After rephrasing several obvious limitations and claiming that their gender clinic treats "over 95% of the Dutch gender-dysphoric patients," they judge the number of 584 patients reported by our respondents to be unrealistically high, "unless proven otherwise." However, our results strongly suggest that their claim that their clinic treats over 95% of gender-dysphoric patients is unrealistic. The results from our survey do not leave much room to doubt that many Dutch psychiatrists are cautious in referring patients to specialized gender clinics. Only 12.5% of the 584 gender-dysphoric patients we reported on were indeed referred to such a specialized gender clinic by the responding psychiatrist. Without being asked specifically for this information, psychiatrists wrote on the survey forms that they would "never advise this treatment route," and their quantitative reports on the closed questions underline this. Other psychiatrists spontaneously reported on alternative treatments that they recommend and use (psychotherapy, psychopharmacological treatment, etc.). Simply on the basis of the experiences reported, it is likely that there may be a substantial group of patients with gender dysphoria who are not referred to investigate the options of undergoing hormonal and surgical sex reassignment. Furthermore, we would like to point out that 584 cases spread over 186 respondents with an average working experience of 14 years means that Dutch psychiatrists are consulted by a patient suffering from gender dysphoria every 4.5 years. Judged from our own psychiatric hospital experience, this figure is far from unrealistically high.