Krakow Film Festival 2024

The Dutch gender clinic negotiating teen futures

HEALTH / The complexities of a Dutch gender clinic, from the challenges of young people facing gender transition to the role of experience-based experts, and the clinic's operational struggles.
Producer: Tangerine Tree
Distributor: VPRO
Country: Netherlands

Dutch documentarian and psychologist Ingrid Kamerling has made a number of films about mental health, young adults, and the medical system, including Blue Monday (2021), about three people with psychosis, Echo (2021), about people detained under hospital orders, and Vivian, Vivian (2017), in which she reckoned with her own sister’s suicide. Many of the young people we meet in They & Them (2023), her latest documentary, are experiencing depression and psychological distress for a very specific reason: the long waiting lists to be referred for gender transition treatment, as policymakers fail to prioritise their care as urgent and essential. The film, which gathers views from a number of perspectives and experiences, aims chiefly to be informative and convey reliable facts and insights, reducing the prevailing stigma and misinformation around gender transition and care that has been the basis of a firestorm of recent media controversy worldwide.

They and Them Ingrid Kamerling
They and Them, a film by Ingrid Kamerling

Youz

They & Them had its world premiere at IDFA in the Frontlight section and will be broadcast on Dutch television. It takes us inside the day-to-day functioning of Youz, a gender clinic in the Dutch city of Zaandam, which offers psychological support to kids who are exploring their gender identity and may want to transition and the parents who, in many cases, are struggling to accept this and adapt. It is the only clinic in the Netherlands that includes experience experts who are trans on their team. This diversity adds an invaluable dimension of knowledge and guidance but also a degree of inner friction and a sense of two sides in the clinic. Cisgender employees must face their own discomfort and assumptions as debates over team operations arise in group meetings — an at times pressurised environment exacerbated by a funding shortfall and heavy demands on workload and performance.

Kamerling is granted close access to client appointments and team meetings and conducts one-on-one interviews with the staff. She has edited the footage for a well-rounded sense of what is involved in running the gender clinic and seeking assistance there, and the involved process for treatment, assessments, and referrals to doctors for hormone inhibitors. The ethical and philosophical concerns around allowing young people to act on what they believe is best for themselves and make irreversible decisions and the pervasive fear of potential regret that drives a lot of the controversy around treatment are examined from a number of angles. Changing gender before the law has meant that infertility is mandatory, and teenagers must decide already on whether to close the door on having biological children at an age where they are not yet mature. But, delaying the decision without hormone treatment means the development of unwanted sex characteristics and the mounting distress of inhabiting a body that does not suit one’s identity. A crisis situation at the clinic involves a trans boy with breasts who is suicidal; one staffer expresses helplessness over only being able to prescribe anti-depressants when another medication would be much more suitable for them. One particularly tricky case for the clinic involves a client with an intellectual disability, Sem, who is adamant she wants to start the physical transition with the support of her parents but encounters a lot of institutional resistance and complexity as the clinic presents her case for approval.

When a cisgender person feels uncomfortable, the clinic is going in the right direction

Necessity of existence

Whether or not to state pronouns in staff email signatures and whether or not to hang a rainbow flag outside the premises are among the internal matters debated in staff meetings. Bianca, an experience expert who is non-binary, had to contend with disapproving parents without the kind of support the clinic offers and hopes ultimately for a society in which autonomy lies with the individual, completely separate from gender and other people’s opinions. When a cisgender person feels uncomfortable, the clinic is going in the right direction, Bianca contends, as trans people suffer with this feeling every day. We hear a lot also from Sander, a cisgender, straight psychologist who drives a Harley, smokes cigars, and jokes that these stereotypically macho pastimes may signal a mid-life crisis. He is reluctant to declare his pronouns, arguing that inclusivity must also mean a place for him — a position that, some counter, assumes normalcy. The discussions around power, the clinic’s public face, and how best to create a welcoming environment in which all can work most effectively are sometimes tense but always civil and fruitful, providing a lively and multi-faceted window onto the gender clinic’s work and, above all, the necessity of its existence in a town in which municipal policy prefers to regard it as a luxury.

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Carmen Gray
Carmen Gray
Freelance film critic and regular contributor to Modern Times Review.

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