coverage for gender-affirming care. DutchReview
The annual eigen risico (own-risk deductible) is €385. Basic insurance covers HRT costs, mental health assessments at contracted clinics, and most routine labs. Gender-affirming surgeries are also covered under basic insurance, subject to stricter criteria (typically 12 months of continuous HRT and gender team approval).
If your wait exceeds a year: Contact your insurer and request wachtlijstbemiddeling (waiting list mediation). They are supposed to help arrange faster access, and it's free. Gender Clinic Many people don't know this exists — ask for it explicitly.
5. Alternatives and options beyond the standard route
The wait has pushed providers and patients to create real alternatives. These are confirmed active as of early 2026.
GP-direct / informed consent
Some trans-affirming GPs in the Netherlands will prescribe HRT under an informed consent model — without requiring a full gender clinic diagnostic trajectory first. A June 2025 guide for GPs on supporting gender-affirming hormone therapy in primary care was published in the Netherlands Trans In Eigen Hand, reflecting growing momentum for this approach. It requires finding the right GP and coming with solid documentation, but it's a legal pathway that's increasingly practiced, particularly in the larger cities.
Psytrans
A diagnostics-only provider that works on an intake-stop model rather than a traditional waitlist. Psytrans publishes on their website on the first Monday of each month whether new registrations are open. Patients on their intake list are seen within 16 weeks, and the diagnostic phase typically completes within a year. Trans In Eigen Hand This is meaningfully faster than the UMC route for those who catch an open window. Check psytrans.nl on those Mondays.
Shared care with an EU-based specialist
A shared care agreement involves a specialist (often abroad) initiating and overseeing a treatment plan — including prescribing HRT — while a Dutch GP takes over monitoring and repeat prescriptions. Some trans people have used this route with EU-based doctors. Trans In Eigen Hand Belgium (Ghent University Hospital's CEGO center) is approximately two hours from Amsterdam and is well-regarded. This requires a GP willing to participate in the arrangement and careful documentation.
EU Cross-Border Healthcare Directive
EU residents have the right to access healthcare in any EU member state and receive reimbursement from their home country's insurer. European Commission In practice, this means you can initiate care in Belgium, Denmark, or another EU country and apply for partial reimbursement from your Dutch insurer. Contact your insurer before traveling, and arrange Dutch GP follow-up in advance. Denmark removed psychiatric gatekeeping requirements for trans care in 2017 and uses an informed consent model; Belgium's CEGO is one of Europe's most experienced gender centers.
Trans United Clinic (Amsterdam)
An active, community-run clinic run in partnership with GGD Amsterdam. The Trans United Clinic is specifically for people from the Amsterdam metro area who face extra barriers to regular care — including people with refugee status, in asylum procedures, undocumented persons, those who are homeless or in a crisis shelter, and migrants or children of migrants. Transunitedeurope If you fall into one of those groups and can't access the standard system, this is a real option. Contact via their website at transunitedeurope.eu.
6. Legal gender marker change
Changing your legal gender marker no longer requires surgery or hormones. You need a "Change of Gender" statement (wijziging geslacht) from a qualified expert, then apply at your municipality.
For the X marker: The process for an X gender marker has been stalled since June 2025 while it awaits a ruling from the Supreme Court. Trans In Eigen Hand
For foreign nationals: Update your passport in your country of origin first, then notify your Dutch municipality.
7. Surgery
At least 12 months of continuous HRT is required before applying for surgery coverage. The gender clinic coordinates referrals to certified surgeons, usually within the same university hospital network. Some patients travel to Belgium for certain procedures.
8. Crisis and emergency contacts
Emergency / immediate danger: 112
Mental health crisis / suicidal thoughts: 113 (113.nl — 24/7)
GGZ Amsterdam crisis line: 0800-1540
Urgent medical issues (e.g., clotting on estrogen): Go to the nearest Spoedeisende Hulp (A&E). No referral needed.
9. Resources
These are the most useful English-language resources for expats navigating this system:
transineigenhand.nl — The most thorough guide to trans healthcare in the Netherlands, written specifically with migrants and internationals in mind. Includes a live wait-time tracker updated monthly. Start here.
transgenderwegwijzer.nl — Interactive map of gender clinics, trans-friendly GPs, psychologists, and surgeons across the Netherlands.
rozeinwit.nl — Directory of LGBTQ+-friendly doctors by specialty and city.
Transvisie English Contact Group — Peer support group in English for anyone connected to trans life in the Netherlands. Find it via transvisie.nl.
Genderpraatjes (genderpraatjes.nl) — Online chat with gender care experts. Dutch site, but the team speaks English.
Quick checklist for new arrivals
Register with a trans-friendly GP immediately. Don't wait. The referral is the starting point for everything.
Choose your Dutch health insurer carefully — get a combinatiepolis and confirm which gender clinics are contracted before signing up.
Register on multiple waiting lists at once. Check transineigenhand.nl for current wait times.
Ask your insurer about wachtlijstbemiddeling if you've been waiting over a year.
Check Psytrans on the first Monday of each month for open registration windows.
Talk to your GP about the informed consent route, especially if you have prior documentation from abroad.
Find peer support now. The wait is long and hard. Community knowledge — who's moving faster, which GPs will work with you — is often more current than any published guide.
Last updated March 2026. Wait times and clinic availability change frequently. Always verify directly with providers before making decisions. This is not medical or legal advice.
RJ Pesigan is the founder and owner of Cornerstone Health, created to address the multifaceted healthcare needs of expats in the Netherlands. Trained in Internal Medicine and Sport & Exercise Medicine, RJ has worked in both resource-limited and advanced clinical environments—from busy hospital wards treating critically ill patients to performance-focused sports clinics guiding athletes to peak health. Through Cornerstone Health, RJ leverages clinical expertise and real-world expat insight to help families and professionals navigate the Dutch healthcare system with confidence, clarity, and peace of mind.