Are critics of transgender care not getting the hoped-for response? Then mistrust follows

For anyone who has been following the news about transgender health care in recent years, it may have come as no surprise that columnist Rosanne Hertzberger in NRC on July 2 wrote about this subject. Hertzberger came to the House of Representatives in 2023 for Pieter Omtzigt’s NSC, a party that wholeheartedly participated in almost every wave of criticism of trans people. It was expected that Hertzberger, as spokesperson for medical ethics on behalf of that party, would have a lot to say about transgender care. That happened: Hertzberger requested that the government conduct research into transgender care for young people in 2024, which takes place according to the ‘Dutch protocol’.

After this, the Minister for Medical Care Pia Dijkstra requested the Health Council an advice to release. By the way, Hertzberger had more requests: them asked the government also collect data to gain insight into the number of diagnoses and treatments broken down by year, age and sex at birth. This register should then be shared with the House of Representatives. Dijkstra advised against the motion; it was not voted on.

The Health Council came up with a decision on June 30 his long-awaited report. The scientific basis for gender care is assessed as shaky, but the care is considered sensible. The results are as intended on a physical level, but on a mental level there are signals that indicate good results. Although more research is required into various long-term effects, according to the Health Council there is no reason not to offer transgender care that has been carefully assessed.

‘Pause button’

Anyone who reads the column will learn very little about what exactly the Health Council has advised, but they will get an impression of Hertzberger’s attitude towards trans people. She contradicts the function of treatment with puberty blockers as a ‘pause button’ by writing that 98 percent of young people then continue with hormone treatment. She bases this on a study from 2022, and although the researchers saw this result as reassuring – after all, many young people have not changed their minds – Hertzberger presents it as something disturbing.

Hertzberger writes that young people who continue with the medical process will later experience “consequences” for their “future family life and sexual functioning.” Excuse me? What kinds of problems are caused in those areas and how are they related to assumed problems in healthcare? Anyone who knows the numbers knows that research shows that the sexual satisfaction of trans people is comparable to the general population. According to the Health Council it does not matter whether minors have been given puberty blockers. And the consequences for “future family life”? What is that about? The claim that this all depends on a fourteen-year-old’s self-image is untenable. In addition, Hertzberger states that these young people proceed to “surgical reconstruction” as adults, but there are plenty of trans people who do not choose to do so.

Restrictive

Hertzberger mentions the countries that are almost always mentioned by critics of transgender care for young people: the United Kingdom, Sweden and Finland. Although these countries have adjusted their policies, both policy and practice differ greatly in those countries. In the United Kingdom, politicians practically banned healthcare after the so-called Cass Reviewthe report of independent research led by British pediatrician Hilary Cass, who assessed the substantiation of the treatments as weak. International medical organizations have significant criticism on this report. Healthcare in Sweden is restrictive, but doctors still prescribe treatments. The guidelines in Finland are indeed extremely strict. They recommend treatment in advance by researchers and interest groups is considered as a ‘pseudoscientific conversion treatment’, which primarily tries to change the patient’s mind.

In Belgium, Germany, France, Spain, Austria and Switzerland, researchers and organizations are in favor of transgender care, including puberty blockers and hormones above a certain age. Care is still provided there. Other countries, such as Denmark, also still offer transgender care. And the United States and New Zealand, which have banned healthcare, did so explicitly against the objections of trans people, experts and professional organizations.

While what we do know points to positive effects, opponents want to get rid of the available care completely. Hertzberger makes a caricature of the Dutch situation, as if doctors here claim a “unique care” inherent in Dutch practice to justify offering care while “the rest of the world” does something else.

Utah

After reading Hertzberger’s column, the ban on transgender care by Republicans in the American state of Utah crossed my mind. In their obsessive persecution Americans have taken care of trans people in dozens of states, without any substantiation. Utah is a good example, as Republicans banned trans care for minors there in 2023, asking the state’s Department of Health to investigate the care. After more than two years of research, the researchers arrived at: the conclusion that transgender care for minors is physically safe and has a positive effect on their mental health. In fact; the authors indicated that they saw no justification for restrictions on care.

Within a few days of the publication of the study, Republicans announced that they would maintain the ban because “children should not have to make these kinds of decisions.” In other words: it was never about the research or the recommendations, the Republicans just wanted to hear that they were right for form’s sake. For these people, evidence will never be enough, any research that does not give them the hoped-for answer is reason to remain suspicious.