VU Medical Center has a special position concerning transgender people in the Netherlands. They have a very large market share in transgender health care (estimates range from 70 to 90% of all transgender care in the Netherlands). People who work at VUmc quite often publish investigation reports on international conferences like EPATH and WPATH.
Route via VUmc
There are big advantages and big disadvantages to the gender teams in Amsterdam (VUmc) and Groningen (UMCG). The main advantage is you only have to deal with one group of people who organize many things for you. If you get permission to take hormones they arrange an appointment with a hormone expert (endocrinologist) for you. And if you need gender surgery, they make sure all checks before and after the operation are carefully planned.
But this advantage also comes with a disadvantage. The disadvantage is that all the care providers in the gender team know about your status and your files. The team makes decisions together, so if a hormone expert is of the opinion that you shouldn’t get an operation, it doesn’t make any difference what the surgeons think of it: the team makes decisions based on consensus, so if anybody is opposed to a treatment, the whole group is opposed to it.
Another disadvantage of the gender teams is their location. Transgender people can go to Amsterdam (VUmc) or to Groningen (UMCG). If you happen to live in the east of the Netherlands and you don’t possess a car, you will spend a lot of time traveling.
It is very well possible to get your diagnose and the hormones via the gender teams in Amsterdam or Groningen and have your surgery done in a foreign country. The other way around, so diagnosis and/or hormones outside the VU and UMCG and hormones and/or surgery from VUmc or UMCG, is much more difficult. If you want that, make sure you get the right information.
Experiences from others
VUmc uses the DSM as a manual for diagnosis. They also have their own protocol, which they claim to be close to the WPATH Standards or Care.
See the table below. For the diagnostic phase you can expect 4-6 consultations with minimum of 4 weeks between consecutive appointments, in holiday periods and during EPATH/WPATH the intervals will be longer. We also count one meeting where mainly a written investigation is done. The VU doesn’t count this; they only count the 4-6 meetings with your "own" psychologist. For the table below we have worked with the most optimistic scenario of 4 consultations + 1 session for filling out questionnaires.
For the most current data on waiting times see this site. Let’s have a look at how the procedure works: looking at the situation on July 15th 2016 for a vaginoplasty (gender surgery from male to female), the procedure is as follows:
|Treatment||Waiting time||Total lead time|
|Waiting list||12 weeks||12 weeks|
|Waiting list||20 weeks||32 weeks|
|Diagnostic phase: 5 x 4 weeks + 5 weeks due to vacations and conferences||25 weeks||57 weeks|
|Waiting list||8 weeks||65 weeks|
|Hormone treatment / RLE||52 weeks||117 weeks|
|Waiting time for vaginoplasty||10 weeks||127 weeks|
Checks for hormone levels (once every 2 years)
According to this overview, the waiting time between entry and hormone therapy would be approx. 57 weeks (more than 1 year and 1 month) and between entry and surgery approx. 127 weeks (= more than 2 years and 4 months).
Important: at VUmc everyone has to go through the Real Life Experience phase. It doesn’t matter whether you have been using hormones before/during the diagnostic phase and whether or not you are already living full-time in your desired gender presentation: the VU forces everyone to come to the psychologist once every three months during the first year of taking hormones. Both the diagnostic phase and the Real Life Experience phase only end when the VU psychologist gives permission for it. So if the psychologist thinks more than 6 consultations are necessary, or needs more than a year to judge whether your Real Life Experience is successful, that means delay for your hormone treatment or your gender surgery.
Pitfalls in the treatment: what is not in the protocol?
The following points are not in the VU treatment protocol:
- A minimum of 4-6 consultations in the diagnostic phase
- A minimum interval of 4 weeks between consecutive consultations
Requirements for hormones and operation
The VU is very strict with the rules for overweight and underweight (see here for male to female, or here/here for female to male): They use the Body-Mass Index = BMI for this. This can be calculated by dividing your weight by your body height squared, for instance if you weigh 70 kg and you are 1.91 tall, your BMI = 70 / (1.91 * 1.91) = 19.19. Your BMI has to be between 18 and 30 according to the VU requirements. The VU is also strict about smoking, drinking and substance abuse: these habits are blocking circumstances for an operation. People who have diabetes must have their glucose level well under control. If they don’t: no operation.
Want to read the protocol?
The VU refuses to publish their protocol, even though they keep referring to it, saying: “we cannot do anything else than we are doing now, because we must follow a protocol”. We disapprove of the fact that transgender people get no further explanation than this, we refer to the quality protocol of the organization of medical doctors KNMG (point 3.1.3.c), which state that doctors can, and sometimes must, deviate from protocols. The VU protocol does say in the first chapter that "in individual situations motivated deviations from these directives are possible". So if patients ask why a deviation isn’t possible in their individual case, the answer should be more informative than “we simply follow the protocol and that cannot be changed”.
The refusal to publish the literal text of the protocol has led to a lot discontent amongst the clients: if the protocols are referred to so explicitly, logic dictates that we should be able to learn about the actual text in that protocol ourselves. For this reason some individuals do give out literal copies of the protocol text (in violation of copyrights). If you want know what is in this protocol, ask for it in one of the Facebook groups (see “Contact”). There will undoubtedly be people who are willing to mail it to you. We have also translated the text of the VU protocol into English.
In difficult situations the VU therapists make use of a method they call Moreel Beraad (moral deliberation). This procedure has the purpose to investigate a problem from multiple points of view, the primary purpose is not to solve the problem. In most cases only care providers take part in this Moreel Beraad, but occasionally clients or their family members are also involved. If you have a problem with your care provider and you have the feeling that the care provider totally misunderstands your side of the situation, you might ask your care provider to start such a moral deliberation session, in order to improve your mutual understanding. More information about Moreel Beraad can be found in this summary about WPATH.