More than 4 in 5 young people referred to Amsterdam UMC started medical treatment

On March 9, 2026, the Centre of Expertise on Gender Dysphoria at Amsterdam UMC (VUmc location) published a study in the Journal of Sex & Marital Therapy on 1,470 young people who were referred to the clinic consecutively between 2009 and 2019. The researchers — Frédérique de Rooy, Femke Dekkers, Thomas Steensma, Arne Popma, Baudewijntje Kreukels and Annelou de Vries — examined the group that did not start gender-affirming medical treatment, and why not. The figure on the other side of the equation is at least as telling: more than four in five referred young people did start puberty blockers or hormones. The clinic’s figures and waiting times are listed on trans-nederland.nl.

1,206 of the 1,470 young people received medical treatment

Of the 1,470 young people referred, 264 — 18% — did not start medical treatment. The remaining 1,206, or 82%, did. A diagnosis of gender dysphoria is required for puberty blockers and hormones. Of those referred to the clinic during this ten-year period, more than four in five therefore received that diagnosis, followed by medical treatment.

Gender dysphoria was ruled out in approximately 7%

Within the group of 264 young people who did not start treatment, the main reason — accounting for 38.3% — was that further assessment found no gender dysphoria. That amounts to approximately 100 young people, or around 7% of all referrals. In a further 27.7% of the 264 cases, the young person did experience gender dysphoria, but a diagnostic process proved unfeasible, for example because other issues required attention first or because the young person dropped out. The diagnostic process therefore ruled out gender dysphoria in approximately one in fourteen referred young people.

Those who did not proceed had more psychological difficulties

The researchers compared the two groups at intake. Young people who ultimately did not start medical treatment initially reported less severe gender dysphoria and a less negative body image than those who did start puberty blockers or hormones. At the same time, the untreated group scored higher on problems with overall psychological functioning. Those who did not start medical treatment were therefore not simply “healthier”: their broader psychological problems were more pronounced, while their specific gender dysphoria-related complaints were less severe.

What this means for the Dutch debate

The Health Council of the Netherlands concluded in June 2026 that Dutch transgender care for young people is “carefully structured,” with extensive diagnostic assessment before each medical step. This VUmc study shows what that assessment produced in practice: 82% of referred young people proceeded to medical treatment, while gender dysphoria was ruled out in approximately 7%. Anyone citing the 18% who did not proceed as evidence that the clinic applies strict selection criteria should consider that figure alongside the 82%. During this period, a referral led to puberty blockers or hormones in the vast majority of cases.

Moreover, the group that did not proceed had more severe psychological difficulties than the group that did receive treatment. This raises the question of what happens to these young people after their gender-related care pathway ends, and whether they subsequently receive appropriate care. The study does not answer that question, but it does document this group’s size and characteristics in detail. The role of autism and ADHD among young people who do not receive a diagnosis is discussed by genderautisme.nl.