Several studies estimate the prevalence of gender dysphoria among adults by examining the number of individuals turning to health services. Since individuals might be hesitant to seek medical care related to gender dysphoria, these studies could underestimate the prevalence. The studies also lack information regarding the variance among different aspects of gender dysphoric conditions. Therefore, the current study estimated the prevalence by examining self-reported gender identity and dysphoria in a Dutch population sample (N = 8,064, aged 15–70 years old). Three measures assessed aspects of gender dysphoria: gender identity, dislike of the natal female/male body, and wish to obtain hormones/sex reassignment surgery. Results showed that 4.6 % of the natal men and 3.2 % of the natal women reported an ambivalent gender identity (equal identification with other sex as with sex assigned at birth) and 1.1 % of the natal men and 0.8 % of the natal women reported an incongruent gender identity (stronger identification with other sex as with sex assigned at birth). Lower percentages reported a dislike of their natal body and/or a wish for hormones/surgery. Combining these figures estimated the percentage of men reporting an ambivalent or incongruent gender identity combined with a dislike of their male body and a wish to obtain hormones/surgery at 0.6 %. For women, this was 0.2 %. These novel findings show that studies based on the number of individuals seeking medical care might underestimate the prevalence of gender dysphoria. Furthermore, the findings argue against a dichotomous approach to gender dysphoria.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
For the current study, the prevalence of ambivalent and incongruent gender identities was examined. This was operationalized as individuals who psychologically experience themselves the sex assigned at birth to the same degree as they experience themselves the other sex (ambivalent) or more as the other sex than the sex assigned at birth (incongruent). However, one could, of course, also argue that individuals reporting neither experiencing oneself as a man or woman (scores 1,1; 2,2; 1,2; 2,1) should be classified as individuals without a gender identity. These data can be found in Table 2.
Bakker, F., de Graaf, H., de Haas, S., Kedde, H., Kruijer, H., & Wijsen, C. (2009). Seksuele gezondheid in Nederland 2009 [Sexual health in the Netherlands 2009]. Utrecht: Rutgers Nisso Groep.
Bakker, A., van Kesteren, P. J. M., Gooren, L. J. G., & Bezemer, P. D. (1993). The prevalence of transsexualism in the Netherlands. Acta Psychiatrica Scandinavica, 87, 237–238.
Bakker, F., & Vanwesenbeeck, I. (2006). Seksuele gezondheid in Nederland 2006 [Sexual health in the Netherlands 2006]. Delft: Eburon.
Bethlehem, J. (2006). Representativiteit van web-surveys–Een illusie? [Representativeness of web surveys: An illusion?]. Voorburg: Statistics Netherlands.
Bockting, W. O., Benner, A., & Coleman, E. (2009). Gay and bisexual identity development among female-to-male transsexuals in North America: Emergence of a transgender sexuality. Archives of Sexual Behavior, 38, 688–701.
Bradley, S. J., & Zucker, K. J. (1997). Gender identity disorder: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 872–880.
Cohen-Kettenis, P. T., & Pfäfflin, F. (2010). The DSM diagnostic criteria for gender identity disorder in adolescents and adults. Archives of Sexual Behaviour, 39, 499–513.
Collier, K. L., Bos, H. M., & Sandfort, T. G. (2012). Intergroup contact, attitudes toward homosexuality, and the role of acceptance of gender non-conformity in young adolescents. Journal of Adolescence, 35, 899–907.
de Cuypere, G., van Hemelrijck, M., Michel, A., Carael, B., Heylens, G., Rubens, R., et al. (2007). Prevalence and demography of transsexualism in Belgium. European Psychiatry, 22, 137–141.
de Graaf, H., Kruijer, H., van Acker, J., & Meijer, S. (2012). Seks onder je 25e. Seksuele gezondheid van jongeren in Nederland anno 2012 [Sex under 25. Sexual health of young people in the Netherlands in 2012]. Delft: Eburon.
de Heer, W. (1999). International response trends: Results of an international study. Journal of Official Statistics, 15, 129–142.
de Leeuw, E. D., & de Heer, W. (2001). Trends in household survey nonresponse: A longitudinal and international comparison. In R. M. Groves, D. A. Dillman, J. L. Eltinge, & R. J. A. Little (Eds.), Survey nonresponse (pp. 41–54). New York: Wiley.
Geerdinck, M., Muller, L., Verkleij, C., & van Weert, C. (2011). Transseksuelen in Nederland. Is er sprake van ongelijkheid? [Transsexuals in the Netherlands. Does inequality exist?]. The Hague: Statistics Netherlands.
Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Retrieved from http://www.nap.edu/catalog.php?record_id=13128.
Keuzenkamp, S. (2012). Worden wie je bent. Het leven van transgenders in Nederland [Be who you are. The lives of transgender individuals in the Netherlands]. The Hague: The Netherlands Institute for Social Research.
Kuyper, L. (2012). Transgenders in Nederland: Prevalentie en attitude [Transgender individuals in the Netherlands: Prevalence and attitudes]. Tijdschrift voor Seksuologie, 36, 129–135.
Kuyper, L., de Wit, J., Adam, P., & Woertman, L. (2012). Doing more good than harm? The effects of participation in sex research on young people in the Netherlands. Archives of Sexual Behavior, 41, 497–506.
Kuyper, L., Wijsen, C., & de Wit, J. (2013). Distress, need for help, and positive feelings derived from participation in sex research: Findings of a population study in the Netherlands. Journal of Sex Research. doi:10.1080/00224499.2012.736092.
Lai, M., Chui, Y., Gadow, K. D., Gau, S. S., & Hwu, H. (2010). Correlates of gender dysphoria in Taiwanese university students. Archives of Sexual Behavior, 39, 1415–1428.
Lawrence, A. A. (2010). Societal individualism predicts prevalence of nonhomosexual orientation in male-to-female transsexualism. Archives of Sexual Behavior, 39, 573–583.
Lawrence, A. A., & Zucker, K. J. (2012). Gender identity disorders. In M. Hersen & D. C. Beidel (Eds.), Adult psychopathology and diagnosis (6th ed., pp. 601–635). New York: Wiley.
Little, R. J. A., & Rubin, D. B. (1987). Statistical analyses with missing data. New York: Wiley.
Meyer zu Hoberghe, S. (2009). Prävalenz, Inzidenz und Geschlechterverhältnis der Transsexualität anhand der bundesweit getroffenen Entscheidungen nach dem Transsexuellengesetz in der Zeit von 1991 bis 2000 [Prevalence, incidence and sex ratio of transsexualism in Germany established by counting applications of the German transsexuals’ act during the period 1991 until 2000]. Retrieved from http://eldiss.uni-kiel.de/macau/content/below/index.xml?lang=en.
Olsson, S., & Möller, A. R. (2003). On the incidence and sex ratio of transsexualism in Sweden, 1972–2002. Archives of Sexual Behavior, 32, 381–386.
Shields, J. P., Cohen, R., Glassman, J. R., Whitaker, K., Franks, H., & Bertolini, I. (2013). Estimating population size and demographic characteristics of lesbian, gay, bisexual, and transgender youth in middle school. Journal of Adolescent Health, 52, 248–250.
Stoop, I. A. L. (2005). The hunt for the last respondent: Nonresponse in sample surveys. The Hague: The Netherlands Institute for Social Research.
Te Riele, S. (2002). Vertekening door non-response. Hoe nauwkeurig zijn uitkomsten van persoonsênquetes? [Bias due to nonresponse. How reliable are results from questionnaires?]. Sociaal-economische maandstatistiek, 19. Retrieved from http://www.cbs.nl/NR/rdonlyres/C4F72666-8C9D-463D-89E1-768FD57B0555/0/2002m04v4p020art.pdf.
Tick, N. T., van der Ende, J., & Verhulst, F. C. (2008). Ten-year trends in self-reported emotional and behavioral problems of Dutch adolescents. Social Psychiatry and Psychiatric Epidemiology, 43, 349–355.
van Beijsterveldt, C. E. M., Hudziak, J. J., & Boomsma, D. I. (2006). Genetic and environmental influences on cross-gender behavior and relation to behavior problems: A study of Dutch twins at the ages 7 and 10 years. Archives of Sexual Behavior, 35, 647–658.
Wijsen, C., & De Haas, S. (2012). Seksuele gezondheid in Nederland 2011: Achtergronden en samenstelling van een representatieve steekproef voor een bevolkingsonderzoek [Sexual health in The Netherlands 2011: Creating a representative sample for a population study]. Tijdschrift voor Seksuologie, 36, 83–86.
Wilson, P., Sharp, C., & Carr, S. (1999). The prevalence of gender dysphoria in Scotland: A primary care study. British Journal of General Practice, 49, 991–992.
Zucker, K. J., Bradley, S. J., & Sanikhani, M. (1997). Sex differences in referral rates of children with gender identity disorder: Some hypothesis. Journal of Abnormal Child Psychology, 25, 217–227.
Zucker, K. J., & Lawrence, A. A. (2009). Epidemiology of gender identity disorder: Recommendations for the Standards of Care of the World Professional Association for Transgender Health. International Journal of Transgenderism, 11, 8–18.
We would like to acknowledge the funding for the research project by the Dutch Ministry of Health, Welfare, and Sports and the role played by Floor Bakker (previous lead investigator of the research team) in the design and logistics of the study in its early days. The prevalence figures related to gender identities and gender dysphoric feelings have previously been published in the Dutch journal Tijdschrift voor Seksuologie (Kuyper, 2012).
About this article
Cite this article
Kuyper, L., Wijsen, C. Gender Identities and Gender Dysphoria in the Netherlands. Arch Sex Behav 43, 377–385 (2014). https://doi.org/10.1007/s10508-013-0140-y
- Gender identity disorder
- Gender dysphoria
- Sex reassignment surgery