gender reassignment surgery norway

The rocky road to sex change treatment in Norway

‘From ex-soldier to blond beauty’. These words covered the front page of Daily News 1 December 1952. The news story was about Christine Jørgensen, previously George, who had undergone gender-confirming treatment in Copenhagen. It was the story about the world’s first successful gender reassignment treatment, a story that would also be significant in Norway.

“In the 1950s, medical doctors began to experiment with gender hormones, and at the same time, people started to think differently about gender in society,” says Sigrid Sandal.

She is an historian, and has recently submitted her master’s thesis En særlig trang til å ville forandre sitt kjønn. Kjønnsskiftebehandling i Norge 1952-1982 (‘A certain need to change their sex. Gender reassignment treatment in Norway 1952-1982’) at University of Bergen. The spirit of the age in the post-war period played an important role for the development of the treatment offered to transgendered people, according to her.

“During the war, women had performed different roles than before, and consequently the gender roles were discussed in new ways. At the same time, medical researchers understood more of how hormones work and affect the body.”

Two separate genders

“There was a general understanding of women and men as two different biological variants,” Sandal explains.

The big news story about Jørgensen challenged the conventional ways of thinking about body and gender. The fact that she was the first to receive treatment was the result of lucky coincidents.

“Jørgensen met the Danish medical doctor Christian Hamburger, who wanted to experiment with gender hormones.

Jørgensen was a willing guinea pig. Every day she had to come into the hospital to deliver urine tests and receive hormone injections. The study became the first medical proof of what happens when oestrogen is injected into male bodies. When the news about the result of the treatment reached the press, the reactions were positive both internationally and in Norway.

“The tabloid press described a total change, an almost magical change from man to woman. This was completely new to the public, so when the doctors said they had changed Jørgensen’s gender, people interpreted it literally.”

People thought she had grown a vagina and ovaries – and that she could have babies.

“Motherhood was central to the female role in this period. At the same time, many had an enormous faith in the doctors’ abilities,” says Sandal.

When the papers began to write more about the technical realities, it became clear that the sex change was not as magical as many had previously thought. For instance, Jørgensen could not have babies.

”Then the discussion changed. Jørgensen was not a real woman, but rather a castrated man – an in-between. Many felt cheated.”

Split professional environment – also in the 1950s

The Danish doctors received thousands of inquiries from people who wanted similar treatment. Approximately fifty of these were Norwegian. Norwegian doctors also had experience with patients who felt that their gender identity and body did not correspond. When the issue was raised with Karl Evang in 1955, the health director at the time, a group of expert psychiatrists was appointed to give an account of the treatment of ‘genuine transvestism’, as it was referred to at the time. 

­”The group had differing opinions,” says Sandal.

The expert group consisted of people who were about to position themselves as leading experts on the field over the next twenty years. The leader of the group was Per Anchersen, senior consultant at the psychiatric ward for men at Ullevål hospital. Psychiatrist Gabriel Langfeldt, one of the most renowned psychiatrists, was a member of the group. Another prominent member was Johan Bremer, senior consultant at the women’s ward at Gaustad psychiatric hospital. They did not agree with each other.

”One stance, represented by Bremer, thought this was a problem that had to be dealt with in the psychiatry.”

”The other stance was that despite lack of certainty, there was enough evidence to say that the quality of life increased with hormones and surgical treatment. These doctors were convinced that psychology could not solve the patients’ problems.”

­ ”Were they strong in their conviction?”

”They were all very insecure in their argumentation. They had little experience, and they sought across national borders in order to learn more. The argument against treatment was precisely that they did not have enough experience and that the existing studies were not of sufficiently high quality.”

Harry Benjamin, a German doctor based in the U.S., published a book in 1966 that was to become significant. He had done systematic research to find the reason behind the desire to change sex. His conclusion was that it was impossible to establish whether the desire for change of sex solely took place in the brain or whether it was also physically founded. Since psychotherapy had no documented effect, he was of the opinion that operative and hormone treatment was right and important.

“This is related to how we think about what constitutes gender,” Sandal explains.

“If you believe that biological gender is also a social construction, this problem no longer applies. Parts of the transgender movement think that our sense of gender is in the head. But within medical circles the opinion is that it is psychosomatic – mostly because there is no satisfactory explanation.”

Trouble for public health services

As opposed to many other countries, Norway has a public health service to deal with this group of patients. Health director Evang was considered radical in his views on sexual education, abortion and homosexuality. But transvestism was difficult to deal with.

”Evang had to approve a potential formal treatment. To begin with he was expectant and primarily wanted to explore the legal aspects.”

After the expert group had submitted their report, Evang forwarded the case to the Ministry of Justice. A sex change would after all involve the law and a change of status in public registers. When the jurists concluded that this matter had to be determined by medical doctors, nothing further happened. It would take many years until a formal treatment came into place. At Oslo University Hospital, doctors Per Anchersen and Jørgen Herman Vogt initiated an informal collaboration and began to assess patients for transsexualism and gave them hormone treatment and gender reassignment surgery. The psychiatry office at the Norwegian Directorate of Health were responsible for handling the doctors’ inquiries.   

”It may seem as if everybody tried to avoid taking responsibility and push it over to the individual doctors who performed the treatment. It was simply perceived as a terribly difficult matter.”

They risked tampering with the social order if seeing men with breasts or women with facial hair was to become the norm.

Transgender was a little known issue, both within medicine and other academic disciplines. But it was considered to have major consequences both for the individual and for society.

”This is clear when they discuss criteria for treatment. The patients had to ‘pass’ these criteria, meaning that they had to be convincing in their new sex. This would have been problematic unless they were socially adjusted. The doctors were afraid that they would be ridiculed, or that they wouldn’t get a job,” says Sandal.

”So the doctors showed some kind of concern for their patients?”

”This was long before the sixty-eighter generation; the gender expressions were more rigid and social adaptation was much more important than it is today. You were supposed to look like a typical man or a typical woman, and to have a profession that was typical for your sex. They feared that it would create social unease, that people would be provoked – they risked tampering with the social order if seeing men with breasts or women with facial hair was to become the norm.”  

” What were the legal assessments in the 50s and 60s?”

“The jurists concluded that you had to have undergone a complete gender reassignment treatment – that is removal of ovaries of testicles – in order to change sex legally.

This involved an irreversible sterilisation. It was important that a woman-to-man transperson could not become a mother.

”That men could become mothers had a totally different explosive force back then. In a report from the Norwegian Biotechnology Advisory Board a few years ago, Head of Board Kristin Halvorsen gave her approval to men becoming mothers. There was little debate about this except from in the online comment sections. But such drastic changes were seen as something that might hamper with the gender rank. Moreover, the treatment would fall into disrepute. Both doctors and jurists were worried that the practice would lose its legitimacy.”

In 2016, the law on change of legal gender was introduced in Norway. The law established that you no longer have to have gone through gender confirming treatment or sterilisation in order to change status in public registers. Sandal emphasises that until 2016 there was no clear legislation on this matter.

”The demand for irreversible sterilisation was never defined in any legislation; it was just practiced that way. The cases were dealt with ad hoc, and decisions were made from case to case.”

A treatment for those who knew

Despite reports from both doctors and jurists, no public authority for matters related to transpeople was established in the 1950s. They were thus left to chance.

”It is safe to assume that the treatment was not easily accessible. You had to know whom to ask; otherwise, you were left to the mercy of doctors and psychiatrists in the hope that they were unprejudiced and that they knew Vogt and Anchersen, the only two who examined transpeople.

”Many people are of the opinion that the level of knowledge on trans issues is too low within today’s health care. How was it in the 1950s and 60s?”

­­”Many doctors were familiar with the Christine Jørgensen case. If they recognised their own patients as such cases, they could use her case as a starting point and write to the Directorate of Health and apply for treatment on their behalf.”

You had to know of the informal collaboration between surgeons and psychologists at Oslo University Hospital.

”What was the treatment like in the beginning?”

”For the first patients who received treatment, it took a long time before they got their personal I.D. code and gender status changed in public registers. One person, who had managed to change his gender status locally with a medical certificate, ran into problems when he wanted to get married, for instance. When the authorities found out that he did not have the correct gender in the public registers, the marriage was annulled.”

”It is quite harsh to read the letters that were sent back and forth. It cannot have been any fun to live like that. Fortunately, many had contact with doctors who argued and wrote letters for them.”

Requirement for formal offer of treatment

In the 1970s, the counselling service for homosexuals was established in Oslo. People with gender identity issues also came here, but the counselling service had nowhere to refer them further. In 1979, the counselling service in collaboration with Oslo Health Board approached the authorities expressing the need for a formal authority for transpeople.

”They found the existing arrangements too inaccessible. You had to know of the informal collaboration between surgeons and psychologists at Oslo University Hospital.”

They saw the challenges and wanted to help, but they did not have the competence. The informal collaboration between Vogt and Anchersen had limited capacity, but it worked during the 1970s.

”When they started in the 1950s and 60s, they were convinced that it only applied to a very small group. No one imagined that the numbers would rise. They were considered special cases, and this understanding is what made it possible to handle it the way they did.”

But as it happened, more people needed their competence. The doctors at the counselling service for homosexuals received several who needed help, and they wanted to do their best to assist them. Many were young and had recently graduated, with a social engagement for homosexuals.

”This was a different type of doctors than the pillars of Norwegian psychiatry in the 50s,” Sandal explains.

The medical side of trans history is characterised by persevering and tough patients.

”Now it was the 1970s. There was a new gender discourse, with a perception of a distinction between biological sex and social gender roles.” 

Oslo Health Board developed a new report. When Sandal compared the two reports, the change in the perception of gender became clear. 

”For instance, they were no longer worried that people would not fit into their new sex.”

In the report, the doctors proposed a system with doctors and psychiatrists, but also a social worker. This demonstrated that they were not only preoccupied with the body; they were also interested in family history, social adaptation and work life. All areas of life were to be included in the assessment and the treatment. They also described the need for health care to those who did not receive the right treatment.

”This was the idea, although it was never realised.”

Meetings with the Directorate of Health were arranged. Experts from Sweden were invited to share their experiences.

”The Health Board was clear in its message that we needed a national service to where doctors across the country knew that they could refer their patients. The idea was to ensure high competence and good treatment. At some stage, someone had to take over for those who ran the limited service at Oslo University Hospital.”

The clinic is established

Anchersen and Vogt gradually discovered that the group of patients was bigger than they had thought, and that some of them sought hormone treatment from others than themselves. It was only then that they realised that they needed to streamline the service for transpeople. The official year for the establishment of the predecessor of today’s National Treatment Service for Transsexualism (NBTS) is 1979. But Sandal has found letter correspondences from as late as 1982 showing that it was still not in place by then. She believes that an informal professional team was established, but she has not found a formal resolution.  

”This may be because they actually wanted to keep it under the radar. They worried that too much attention would generate many more patients and that they would have to turn people away. This had been their experience from the media circus following the Jørgensen case in the 50s. It had nothing to do with laziness, there was a real concern that more people with desire to change sex would appear and that they would have to turn them down.”

During the period between 1960 and 1980, fourteen people had gender confirming treatment in Norway. Today the figures are much higher, with approximately twenty treatments annually at Oslo Univeristy Hospital’s NBTS clinic. The period between 1980 and the establishment of the GID clinic in 2003, which later became NBTS, is not documented in any other research. According to Sandal, it is useful to look into history in order to put today’s situation into perspective.

”The motivation for writing history is not necessarily to demonstrate abuse or to glorify, but to see the world from a more nuanced perspective. It shows that we have a different society today in which we have other prerequisites for understanding, both as individuals, society and medical professionals.”

”The early doctors acted contrary to status quo. The medical side of trans history is characterised by persevering and tough patients and doctors who had the guts to be obstinate.” 

See also:  Children have the right to their own gender identity

Translated by Cathinka Dahl Hambro. 

A person who identifies as transsexual perceive his/her own gender identity as not being in correspondence with the gender ascribed at birth based on external genitalia.

Transsexuals/those who have transsexualism will often go through a transition from one gender category to another through the aid of hormones, surgery and social and legal adjustments. However, some transsexuals do not wish to undertake all the various hormone treatments and surgical procedures, but are satisfied with what they perceive as sufficient for them.

In Norway, it is primarily Oslo University Hospital that diagnose transsexualism and decides whether one qualifies for gender confirming treatment.

In Norway, approximately 100-120 people are referred to Oslo University Hospital for medical assessment, and approximately 20-25 of these are diagnosed with F64.0, transsexualism. Some typical characteristics of transsexualism is, according to the diagnose manual: a) particularly strong aversion, b) lasting identification across gender and/or a sense of not fitting into the expected gender role, c) strong restraints related to social and professional areas.

Other expressions used are gender incongruence, gender dysphoria, non-binary gender identity or previously transvestism and genuine transvestism.

Source: Store Norske Leksikon/Esben Esther Pirelli Benestad and Janneke van der Ros

Children have the right to their own gender identity

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Latest news, call for papers: speculative futurities – queer and crip interventions, call for papers: would you like to contribute to a new norwegian textbook on gender studies, news magazine.

Our news magazine is an independent online newspaper and a member of the Norwegian Specialised Press Association Fagpressen .

European Countries Restrict Trans Health Care for Minors

Citing insufficient research, European health bodies from Sweden to France are taking a more conservative approach to gender-affirming care for minors.

Europe Cools on Trans Care for Minors

Vuk Valcic | SOPA Images | Getty Images

Protesters hold 'Trans rights now' placards and a transgender pride flag during a demonstration in London on Jan. 21, 2023. The United Kingdom is among several countries in Europe that are rethinking minors' access to gender-affirming care.

Chase, a transgender teenager who identifies as non-binary, has been trying to access gender-affirming health care in the United Kingdom since the age of 13. Three years later, the wait continues.

Chase has been officially on a waitlist for care within the National Health Service system for more than a year due to high demand and, more recently, operational delays. The 16-year-old, who uses the pronoun they, says the long wait has been harmful to their mental health and, about six months ago, decided to turn to private hormone therapy treatment.

Due to an ongoing independent review of gender identity services for youth in the U.K. commissioned by its public health authority, minors like Chase might be waiting a while for clarity. Theresa, Chase’s mother, notes that because of the uncertainty around possible care-related policy changes, their situation can feel like “death by a thousand cuts.” (U.S. News is not using the real names of Chase or Theresa to protect their privacy.)

“It's infuriating really,” Chase adds.

The U.K. is not the only European country that is rethinking how to approach gender-affirming care for minors. Several countries, including traditionally more progressive nations like Sweden and Norway , are changing guidelines at least in part due to questions from some doctors about the risks of such procedures. The changes in Europe are occurring more often at the health care policy level initiated by medical professionals, rather than through new or adjusted laws pushed by legislators, and experts say they haven’t been politicized to the extent they have been in the U.S.

“This is not a legal battle in Europe,” says Cianán Russell, a senior policy officer at ILGA-Europe, the European arm of the International Lesbian, Gay, Bisexual, Trans and Intersex Association. Rather, “governments are changing guidelines or instructions to different institutions, or the institutions are changing their policies themselves.”

The Human Rights Campaign, an LGBTQ+ advocacy group based in the U.S., defines gender-affirming care as “age-appropriate care that is medically necessary for the well-being of many transgender and non-binary people who experience symptoms of gender dysphoria, or distress that results from having one’s gender identity not match their sex assigned at birth.” Care can come in a variety of ways, from mental health support to hormone treatment like what Chase is using, to, in some cases, surgical procedures. Advocates say holistic support, or a combination of mental and medical treatments – which is recommended in the World Professional Association for Transgender Health’s standards of care – is generally the best approach.

In the U.S., conservatives often oppose the concept of youth gender-affirming due to religious beliefs and concerns about child abuse. However, in Europe the reluctance appears to be more based on science than politics, with some medical professionals questioning the health risks of administering transitional treatments on minors. One 2022 report commissioned by the Swedish government, for example, concluded that the “scientific basis is not sufficient” to continue to conduct hormone treatments on children without further research.

“Health care should not provide interventions that we do not know to be safe and beneficial,” Mikael Landén, a professor and chief physician at the University of Gothenburg in Sweden and co-author of the report, wrote in an email. “From the lack of evidence follows that a conservative approach is warranted.”

But the broader picture in Europe is not all negative from the perspective of those in favor of trans rights, Russell says, and there are plenty of examples of trends viewed positively by advocates. They say that more than 60% of the total population of the European Union – including countries such as Belgium , Germany , Italy and the Netherlands – have “clear policies in place about offering transition-related care to minors,” such as puberty blockers and hormone treatments. Additionally, the recently updated trans rights map published by Transgender Europe – a nonprofit that promotes the full equality and inclusion of all trans people on the continent – finds that 25 of the 27 E.U. member states provide legal gender recognition procedures.

A more detailed picture given by the organization brings advocates some cause for worry, however. Of the 25 E.U. members that offer those procedures, four demand sterilization, only one offers full non-binary recognition and less than half (12) offer legal gender recognition procedures for minors.

In recent years, at least a handful of European countries have gently tapped the breaks on gender-affirming care for minors.

In Finland , specialized adolescent psychiatric gender identity teams have been available for minors at two university hospitals since 2011 through the country’s adoption of the so-called “ Dutch approach ,” which in part holds that adolescents experiencing gender dysphoria “can be considered eligible for puberty suppression and subsequent cross-sex hormones when they reach the age of 16.” But after years of additional research, a public health body in Finland recommended that minors experiencing gender dysphoria first be provided with psychological support and, if further medical treatment is pursued, that the patient be made “aware of the risks associated with them.”

In 2022, the Swedish government’s National Board of Health and Welfare said hormone treatments for minors “should be provided within a research context” and offered “only in exceptional cases,” while adding that the “risks of puberty suppressing treatment … and gender-affirming hormonal treatment currently outweigh the possible benefits.”

In Norway, the country’s Healthcare Investigation Board recommended in part that gender-affirming care treatments such as puberty blockers be defined as experimental. Meanwhile in France , the Académie Nationale de Médecine in February 2022 recommended the “greatest reserve” when considering puberty blockers or hormone treatments due to possible side effects such as “impact on growth, bone weakening, risk of infertility” and others, according to a translation.

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Marci Bowers, the president of the World Professional Association for Transgender Health, says the situation around youth gender-affirming care in some European countries is indeed different than in America – but she has confidence in the direction that ongoing research is headed.

“(European countries) are trying to be objective,” Bowers says. “Although they are forcing patients to become research subjects, basically, as a condition of their care, the good news is that they fund that research.”

Questions about treatment will be answered, she adds, and “they're probably going to be answered affirmatively.”

Russell, of ILGA-Europe, believes the questions around health care for transgender youth on the continent are coming from a “small minority,” but that the “vast majority of doctors who work with trans people day-in and day-out support the kind of care” promoted by the World Professional Association of Transgender Health’s standards of care. They also reference the World Health Organization’s latest International Classification of Diseases, which describes gender incongruence as a sexual – not mental – health condition.

If there is a consensus, it hasn’t been reflected in Chase’s experience.

In late 2022, Reuters reported that England’s National Health Service – as part of its review of gender-affirming care for minors – was considering calling for local authorities to be alerted about cases in which families pursue private care for their transgender children outside of the public system. Chase’s family was one of those that had pursued private options, though they were unaware of the potential consequences.

Courtesy of the family

Chase and their mom Theresa visit Whitby Abbey in England.

Theresa says they were referred to social services, but that the case was eventually resolved when Chase’s general practitioner assured a representative that Chase was “ competent to make their own decisions about their health care” and not being pressured to access private testosterone treatment by their parents.

Almost two years after the review was launched, the NHS last summer announced that it would be decommissioning the Gender Identity Development Service, or GIDS – England’s only clinic geared toward youth with gender dysphoria – and transitioning its services to two regional hubs. The latter piece of the news was largely applauded by advocates. The changes came after the independent review commissioned by the NHS found, in part, a “lack of clinical consensus and polarized opinion on what the best model of care for children and young people experiencing gender incongruence and dysphoria should be” in the country.

But activists have still expressed concern over GIDS’ already long waitlist coupled with delayed openings for the regional locations, along with the fact that no new appointments will be scheduled until one hub opens in late 2023. Bowers notes the difficulty for these children that can come with waiting, adding that the effects of puberty can be “pretty depressing” for some with the angst they are already experiencing.

In the meantime, leaked draft guidelines make the situation even more cloudy. The NHS recently announced an interim policy holding that “puberty-suppressing hormones should not be routinely commissioned for children and adolescents” outside of research settings, citing the “significant uncertainties” surrounding the use of hormone treatments.

The ongoing review’s final report – and, thus, official guidance for how youth gender-affirming care should move forward – is set to be released later this year.

“I talk to young people all the time,” says Kai O’Doherty, the head of policy and research at Mermaids, a nonprofit organization based in the U.K. that supports trans youth. “It seems like they're completely absent from, actually, the conversation of what they need and what they're gonna get.”

Deekshitha Ganesan, a policy officer focused on health at Transgender Europe, says something that’s often forgotten in the recent debate about access to gender-affirming health care is that trans people’s quality of life and, as a result, ability to participate in society, “has improved so greatly” by having that access to such care.

For now, however, transgender minors across several European countries will continue to face uncertainty.

“I'm lucky in that I have a really good support system and stuff like that, but occasionally I think, ‘Things are getting worse. I'm getting older,’” Chase says. “Honestly, the thing I think is best for me at the minute is to go somewhere else. Like I honestly don't know what would happen if I stayed here, you know what I mean? But then it's like, where would you go? Because it's the same in America. It’s the same in a whole lot of places.”

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Gender-affirming surgery is not banned for minors in Europe, but is mostly inaccessible

If your time is short.

Europe doesn’t ban gender-affirming care in the way some American states have by enacting laws to restrict access. Rather, care in these European countries is often dictated by health policy and guidelines. 

Finland and the United Kingdom’s health policies limit gender-affirming surgeries to people older than 18. Sweden and the Netherlands allow chest surgery at age 16 and genital surgeries at 18. Norway generally does not offer surgical care to minors, but has not banned it.

Experts say that most transgender adolescents aren’t considering surgical care before they turn 18, and that such care is rare even in places where the procedures are legal. 

Twenty-two U.S. states have banned gender-affirming care for people younger than 18. An Instagram user said our friends across the pond are doing the same: 

"Norway, Finland, Sweden, Holland, and the U.K. have now banned gender transition surgery for minors," read the Aug. 23 post . 

But this post and its use of the term "ban" doesn’t accurately portray trans health care in Europe.

In two of the five countries listed, health policy reserves all gender-affirming surgeries for people 18 and older. The remaining three countries have mixed guidelines depending on circumstance and type of surgery. But none of these transgender surgical care limitations in Europe result from legal bans like those instituted in some U.S. states. Rather, they stem from agreed-upon medical guidelines, and in Sweden’s case, sterilization laws. 

"The guidelines or recommendations in these policies are simply that — they are non-binding."  said Deekshitha Ganesan, a policy officer at trans rights group Transgender Europe. "There are no sanctions for not following these policies to the best of our knowledge." 

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PolitiFact found one exception to this in Sweden, where a 1975 sterilization law requires administrative approval for certain genital procedures. The law , which ended a decadeslong eugenics and forced sterilization program, doesn’t explicitly ban transgender care.

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This post was flagged as part of Meta’s efforts to combat false news and misinformation on its News Feed. (Read more about our  partnership with Meta , which owns Facebook and Instagram.)

Several European countries are reevaluating their approaches to gender-affirming care for minors, but these changes primarily affect access to puberty blockers and hormone therapy, not surgeries, because minors rarely get surgeries as part of gender-affirming care.

Surgery is often the last step taken in a person’s gender transition and comes after lengthy evaluation and consultation. 

"Often many young people are not even thinking about surgeries," Ganesan said.

We looked closer at each country's policies to explain how they differ. Many health systems have never recommended that people younger than 18 be eligible for genital surgery, and those policies have not recently changed. 

"Norway does not prohibit gender-affirming treatment for children," said Torunn Janbu, the department director at the Norwegian Directorate of Health, which develops health guidelines for the country.

Although there is no law prohibiting gender-affirming surgeries, the Norwegian Directorate of Health’s most recent national guideline states that surgical "gender confirmation" is generally not recommended before age 18. The guidelines make an exception for breast surgery "in special cases," based on a comprehensive interdisciplinary assessment and parental consent. A March report by the Norwegian Healthcare Investigation Board, an independent government agency, recommended greater regulations on care and a reevaluation of national guidelines. 

"Our recommendations do not involve rendering health care services for children and young people illegal, nor do we have specific recommendations concerning surgery," said Anette Bakkevig Frøyland, a senior adviser at the board. 

Meanwhile, Janbu said, the Norwegian Healthcare Investigation Board "has no authority to change guidelines or regulations." So Norway generally does not offer gender-affirming surgical care to minors, but the treatment is not "banned."

Swedish health guidelines advise reserving chest surgeries for exceptional cases. And law states that genital surgeries that lead to sterilization are limited to people 18 and older and require government approval.

In 2022, updated national guidelines from the National Board of Health and Welfare, issued caution about hormonal and surgical treatments among adolescents and said care, including mastectomies, should be administered only in "exceptional cases."

"The guidelines are recommendations, and it's up to the physicians to interpret them and make a judgement in each specific case," said Jêran Rostam, an expert in trangender issues at the  The Swedish Federation for Lesbian, Gay, Bisexual, Transgender, Queer and Intersex Rights, also known as RFSL. 

According to the federation , patients have long been required to be 18 years or older to be eligible for  certain genital surgeries. The Legal Council at the Swedish Board of Health and Welfare must approve these surgeries; people younger than 23 need "special circumstances" to get their applications approved. 

These limitations exist because, under Swedish law , it’s "illegal" to do surgeries that lead to sterilization without going through the proper bureaucratic channels, Rostam said. These restrictions result partly from a 1975 law enacted after decades of compulsory sterilizations and a large eugenics program. This law limits transgender care today, but doesn’t explicitly ban gender-affirming care. 

Additionally, transgender Swedes can apply for a legal change in gender only after they have turned 18.

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The Netherlands, referred to as Holland in the Instagram post, has been a gender-affirming care pioneer since it began treating adults in 1972. When the country’s clinic started treating adolescents in 1997 , it sparked the development of the " Dutch protocol ," which became the global standard for transgender pediatric care.

Mastectomies can be done on patients older than 16, but all other surgeries are reserved for those over 18, according to a statement provided by a spokesperson for Amsterdam University Medical Center , site of the Center of Expertise on Gender Dysphoria. These policies are outlined in the Ministry of Health, Welfare and Sport’s national guidelines . 

Finland was one of the first countries to adopt the Dutch method of treating transgender patients, Forbes magazine reported. But in 2020, the Council for Choices in Health Care , which issues recommendations to the government’s Ministry of Social Affairs and Health, released guidelines prioritizing psychotherapy and stating that puberty suppression should be administered on a "case-by-case basis after careful consideration." 

Ganesan said that these are recommendations, not mandates. In the same guidelines, the Council for Choices in Health Care states that "surgical treatments are not part of the treatment methods for dysphoria caused by gender-related conflicts in minors." 

A 2017 survey by the European Union Agency for Fundamental Rights shows that the 18-year-old age requirement for gender-affirming surgical procedures is not new, but it is unclear whether official law or policy codifies this age limit. The Finnish Ministry of Social Affairs and Health did not answer our questions by publication time. 

In 2023, Finland removed its previous requirement to be sterilized to legally change gender, but this applies only to adults. 

The United Kingdom’s National Health Service website says that people 18 and older can get masculinizing or feminizing genital surgery and chest surgery if they meet certain criteria , which includes "persistent, well-documented gender dysphoria," letters of referral from doctors, and for genital surgeries, at least 12 months of hormone therapy. These policies are outlined and appear to be enforced by the National Health Service. The U.K.’s Department of Health and Social Care, which supports ministers in developing new health policy, did not respond to our questions about current or future legislation by press time.

Generally, in the U.K., people ages 16 and older are " entitled to consent to their own treatment," and can be referred to adult gender clinics at age 17.

However, because of major gender clinics shutting down and long wait times , access to care in the U.K. remains limited. 

An Instagram post said, "Norway, Finland, Sweden, Holland, and the UK have now banned gender transition surgery for minors." 

Gender-affirming surgical care in these countries is mostly regulated through guidelines and recommendations, not laws banning care. None of these countries have banned gender-affirming care for minors outright in the way that some U.S. states have. Some countries’ health systems, such as Finland’s and the U.K.’s, appear to limit all surgeries to ages 18-plus. Sweden and the Netherlands have differing guidance for chest and genital surgery, and Norway generally advises against surgeries before age 18. 

But experts note that these surgeries are rare among minors even in places where they are legal. The statement contains an element of truth but ignores critical facts that would give a different impression. We rate this claim Mostly False. 

Editor’s Note: Google Translate was used throughout the research of this story to translate websites and documents into English. We corroborated our understanding of translated documents with expert sources.

Read About Our Process

The Principles of the Truth-O-Meter

Our Sources

Email interview with Ana Muñoz Padrós, communications and media officer at ILGA-Europe     Aug. 30, 2023

Email interview with Torunn Janbu, department director at the Norwegian Directorate of Health, Sept. 5, 2023

Email interview with Deekshitha Ganesan, policy officer at TGEU (Transgender Europe), Aug. 31, 2023

Email interview with Anette Bakkevig Frøyland, senior adviser at the Norwegian Healthcare Investigation Board, Sept. 1, 2023

Email interview with Jêran Rostam, experts on transgender issues at the The Swedish Federation for Lesbian, Gay, Bisexual, Transgender, Queer and Intersex Rights or RFSL, Aug. 31, 2023

Email interview with Cullen Peele, press secretary at the Human Rights Campaign, Aug. 31, 2023

Email interview with a spokesperson from Amsterdam UMC, Aug. 30, 2023

U.S. News and World Report, " What Is Gender-Affirming Care, and Which States Have Restricted it in 2023? " Aug. 31, 2023

Instagram Post , Aug. 23, 2023

Sveriges Riksdag, " Sterilization Act (1975:580) " (translated from Swedish), June 12, 1975 (translated from Swedish)

Indiana International & Comparative Law Review, " Shared History of Shame: Sweden's Four-Decade Policy of Forced Sterilization and the Eugenics Movement in the United States, " 1998

Associated Press, " Norway didn’t ban gender-affirming care for minors, as headline falsely claims ," June 9, 2023

Norwegian Healthcare Investigation Board, " Patient safety for children and young people with gender incongruence " (translated from Norwegian),  March 9, 2023

Norwegian Directorate of Health, " Gender Incongruence -- Investigation, treatment and follow-up " (translated from Norwegian), June 9 , 2021

The Swedish National Board of Health and Welfare, " Care of children and adolescents with gender dysphoria ,"2022

The Swedish Federation for Lesbian, Gay, Bisexual, Transgender, Queer and Intersex Rights, " Questions and answers about care for youth with gender dysphoria ," July 4, 2023

The Swedish Federation for Lesbian, Gay, Bisexual, Transgender, Queer and Intersex Rights, " Why Do We Need a New Gender Recognition Act? ," Jan. 27, 2022

The Journal of Sexual Medicine, " Children and adolescents in the Amsterdam Cohort of Gender Dysphoria: trends in diagnostic- and treatment trajectories during the first 20 years of the Dutch Protocol ," Jan. 26, 2023

Hormone Research in Paediatrics, " The Evolution of Adolescent Gender-Affirming Care: An Historical Perspective ," Nov. 29, 2022

The Atlantic, " A Teen Gender-Care Debate Is Spreading Across Europe ," April 28, 2023

Transvisie, " Home Page " translated from Dutch, accessed Sept. 4, 2023

Transvisie, " Hormones and puberty inhibitors " translated from Dutch, accessed Sept. 4, 2023

Transvisie, " Operations for transgender men " translated from Dutch, accessed Sept. 4, 2023

Transvisie, " Transition " translated from Dutch, accessed Sept. 4, 2023

Amsterdam UMC, " About ," accessed Aug 30, 2023

Netherlands Ministry of Health, Welfare and Sport, " Quality Standard Transgender Care " translated from Dutch, 2018

Forbes, " Increasing Number Of European Nations Adopt A More Cautious Approach To Gender-Affirming Care Among Minors ," June 6, 2023

Council for Choices in Health Care in Finland, " COHERE Finland ," accessed Aug. 29, 2023

Council for Choices in Health Care in Finland, " Medical Treatment Methods for Dysphoria Associated with Variations in Gender Identity in Minors – Recommendation ," June 6, 2020

Council for Choices in Health Care in Finland, " Medical treatments for gender dysphoria that reduces functional capacity in transgender people – recommendation ," June 6, 2020

European Union Agency for Fundamental Rights, " Access to sex reassignment surgery ," Oct.19, 2018

Reuters, " Finland to allow gender reassignment without sterilisation ," March 3, 2023

National Health Service, " Gender dysphoria ," May 28, 2020

National Health Service, " Gender dysphoria - Treatment ," May 28, 2020

National Health Service, " NHS Standard Contract For Gender Identity Development Service For Children and Adolescents ," April 1, 2016

National Health Service, " Consent to treatment - Children and young people ," Dec. 8, 2022

National Health Service, " Vaginoplasty Feminising Surgery ," July 27, 2021

National Health Service, " Phalloplasty Masculinising Surgery ," Oct. 20, 2021

BBC News, " NHS to close Tavistock child gender identity clinic ," July 28, 2022

BBC News, " Trans people can wait seven years for NHS initial assessment ," Aug. 2, 2023

Gender Identity Development Service, " Puberty and physical intervention ," accessed Sept. 5, 2023

Sveriges Riksdag," Act (1972:119) on determination of gender in certain cases " (translated from Swedish, 1972

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Norwegian Medical Watchdog Encourages Country to Ditch ‘Gender-Affirming’ Care Guidelines

The Norwegian Healthcare Investigation Board (UKOM) has ruled that national guidelines on the use of puberty blockers and gender-reassignment surgeries need to be revised to reflect the lack of sufficient medical evidence supporting such procedures.

Under the new guidelines recommended by UKOM, hormone therapy and gender-reassignment surgery for minors would be restricted to research settings and not made otherwise available.

“The knowledge base, especially research-based knowledge for gender-affirming treatment (hormonal and surgical), is deficient and the long-term effects are little known,” the agency’s report argues. “This is particularly true for the teenage population where the stability of their gender incongruence is also not known.”

UKOM is an independent governmental agency charged with investigating the Norwegian health-care industry to identify “factors that could have led, or could potentially lead, to harm for patients.”

The Society for Evidence-Based Gender Medicine (SEGM), an international group of over 100 clinicians and researchers, wrote that the current Norwegian guidelines defining medical treatments for gender dysphoric kids were based on a “gender-affirming” care model that does not even require a psychological assessment.

The Norwegian Healthcare Investigation Board, (NHIB/UKOM) has deemed puberty blockers, cross-sex-hormones & surgery for children & young people experimental, determining that the current “gender-affirmative” guidelines are not evidence-based and must be revised. /1 — SEGM (@segm_ebm) March 10, 2023

The authors of the UKOM report were particularly concerned by the disproportionate rates of ADHD, autism, and Tourette’s Syndrome found amongst gender-dysphoric youth.

From 1975 to 1990, roughly four Norwegians a year were recommended for medical interventions such as hormone-replacement therapy or reassignment surgery, according to a local news report .

However, the Nordic country witnessed an explosion in medical consultations for gender dysphoria in recent years. Between 2007 and 2010, the number of individuals referred to a medical professional jumped over tenfold, ranging between 50-70 consultations per year. The record was shattered a decade later. Between 2018 and 2021, Norwegian health officials received anywhere between 400-600 referrals per year.

If Norway embraces UKOM’s recommendations, it would align the country with Sweden, Finland, and England, all of whom have recently sought to introduce new safeguards protecting minors from blindly embracing “gender-affirming” care.

“Norway has followed in the footsteps of its Nordic neighbors Sweden and Finland, as well as England, by calling out the experimental nature of youth gender transitions,” a spokesperson for SEGM told Gender Clinic News , a Substack newsletter.

“We simply do not have the evidence to support the widespread use of these risky and often irreversible interventions in general clinical settings.”

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The United Kingdom shuttered the country’s only dedicated clinic treating gender dysphoric patients, the Tavistock Centre , in August 2022 following internal investigations that revealed the institution failed to keep “routine and consistent” data, disregarded other health issues, and pursued a singular and “unquestioning affirmative approach.”

The country has experienced a similar spike in gender dysphoria referrals growing from 250 in 2011 to well over 5,000 a decade later.

Jesse Singal, the American investigative journalist who has written extensively about the subject, applauded the announcement.

“That’s four countries, all with top-tier healthcare systems, where scientists have looked into the evidence, said the local equivalent of ‘Holy shit,’ and determined access to blockers and hormones needs to be more tightly regulated. In the States? Lots of heads in lots of sand,” Singal tweeted on Friday morning.

That's four countries, all with top-tier healthcare systems, where scientists have looked into the evidence, said the local equivalent of "Holy shit," and determined access to blockers and hormones needs to be more tightly regulated. In the States? Lots of heads in lots of sand. https://t.co/cYHDrdI9iz — Jesse Singal (@jessesingal) March 10, 2023

The UKOM report’s executive summary include a section on the concerning state of public discourse on the topic of transgenderism.

“We hear about fear and dread of making mistakes from all quarters,” the report notes. “There is a need to establish a constructive community for everyone who is engaged in good health care for people with gender incongruity.”

More from National Review

NHS Warns Most Trans-Identifying Children Going Through ‘Transient Phase’

English Gender-Identity Center to Close after Report Finds It Not ‘Safe’

Social Security Administration Allows People to Choose Their Own Gender on Forms

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