Translation of the Dutch text by Shirley Haasnoot | Photo: David Meulenbeld
As the first medical centre in the world, the VU hospital, now part of the Amsterdam UMC, started transgender care about half a century ago. Currently, the transgender clinic on 'de Boelelaan' provides care and counselling to around 450 adults and 250 children experiencing gender dysphoria every year. This feeling of dissatisfaction with the body they were born with is sometimes present from their earliest childhood.
'When we talk about trans care, we often assume a positive story', says Dalin Veldman (36), who has been working as a mental health worker at Amsterdam UMC for four years. 'That if there is gender dysphoria, you will be helped at the gender clinic and you will live a nice life afterwards. But in many cases that is not the case at all. It is not because you are not happy with the choice to transition or that the care you get is not appropriate. You can feel that you need something as a human being, while in addition you can feel sadness, because you are saying goodbye to something else.'
Veldman uses the neutral pronouns those/they and is on the gender clinic waiting list. As project leader of the two-year 'Language in Transition' project, together with colleague Lenneke Post, Veldman aims to investigate the complex experiences in gender-affirming care, using literature research and in-depth interviews with transgender people, their loved ones and caregivers. Veldman previously studied philosophy and humanistics. We meet in the room next to the hospital chapel.
'We want to see if other feelings, such as doubt or grief, can also have a place'
'There is a social stigma on trans care, as you see with abortion or euthanasia, for example,' says Veldman. 'As a result, people feel they have to prove that that is absolutely what they want. And that pressure leaves little room for a more nuanced story. In which other feelings, such as doubt or grief, can also have a place. In our research, we therefore want to look at how we can pay attention to that existential side of the process that someone is going through.'
Because a transition often releases a lot. It can mean saying goodbye to your football team or your lesbian community. Or that you feel less safe on the streets. Veldman: 'The world is not friendly in that respect. And if, in a transition process, you are always busy proving that you are completely sure of your choice, it is difficult to share feelings of doubt or grief. While those can also be a big part of such an existential and profound process.'
In recent years, the number of applications to the gender clinic has risen sharply. There are thousands of people on the waiting list, who now have to wait around four years for an intake interview. This is followed by interviews, examinations and diagnostics, and then often a medical process that starts with hormone treatments.
'When people finally get their turn for treatment, here at the outpatient clinic, in addition to the biological side, the main focus is on how someone is doing psychologically, whether there is depression or personality problems, separate from gender issues. And your social situation is looked at, whether you are embedded in your family, for example, or in your environment.'
'As a trans person, you may feel that you are not completely free to speak about your grief'
Although the team of psychologists is also supportive, that ultimately gives the green light in terms of medical care. 'That creates a tricky dynamic, both for trans persons and healthcare providers. Because as a trans person, you can feel that you are not completely free to speak about your grief.'
How can you make space for those existential feelings, and can you create language for them and use that in supporting trans people and their loved ones? As a spiritual director, Veldman often sees how it helps people find words for what they are struggling with. 'Language can be healing. Especially when it comes to grief, words and concepts can make you understand exactly what you are feeling, and that you are not the only one experiencing it.'
Veldman cites retroactive grief, a self coined term, to describe the grief and loss experiences of trans people with a potential treatment desire. In retroactive grief, people look back on a period in their lives, and feel grief because of things they did not previously see as losses. 'Someone told me, "At the time, I didn't think about it further. But looking back, I actually feel tremendous sadness about what I've had to bear all this time." Talking about that, putting the emotions into words, can be very nice.'
'The world is steeped in gender'
Another term is ambiguous loss, which trans people and their loved ones sometimes experience. This involves situations where it is often not entirely clear what exactly is being lost. This can get in the way of acceptance and closure. 'For example, the loss you may feel as a mother or father when your role changes because your child is no longer the same.'
'The world is steeped in gender,' says Veldman. 'When a child is born, it is immediately a boy or a girl. That matters a lot to people, to their hopes and dreams, to the future they envision for their child. Often trans people carry the grief of others. Because when you go to tell your parents, or your partner, it can be a huge blow to them. Although it can also be that your surroundings are very supportive while you yourself are struggling with your feelings. Often that does not run parallel.'
Dealing with loss or with grief, that is an art and a skill that we do not get enough of in life, says Veldman. 'And yes, my own experiences are also an inspiration for this research. I was 11 when my mother died at the age of 45. I know what grief is and how damaging it can be if you don't get the right support in it. I do feel called to make a difference in that.'
'A gender transition is a human experience, just like any other life transition'
'I think, in a way, I have always struggled with masculinity and femininity and what I am in it. For a long time that was not in the foreground and I just lived as a woman, or tried to be that in many ways. I was preoccupied with my mother's death, and later with other things that took up more space. If I had had access to the experiences of people who don't identify as male or female, so to speak, I might have dealt with this earlier.'
Change hurts, but that doesn't mean some things shouldn't happen. That applies to personal choices, such as the transition people can choose to make at the gender clinic. It also applies to the way society looks at it. Veldman: 'Especially in situations where there is stigma, it is important to make room for multi-voicedness and nuance, by being inclusive and compassionate. A gender transition is a human experience, just like any other life transition.'
VUvereniging has awarded a grant from 1 January 2026 to the two-year research project 'Language in transition. Addressing ambiguous and complex experiences in gender-affirming care'. With the knowledge generated by this research, the Amsterdam UMC's Spiritual Care Department, together with the Knowledge and Care Centre for Gender Dysphoria, aims to provide better care for both people with gender dysphoria and their loved ones