Tycho01

Netherlands MtF transition tutorial

Insurance

There's a guide on general insurance stuff at transvisie. One gotcha is that if a care supplier hasn't made contracts with insurance companies, you need a 'restitutiepolis' health insurance contract to get full coverage (if not, exact percentages differ by plan, ranging from 60% to 90%). You can change your health insurance for the new year starting from mid November. Note that while restitutiepolis normally means costs are only reimbursed afterwards, for surgeries performed outside of the country yet within the EU, a S2 (E11) form will help get the costs reimbursed upfront.

Recommended insurance companies for transgender stuff include Zilveren Kruis (Basis Exclusief for restitution policy), ONVZ and Zekur. Others have had bad experience with CZ Groep, which includes CZ, Just, OHRA, Nationale Nederlanden, and Delta Lloyd. The one insurance company that should be avoided at all costs is Pro-Life, which as a christian organization received legal permission not to offer transgender healthcare.

Insurance companies that have specifically compiled info for transgender people:

• Zilveren Kruis

Care providers

Multi-disciplinary teams

this category is authorized to give references for insurance for all categories of care, but as demand is high, these generally have longer waiting lists (inquire with them for current waiting times).

Options include:

• Amsterdam VUMC
• UMC Groningen
• Radboud UMC
• UZ Gent: may no longer accept people from the Netherlands due to high demand.
• StepWork
• T-cendent

To get costs of these providers covered by insurance, you need to get referred by your GP. You can however get referred to multiple to allow you to just go with whichever ends up able to help you first.

Specialized care

This category includes independent care providers specialized in one area, e.g. beauty parlors offering lasering, logopedics providers, psychologists, fertility clinics, etc. As there is no monopoly here waiting times are generally limited, but to get these covered by insurance you will need a reference. Depending on the category, your GP may well be authorized to provide these.

Diagnosis, needed for insurance coverage, can be obtained at various places (select 'diagnostiek'). Given their waiting times it may be best to inquire about waiting times at several of these and sign up at multiple quicker ones.

general practicioner

These have relatively limited authority in specialized areas, so may refer you to multi-disciplinary teams or specialized care. The good part is these are all over the country and you generally don't need to wait long to talk to them. Quite some communication could even be handled online. This makes general practicioners the preferred option for any area within their authority (e.g. to prescribe hormones they need to have followed a training as per the Dutch association of endocrinologists). If your current general practicioner is not cooperative toward your transition, you might even consider switching to one who is.

In case your GP doesn't have much expertise on trans stuff, Trans in Eigen Hand can help them learn more and get certified to prescribe hormones.

Social

Events like transvisie and Trans United's T-huis are nice ways to get to know more people. Alternatively, consider joining a local trans Discord.

Coverage

The following table summarizes which entities are authorized to provide references for insurance coverage for different care categories. Note that, while multi-disciplinary teams may be authorized to give references for any category, in practice their long waiting times may lead one to prefer going through a GP instead.

'free choice' indicates the category allows coverage through any care supplier -- if not available, then for suppliers that have not been contracted one will need to apply for permission with the insurance company beforehand. Note this doesn't imply full coverage, which without a 'restitutiepolis' insurance plan still requires contracts between the insurance company and the care supplier.

Category of care	multi-discipl.	BIG physician (GP)	free choice	Notes
logopedics	✅	✅	✅	as per insurance rules, sessions are 25 mins, with a limit of 1 session per day.
hormones (HRT)	✅	depends	✅	Different kinds below. To get a recipe law requires you get 30 days to think it over. After they may recommend you to also measure some blood/hormone levels at your GP. BIG-certified physicians require an endocrinology training to prescribe hormones, so others may defer to a specialist. Turn to Adrie for shorter waiting times.
freezing sperm	✅	✅	✅	Major hospitals offer this.
gender affirmation surgery (SRS)	✅	❌	❌	Popular destinations to perform the surgery include Thailand. Note that this surgery may involve various options.
breast enhancement surgery	✅	✅	✅	covered by insurance only after 2y HRT if no breasts (if no Inframammary fold, breast (klierweefsel) <1 cm), tho the gov subsidizes breast implants after 1y of HRT.
psychological help	✅	✅	✅	as per insurance rules, sessions are 45 mins, with a limit of 1 session per day. coverage on additional plans depends.
laser epilation	✅	❌	❌	coverage is only for face and genital area (as part of SRS), and may require deals between the supplier and the referring physician, which major gender teams have. coverage on additional plans depends. such lasering is usually advertised as IPL. alternatively, though not covered by insurance, one can purchase a device.
voice surgery	✅	❌	❌	I heard Korean hospitals are experienced at this.
orchidectomics (testis removal)	✅	❌	❌	n/a
facial feminization surgery (FFS)	✅	❌	✅	most renowned FFS provider is Facial Team (Spain). in NL there's also Brigitte Meijer (@ VUmc but not part of gender team so shouldn't require 2y waiting list). Belgium has 2pass (cheaper than Facial Team), which may be covered by Dutch insurance tho their surgeon got bad reviews on /r/TransDIY. generally should do FFS only after 1y of HRT.
wigs	n/a	n/a	n/a	no reference needed, necessity/coverage judged by the insurer (e.g. degree of baldness). coverage on additional plans depends.

Hormone Replacement Therapy (HRT)

Sources listed at HRT cafe, rated at Reddit's /r/TransDIY wiki.

• pills: ubiquitous, risk of trombosis, max prescription here 4 mg, better effect if consumed under the tongue
• patches: may fall off, E may die in the liver
• spray: easy, covered, no liver/needles, but may need a lot
• capsules in skin w/ depots: not sure if this is a thing
• gel: no coverage, not currently available, can focus on certain tissue
• injections: high E, locally pricy, hard to get coverage, elsewhere cheaper
• powder: needs preparation to work, not available locally, elsewhere cheap but likely to face importing fines

There is also the 'femboy hormone' Raloxifene (paper), which blocks the estrogen receptors so you can feminize without growing boobs.

legal name / gender change

The Netherlands has only a dozen people authorized to handle this, covering major organizations like VUMC, StepWork and trans clinic. Flow at the last one:

• consult with Adrie
• mail her
• pay (e65)
• wait for the document ('deskundigenverklaring')
• apply at your municipality of birth to update your birth certificate
• at your municipality of residence get an updated passport/id

Logopedics

Independent providers (should be 11 in the Netherlands specialized in transgender logopedics):

• Amsterdam: Logopedie Amsterdam (Marieke van Hal)
• Flevoland: Logo Flevo

You can also use apps to train (Android).

Laser epilation

Insurance only covers face / genitals (as part of SRS), not limbs/body. For such remaining areas, it may be cheaper to purchase a laser device (permanent but presumes dark hair and light skin) or IPL device (any skin tone tho not permanent). The lasering window on these personal devices is tiny tho, so it may be better to get this done professionally, rely on HRT to lighten body hair (limbs), or shave.

Independent providers may be found here.

Facial feminization surgery (FFS)

• Upper third of face
  • Hairline correction
  • Forehead recontouring
  • Brow lift
  • Orbit recontouring (eyes)
• Rhinoplasty (nose)
• Cheek implants
• Lips
• Chin contouring
• Jaw contouring
• Adam's apple reduction: insurance coverage requires showing the Adam's apple sticks out by at least 5 mm.
• Associated procedures
  • Blepharoplasty (correct eye bags, sagging eyelids)
  • Rhytidectomy (face and neck lift)

Sexual function

For pre-SRS mtf transgenders, anti-androgens (e.g. the most commonly used cyproterone acetate) may inhibit sexual function (erections). This may be countered by:

• taking anti-androgen lower dosages
• using alternative anti-androgens such as bicalutamide, which block the receptors rather than lowering actual testosterone value
• replacing anti-androgens with higher concentrations of estrogen (such as from injections)
• taking sildenafil (aka viagra / kamagra)