In 2022, people with a gender question in the Netherlands had to wait an average of two years before any indication for medical care could be made. A team of researchers from the Faculty of Arts, the Nijmegen School of Management and Radboud university medical center examined how this ever-increasing waiting time could be explained and solved. “There is a mismatch between the demand for and organization of transgender care,” say Enny Das, professor of communication at Radboud University, and Chris Verhaak, clinical psychologist at Radboud university medical center.
Trans people with a care need in the Netherlands are always referred to specialist care. However, that is not the most appropriate place for part of the urgent care needs. Verhaak: “Specialist care is mainly geared to gender-affirming medical treatments, not to solving the social side of the care demand.”
This social side, described by the researchers as “a lack of acceptance in the social environment”, can cause minority stress in transgender people. That minority stress is described as the mental burden of ‘being different'. With this mental burden, trans people should be able to turn to regular health care (general practitioner, mental health care), but the system is not yet equipped for this, the researchers argue. As a result, specialist care is getting overloaded, and waiting lists are getting longer.
The growing demand for specialist care could also be explained by a potentially increasing number of trans people in the Netherlands. The researchers could not determine on the basis of figures from previous studies whether such an increase is actually happening. However, trans people have become more visible in recent years. Das: “They let themselves be seen and heard more, and there is more attention and recognition for their place in our society.”
According to the researchers, this increasing visibility also allows transgender people to recognise themselves in (experiences of) others, which may also make them more daring to express themselves. This is also evident from the focus group discussions, in which healthcare professionals and trans people themselves spoke. A significant proportion of the researchers, discussion leaders and focus group also identified themselves as queer and/or trans. In this way, the research team conducted research with trans people, rather than simply about them.
During the focus group discussions, participants arrived at a unified vision of the future: a society in which gender diversity is visible and accepted. In gender care, waiting lists have disappeared, or at least there is support for trans people during the waiting period. There is more integration between the trans community and healthcare providers through the use of experts by experience and through representation of trans persons among healthcare professionals. There is also more gender diversity expertise outside specialist trans care, so that trans people with diverse (care) questions can also be heard and supported naturally within general healthcare. To realize this vision of the future, the researchers give five recommendations, which they will present on 10 May.
The research team came up with five recommendations to ease the pressure on transgender care.
- Encourage knowledge about and integration of trans people in society; when integration increases, the number of persons with minority stress will decrease;
- Offer the right care in the right place; when comprehensive care becomes more inclusive for trans persons, the specialist care funnel is less likely to become clogged;
- Provide inclusive mainstream care; when inclusion increases, comprehensive care will be perceived as more appropriate;
- Increase knowledge about gender diversity in care; when knowledge increases, care in a broad sense will be perceived as more appropriate;
- Ensure transparent and up-to-date communication about the care structure; this way, those seeking care know who to contact with which questions and where they can find reliable information.
The Radboud study is part of a commission by ZonMW. The assignment consisted of two studies: one by Radboud University together with Radboudumc into the increase in and change in demand for transgender care; and one by research agency SiRM, which examined the development of demand for care and supply of transgender care. This is what ZonMw says about the results of the research assignment.