Sam holds Dutch gender clinic liable for misdiagnosis: “Going into transition was not the solution to my problems”

• 20-06-2024 07:00
• Authors: Leonie van Noort, Caroline van den Heuvel

Sam  Source: EenVandaag

Was it dissatisfaction with his biological sex or was Sam unhappy for other reasons? He was diagnosed with gender dysphoria but, in retrospect, feels that his other problems were not sufficiently addressed. And that is why he is now holding the hospital liable.

Sam* is holding the Amsterdam UMC, which includes the gender clinic of the VU Medical Centre, liable because he feels a proper diagnosis was not made. And he is not the only one: his lawyer is now handling 10 cases surrounding transgender care, two of which involve misdiagnosis.

Obsessed with being a woman

In recent years, Sam, now 25, was transitioning from male to female and being treated with female hormones. He was obsessed with his body and all he was doing was making sure he looked convincingly female and that others would not realise he was born a boy. To this end, he undergoes several cosmetic surgeries.

However, going through life as a woman did not bring him more self-confidence, self-esteem, or happiness. On the contrary, it tended to make his depressive symptoms worse. So Sam started to doubt whether life as a woman could be the answer to his despondency. And whether gender dysphoria was his most essential problem - because there was more to his problems than that.

“Tangled up with myself”

Sam was struggling with himself when, at 16, he thought he was transgender. "There was a broadcast on television with a trans boy sharing his story," he looks back. "And that was when I was already feeling very unhappy, I was very confused with myself."

During that time, Sam also discovered that he fancied men. The teenage boy found it difficult, which he "certainly didn't want. Also, I had a lot of trouble with myself as a person: I found myself disgusting, I hated myself and thought I was a terrible person."

Becoming a new person

"I also thought that everyone saw me like that and that made me look for what could be wrong with me, what I needed to change," he explains. "Seeing that trans boy on TV gave me the idea that this was an opportunity to become a new person. Someone who was okay and who was fun."

Sam sought help from the gender team at the University Medical Centre Groningen (UMCG). Several interviews followed, after which a diagnosis of gender dysphoria was made: a strong feeling of dissatisfaction with the sex a person is born and raised with. However, a decision was made not to start treatment yet.

“You are transgender, period”

That changed when Sam moved to Amsterdam and attended the gender clinic at the VU Medical Centre (VUmc). "The intention was to diagnose me there again, but I don't feel that happened," he looks back.

"Actually, from the very beginning when I was at the VU, it was like, 'Oh, you're transgender, period.'" According to Sam, whether gender dysphoria was his main problem was no longer examined during treatment. "From the start, the process in Amsterdam focused on meeting the conditions for transition," he says.

No regard for other issues

Other issues lurked in Sam’s background: for instance, it was difficult for him to connect with his peers, and his parents split up during this period. But the impact of all these things on how Sam felt, he says, hardly seems to play a role in discussions with practitioners.

"For example, they did say, 'We don't see you suffering a lot from being a man’. Then I said that I could reasonably put that aside because I had the prospect of transitioning to treatment. Indeed, in my head, I thought this would solve my problems," Sam explains. "This is something they then never asked about. There was never any pushback one way or the other."

Self-determination from 16 years

Sam acknowledges that he wanted the transition himself and was clear about it to his practitioners. According to the Medical Treatment Agreement Act (WGBO), a person aged 16 and over can decide whether to undergo treatment.

But he now thinks that does not negate the fact that the psychologists in the gender team could have countered. "They should have helped me look at the whole picture and not just that transition," he says. He also feels that his parents were not involved enough and that his mother was not listened to when she expressed doubts about the process.

Stopped transitioning again

When Sam was about to undergo more cosmetic surgery at 22, he came to the conclusion that transitioning to become a woman was not the answer. He decided to stop using female hormones and said “no” when he was later called by the hospital for gender-affirming surgery.

Sam has since been living as a man for 3 years and is gradually improving. "I was this close to having the sex operation. If I think about that, it can be very upsetting. I think I was very lucky to have narrowly escaped."

Guideline for transgender care

It’s not clear whether Sam's experiences are common. The guidelines, called the Quality Standard for Medical Transgender Care, agree that the diagnosis of gender dysphoria in children and adolescents should be performed by a psychologist, psychiatrist or remedial educationalist.

It also states that teenagers and young adults are eligible for gender-affirming hormone treatment only if “secondary problems in the psychological, medical or social field (...) are sufficiently under control so that the adolescent's situation and functioning are stable enough to start and oversee treatment with cross-sex hormones”.

“Trouble because you're trans”

Sam doubts whether this was the case in his situation. Moreover, he says his experience shows that practitioners often assume that patients' (mental) problems are caused by the fact that someone does not identify with his or her sex and by the reaction of the environment to this.

"Someone is bullied, abused, neglected, etcetera because he or she is trans. Or someone has an unhealthy obsession with their appearance or genitals because they are trans. Other possible causes are not looked at or examined," Sam notes.

Due diligence procedures

Robert Vermeiren is a child psychiatrist at Leiden University Medical Centre (LUMC) and does not treat children with gender issues himself, but does treat children with other mental vulnerabilities such as autism and eating disorders. He points out that there are procedures in the Netherlands to ensure care in this kind of treatment.

He stresses the importance of taking possible gender dysphoria seriously. "If a child or young person comes to us with an intense story, we as practitioners naturally tend to listen to it and consider it. If we didn't, we would leave many young people out in the cold."

“Thinking about where the boundary lies”

"At the same time, hearing that there are stories of young people saying afterwards, 'You listened to me too much', I think that's also important," he adds. "And I think we need to start thinking about where the boundary is and how we will do that?"

Sam does feel a line has been crossed. He feels mistakes were made. "If they had been more careful and not just encouraged and affirmed me, I would have been much more critical myself, and I might never have done it." Along with a fellow sufferer - who was transitioning from girl to boy but also detransitioned  - he holds the hospital liable for misdiagnosis.

Source: EenVandaag

Child psychiatrist Robert Vermeiren of Leiden University Medical Centre

Compensation and recognition

They want compensation, but above all, they want recognition. So that something changes and the same thing cannot happen to others, he concludes by explaining. "Because young people who should not enter such a transition, because it does not benefit them at all and it only makes their problems worse, can now end up in it anyway."

Amsterdam UMC said in a written response it could not comment on individual cases, but stated it works carefully and follows professional medical standards. The hospital has rejected liability. This means that Sam and his lawyer must look for a medical expert who is acceptable to both parties and can independently investigate how the treatment went.

*Sam is a pseudonym. His real name is known to the editor.