How the Dutch Normalized Medical Madness

The Dutch campaign to sell gender medicine overruled human instincts and normalized the unthinkable

In February 2009, a Dutch late-night TV show aired a segment intended to educate viewers on the intricacies of genital surgeries for trans-identified people. The star of the clip was Jos Megens, the then coordinator of the Amsterdam gender clinic that was Ground Zero in the puberty suppression experiment.

In a graphic clip that is most definitely not for the faint of heart, Megens, with the help of diagrams and gruesome photographs, walks the audience through vaginoplasty, phalloplasty, and metoidioplasty (the creation of a micropenis out of a testosterone-enlarged clitoris).

Viewers are treated to full-color photographs of a gory flayed penis, a dissected arm being harvested for the construction of a non-functional penis-like appendage, an enlarged clitoris “micropenis” dwarfed by ludicrously disproportionate silicone testicular implants, and a finished product arm-flesh appendage sewn onto a woman’s groin.

The most bizarre moment of the 5-minute clip, however, comes when the host, Sophie Hilbrand, is confronted with the outcome of a vaginoplasty that resembles nothing so much as a groin ravaged by a particularly vicious wild animal. Hilbrand responds with a forced and surely not truthful: “It’s indistinguishable from the real thing!”

When the grotesque spectacle is over, only one question remains: how could this possibly be real life?

The answer requires a journey back to the earliest days of this experiment in the Netherlands, when a gang of eccentric, fringe individuals banded together and set about selling gender medicine to the medical world and wider Dutch society. It is the story of how a powerful cultural force overruled medical ethics and human instincts, and it begins with the sensational case of Christine Jorgensen.

Dyspsychopathologization is Born

It is impossible to overstate the impact of Danish doctor Christian Hamburger’s decision to embark upon his mad experiment to fulfill Jorgensen’s desire to change sex. When George reemerged as Christine in 1952, and the story made international headlines, Hamburger found himself inundated with requests from individuals desperate for the same medical procedures. Overwhelmed, and with the Danish government now refusing further foreign patients, Hamburger contacted the few sympathetic sexologists around the world who might be interested in fulfilling the unusual requests of the letter-writers.

One such sexologist was Coen van Emde Boas in the Netherlands, a psychiatrist who had earned himself the reputation of being “progressive.” He treated around 40 patients from the US between 1954 and 1956, whom Harry Benjamin had sent over to the Netherlands. But the debate was by no means settled in the Netherlands at the time, and a pivotal case in 1959 caused ethical outrage amongst the Dutch medical community, bringing the nation’s first foray into the sex change experiment to an abrupt halt.

But it would not stay dormant for very long.

At this time, in the Netherlands as elsewhere, “transsexualism” was recognized as a psychiatric disorder—admittedly, a poorly understood one with no effective psychological remedy—and surgical interventions were considered to be a serious breach of medical ethics.

Then along came an especially unorthodox endocrinologist by the name of Otto de Vaal. Seized with the progressive values of the era, he rejected the psychiatric framing of “transsexualism” and began prescribing hormones to trans-identified adults, many of whom were sex workers, out of his Amsterdam home in 1968.

The first in a long line of medical professionals to combine political activism with the provision of health care, de Vaal embarked upon a media campaign shortly afterward.

In 1971, he appeared on Dutch television, alongside one of his earliest patients, a trans-identified female called Rik Henning. De Vaal used the platform to advance his belief, set out in his book published that same year, that “transsexualism” was a medical condition requiring hormones and surgery, not a psychiatric disorder best treated with psychotherapy.

With his radical stance, depsychopathologizationwas set in motion, and De Vaal earned himself the reputation as the “founding father of Dutch transgender health care”. However, finding a surgeon to join him on this ethically dubious endeavor was no easy feat, but eventually one by the name of Philip Lamaker agreed to try cutting into healthy bodies as a means to alleviate psychological distress.

Undoubtedly, some will view De Vaal’s actions as a heroic quest to help an oppressed minority access essential, medically necessary care. Yet his story could just as easily be interpreted as a mad scientist colluding with the poorly understood madness of his patients, who unleashed a medical scandal upon the world.

With his retirement, De Vaal handed the baton to psychologist Anton Verschoor and endocrinologist Louis Gooren. Around this time, Jos Megens, star of the astonishing 2009 clip, joined the team as clinic coordinator. Meanwhile, a lack of willing surgeons continued to cause a bottleneck within the fledgling field, with each surgeon approached refusing to participate.

Then came Freek Bouman, of the VU hospital. Along with an unusual interest in gender-related genital surgeries, Bouman had already attempted one phalloplasty, and the less-than-perfect results did nothing to dampen his interest.

In fact, the story of Bouman’s first phalloplasty, performed in 1971, is very telling. The patient was a 45-year-old lesbian working as a truck driver, who wanted the ability to urinate standing up. Severe wound infections followed, but Bouman later wrote that “the patient was very grateful” because the surgery enabled her to marry her girlfriend.

And so, Bouman, fuelled by Christian compassion and a desire to resolve the very real suffering he observed in this patient cohort, requested that the VU’s Medical Ethical Committee consider the admissibility of “sex reassignment surgery.” After two and a half years of deliberations, hearing from Bouman and VU psychiatrists, and reviewing the existing literature, particularly the work of Van Emde Boas, the Committee ruled in 1976 that the surgeries were ethically permitted.

Interestingly, this pivotal decision to endorse cutting into healthy bodies—such a dramatic departure from traditional medical ethics—was never challenged or revisited, which is remarkable when one considers the total absence of physical pathology and the extreme nature of the interventions being offered. On the other hand, other ethical dilemmas, including euthanasia and abortion, were regularly up for discussion.

Still, not everyone at the VU was supportive, but with the endorsement of the Medical Ethical Committee, the gender team was able to dismiss opposition and, in a few short years, according to former medical director of VU hospital Chris Maats, transgender healthcare became “an established fact.”

“With our board it has never been a subject of discussion, in the sense of: should we really do this? Is it ethically acceptable?” Maats told historian Alex Bakker in 2017.

And that is the very core of the problem.

This lack of ongoing ethical discussions shows that the triumph was cultural and political, not scientific. If these procedures had been scrutinized in the spirit of genuine scientific inquiry, the debate would have been lively, heated, and prolonged.

Across the Atlantic, the same ethical conflict was unfolding. At the center of it was Dr. Paul McHugh, then psychiatrist-in-chief at Johns Hopkins, who recognized that the “zeal for…sex change surgery did not derive from critical reasoning or thoughtful assessments” but instead from the “fashions of the 1970s that invaded the clinic.”

McHugh later recalled a sobering conversation with a plastic surgeon at Hopkins, who said: “Imagine what it’s like to get up at dawn and think about spending the day slashing with a knife at perfectly well-formed organs, because you psychiatrists do not understand what is the problem here but hope surgery may do the poor wretch some good.”

This natural horror at the ghastliness of “sex reassignment surgeries” was widespread among surgeons in the early days of this experiment. As historian Joanne Meyerowitz noted, traditionally in medicine, it is doctors who are the pioneers of treatments, but in the case of gender medicine, it was the patients and their “fierce and demanding drive” for these drastic interventions that coerced reluctant medical professionals to override their natural instincts.

Awareness Drums Up Demand

While the ethical battle was the same on both sides of the Atlantic, for a time, the two medical worlds diverged sharply. In 1979, after outcome data on the first wave of men to undergo “sex change procedures” showed unfavorable results, McHugh concluded that Hopkins was wasting precious scientific resources colluding with a mental illness instead of helping patients overcome it, and he shut down John Money’s gender clinic. Many other university-based clinics also closed in the decade that followed.

Meanwhile, with the all-important backing of the Medical Ethical Committee, the Dutch experiment ramped up. Demand surged, and business was booming. In an interview with Alex Bakker, Jos Megens explains what triggered this flood of people seeking care at the Amsterdam clinic.

Starting in the late 1970s, Megens and Gooren—fully embracing their role as activists on behalf of their clinic’s patients—began appearing on Dutch television and radio programs to “explain the existence of transsexualism.” Megens later described the effect these appearances had: “Whenever a TV program had paid attention to transsexualism, my phone would not stop ringing the next day,” he told Bakker. “Crying people who said, ‘This is it. Finally I know what’s the matter with me.’”

The trouble is, Megens and Gooren went on television presenting transsexualism as a medical condition requiring medical treatment, despite not having any evidence to support that framing. The public response might have been very different if the two had gone on air describing the desire for medical alteration of sex characteristics as a mental disorder requiring psychological intervention.

At the time, those who recognized themselves in the description offered by Megens and Gooren would likely have fallen into one of two categories: heterosexual men with a paraphilic fixation on becoming women—a sexual desire that, a decade later, would be named autogynephilia, from the Greek auto (self), gyne (woman), and philia (love), or “love of oneself as a woman.” Or they would have been gender-nonconforming homosexuals living in a homophobic world who sought medical body modification as a remedy for their internalized homophobia. But this more nuanced understanding of transgender ideation and the desire for hormonal and surgical interventions was not yet available. So instead, the Dutch public was presented with an unproven medical explanation that obscured these underlying motivations.

The Power of Iatrogenesis

There is also another subtle yet important effect to be considered: iatrogenesis. From the Greek iatros (physician or healer) and genesis (origin), iatrogenesis refers to symptoms or conditions that arise from medical treatment. The iatrogenic effect of the availability of “sex-reassignment” interventions was observed in the earliest days of gender medicine. In 1965, psychiatrist Ira Pauly noted how once a “transsexual…knows that surgery is possible, this aim becomes the most important single goal of his life.”

Pauly believed the publicity awarded to “successful transsexuals” precipitated the desire for surgical transition and, with the passage of time, that desire solidified into the man often becoming “convinced that he is really a woman.” This observation was later echoed by McHugh, who noted how a patient often reported it being “torture” to continue living as a man after reading “in the newspapers about the possibility of switching surgically to womanhood.”

Evidence of this iatrogenic effect is plentiful. Meyerowitz describes how the increased media coverage of “sex-reassignment” surgeries in the post-Jorgensen 50s and 60s affected individuals feeling a discomfort with their sex, shaping the “inchoate desires to transform their bodies” into quests for medical treatment “with an urgency that bordered on obsession.” During this era, knowledge about the possibility of surgical transformation triggered numerous acts of desperate self-harm, with self-castrations, a bilateral mastectomy performed on a kitchen table, and individuals seeking “sex change” operations from “a quack in Mexico” or even “abortionists.”

One detailed account is that of Annette Dolan, who, after Christine Jorgensen’s story hit the headlines, made the decision to undergo surgery. At the time, surgical castration was not permitted in the US, requiring a trip abroad. Lacking the funds for such an adventure, Dolan decided to perform the operation himself. “I learned to ligate, suture, and anesthetize,” he wrote to Harry Benjamin. “I studied the surgical procedure step by step and memorized its sequence.” After succeeding in castrating himself, he presented to his doctor and later secured urologist Elmer Belt to finish the job of performing vaginoplasty.

There is even evidence of iatrogenesis in Rik Henning’s story, the trans-identified female who appeared on that pivotal late-night television show with Otto de Vaal back in 1971. Henning was a lesbian receiving care from de Vaal for a metabolic disorder. Testosterone formed part of the treatment protocol, and Henning enjoyed the masculinization effects so much that she interpreted this to mean she was, “in essence, a man.” Then, by going on television to raise awareness about “trans men,” Henning unleashed the idea into mainstream culture that some women are men and the appropriate medical treatment is testosterone and bilateral mastectomies.

Now let’s consider this iatrogenic effect through the lens of the overvalued belief, a classification of mental disorder defined by one all-consuming fixation that dominates the mind and drives pathological behavior. In the case of transgender ideation, the individual fixates on the medical alteration of healthy sex characteristics as the path to authenticity and happiness.

Yet before those treatments existed, and before knowledge of them spread, there was nothing upon which to fixate. So the discomfort remained private and inchoate. But as Meyerowitz, McHugh and Pauly each noted, once those feelings—with autogynephilic origins in some, in others the distress associated with being a gender-nonconforming homosexual—collided with the possibility that medicine could relieve the suffering, fixation became possible. The belief could then fulminate in the mind, crowding out all other thoughts, until the single-minded pursuit of body modification—the defining feature of trans as an overvalued belief—commenced.

The Right to Medical Harm

The 2009 clip featuring Jos Megens was one of the last such appearances aimed at educating the Dutch public about transgender healthcare. Not because there was outrage at the gruesome content, but because the VU clinic’s media campaign had succeeded: Dutch society had been successfully conditioned to accept these horrific procedures as ethical medical care.

Fuelled by deeply misguided compassion and the cultural zeal of the progressive era, the marketing campaign of the Dutch gender team met with astonishing success, normalizing the unthinkable and reprogramming an entire society to accept the absurd idea that the medical obliteration of sex characteristics is ethically sound healthcare.

And in the darkest twist of all, along the way untold numbers of innocent youth found themselves ensnared in the medical calamity this social engineering project unleashed, with the wreckage spanning far beyond the Dutch borders. For over five decades, the entire Western world has been hoodwinked into supporting a field of medicine that colludes with the madness of its patients while ignoring natural human instincts and every red flag.

The truth is, neither the Dutch early pioneers nor their American counterparts understood the mental disorder with which they were faced. So they threw their hands up in the air and said: well, we can’t help them psychologically, so we might as well just cut into their healthy bodies. It didn’t matter that no medical root had ever been uncovered because when the experiment fused with the civil rights juggernaut that is modern trans activism, it took on a life of its own and became an unstoppable force.

But today, in 2026, we have a far deeper understanding of why people seek these radical interventions. We understand autogynephilia and the erotic fixation that propels some men to seek hormones and surgeries. We understand how internalized homophobia can fuel the desire for a medical remedy that amounts to conversion therapy by another name. We understand how powerfully seductive the idea of a medical rebirth can be to those in states of vulnerability and distress.

And through the lens of the overvalued belief, we now see this patient group more clearly than ever, and with this clear-eyed view the absurdity of the entire field becomes impossible to ignore—the key symptom of the disorder being treated (the desire for extreme body modification) and the treatment (extreme body modification) are identical. And so, we can no longer plead ignorance and hide behind supposedly good intentions.

Of course, attempting to create a vagina out of an inverted penis could never produce results “indistinguishable from the real thing,” and stripping a woman’s forearm for the purposes of fashioning a non-functional appendage to be sewn onto her groin could never be anything but a ghastly medical crime.

These are obvious truths that only a powerful cultural force could ever have prevented from being uttered. As a result of that forced silence, society took a dangerous detour into medical madness, and charting the course back to medicine that heals instead of harms is long overdue.

This essay is the third in a series. Read essays 1 and 2

Mia Hughes is the author of The WPATH Files, Director of Policy and Research at Genspect, Director of Genspect Canada, and co-host of the Beyond Gender podcast with Dr Stella O’Malley

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