It has suddenly become more difficult for young trans people in Sweden to get puberty blockers and sex-affirming hormones. The reason is a strong concern linked to part of the patient group.
April 3, 2022 – Sverre Lilleeng and Kirsti Kringstad : NRK TV News
The new Swedish guidelines involve a radical restructuring of previous practice, says Pål Surén.
He is a pediatrician and researcher at the Institute of Public Health.
puberty blockers sex-affirming hormones
Psychiatric assessment before commencement is no longer a requirement for children and young people. Those over the age of 16 should be able to receive hormones without parental consent. And more offers are to be created around the country.
This is similar to how the recommendations were in Sweden in the past. But after a thorough review of the research in the area, the Swedes suddenly went in the complete opposite direction in February this year.
The main reason is uncertainty surrounding a patient group that has become much larger in recent years.
One group stands out
In ten years, the number of children and young people in Norway and Sweden who want gender confirmation treatment has more than doubled .
These have what is called gender dysphoria. That is, they experience a strong discomfort with living with a body that does not correspond to their gender identity.
Since 2000, Rikshospitalet has seen a sharp increase in patients seeking help for gender incongruence. Several western countries see the same development.
In the past, it was mostly those who had known until childhood that they were “born in the wrong body” who were given puberty blockers and later estrogen or testosterone. This group still exists.
The National Board of Health and Welfare
In 2015, the number in this group was 107 people in Sweden . In 2018, there were 233. No other group has grown so much, so quickly.
The National Board of Health and Welfare writes in a new report that they cannot explain the increase. They believe that there is too little knowledge about which treatment is right to give to the teenagers who seek help.
They are also concerned that puberty blockers have side effects we don’t know about .
The conclusion is that the risk is greater than the benefit of giving puberty blockers and sex-affirming hormones to patients under 18 years of age.
In Sweden, the medicines must now only be given in exceptional cases, or to patients participating in research. Everyone must now receive psychosocial support before they receive any other help.
Difficult gray areas
– The criteria for receiving treatment are more clearly linked to gender incongruity having made its debut in childhood. It must have lasted until puberty, and puberty has been perceived as psychologically taxing, says Thomas Lindén, head of department at the National Board of Health and Welfare.
Parts of the professional community in Norway have the same concern as the Swedes, according to senior physician Anne Wæhre.
She leads the team for gender incongruence in young people (KID-team) at Rikshospitalet in Oslo. They also experience that the patient group that is increasing clearly the most are biologically born girls.
According to Wæhre, there are big differences between the individual patients within the group. Most have not expressed gender incongruity when they were small. Some may have been a little uncertain.
– Parents may, for example, be concerned that their children have been “boyish girls”. That is what is so difficult in the clinic. There are gray areas, says Wæhre.
The Swedish report also reveals that many of the teenagers who seek help have challenges other than gender dysphoria. Such as depression, anxiety, ADHD and autism diagnosis. At Rikshospitalet they see the same thing.
But the main reason why the Swedes are now turning is the danger of detransition and possible regret, explains Thomas Lindén of the National Board of Health and Welfare.
Gender dysphoria
A psychological discomfort some people have because they do not feel that the gender they were assigned at birth matches their gender identity. For example, that they were registered as a boy at birth, but perceive that they are a girl.
Gender incongruence
A medical diagnosis that describes a situation where a person’s experience of gender identity is not the same as the gender they were registered as at birth, or what is called in medicine the person’s biological sex.
Trans person
People with gender identity(s) or gender expression that violates what society expects of them based on the gender they were assigned at birth. Some trans people are women or men, others are neither men nor women and some do not categorize their own gender identity.
Non-binary
Does not mean twofold. Most often used about people who feel that they do not fit into the categories of woman or man.
Gender confirmation treatment
Treatment with hormones and/or surgery, and/or psychotherapy that contributes to a person being able to function in accordance with their gender identity.
Source: Foreninga Fri, Store Norske Lexikon, Bufdir
Will anyone change their mind?
Detransition means that someone who has gone through hormone treatment and possibly surgery changes their mind and wants to return to their biological sex.
– The knowledge that gender-affirming treatment sometimes leads to impaired health and quality of life, or injury in young adults, is one of the factors that has been important for our assessment, says Lindén.
Few studies have been done on detransition. Lindén cannot point to specific figures – only stories about young Swedes who have regretted it. He believes that these individual stories, which were not heard of a few years ago, are more than enough to put the brakes on.
Emelie Köhler is one of those who has such a story. She thought life would be better as a boy.
Wish she got more critical questions
She has finished treatment herself.
– It was a tedious process for me. And I was also an adult, says Köhler in the NRK program Folkeopplysningen .
Today she runs a website about detransition. She started it because she thought there was a lack of information that matched reality.
– Some of the people I come into contact with today are 20 years old. They went much further than I did, and only have friends within the environment.
As a young trans person, she wishes she was asked more critical questions.
– I had learned from day one that everyone is born with an inner gender, and that it is linked to the “I” and is above biology. It was almost hammered home as pure fact in society. I needed someone who was critical of the whole concept. Like talking about how you don’t have to feel like something in order to be something.
Anne Wæhre at Rikshospitalet says there are not many like Emelie in Norway.
– We know very few people who have wanted to stop starting hormone treatment. It is something we take very seriously .
Not getting support to remove the breasts: – Frustrating
Who should receive treatment?
Different professional groups have completely different opinions about who should receive treatment with puberty blockers and sex hormones.
The doctors at Rikshospitalet only give drugs to children and young people who have undergone a thorough psychiatric assessment.
– We give puberty blockers exceptionally to some patients, says Wæhre.
They give such medicines to between zero and 10 patients a year.
– Why are you restrictive?
– We simply know too little.
On the other side is the Health Center for Gender and Sexuality (HKS).
Moral panic
– I experience what is now happening in Sweden as a moral panic, says Ingun Wik.
She is head of department at HKS. The health center is run by Oslo municipality, and they are particularly concerned with gender diversity and sexuality.
puberty blockers
sex-affirming hormones
At the national service at Rikshospitalet, there were 109 young people who received the same in 2020. The number for 2021 is not clear, but is expected to be fairly similar. 270 adults received sex-affirming hormones at Riksen in 2021.
Previously, Wik urged Norway to look at how people with gender incongruence are treated in Sweden , because they based themselves on the most up-to-date research. But now that the Swedes have reviewed the research again, Wik will no longer recommend seeing them.
– I hope that we in Norway manage to distance ourselves from what is happening in Sweden, and adhere to international guidelines.
Doesn’t recognize himself
According to Wik, at HKS, they do interdisciplinary mapping and clarify expectations with patients before the treatment starts. But they do not require a psychiatric evaluation.
The health center wants it to be easier to get treatment.
– For many, it is necessary to be able to live a good life, says Wik.
Wik does not recognize the large increase in biological teenage girls who experience that they are boys, as reported by the Swedish authorities and Rikshospitalet.
She believes it is very serious if it becomes more difficult for this group to get help to take a place like themselves.
– As healthcare workers, we cannot decide whether someone is trans enough to receive treatment, says Wik, who is critical of the requirements the team at Rikshospitalet places on patients.
Will not give the changes attention
Aleksander Sørlie is outgoing leader of the Patient Organization for Gender Incongruence (PKI). He is critical of the Swedish changes getting attention in Norway.
– First of all, I think that the focus on the details of other countries’ guidelines or practices is a derailment from what is actually important: How we can ensure a good and sound health service here in Norway, he writes in an e-mail to NRK.
Furthermore, he writes that the PKI is concerned about changes that drag other countries in what he calls a more trans-hostile direction.
At the same time, he believes that what is on paper is not always practiced in reality.
– It is a big problem when the media and health authorities in Norway emphasize such matters so early in the process, because we know from experience that the media rarely follow up such matters further, and therefore do not get important updates either.
Raven (19) is neither he, she nor he
The Directorate of Health: – We know that we know too little
In the Directorate of Health, they have familiarized themselves with the new and much stricter Swedish recommendations.
– I think that we are quite restrictive in Norway, but not that restrictive, says division director Johan Georg Torgersen.
The Swedes now believe that the risk associated with detransition is more clearly documented, and also consider that the uncertainty surrounding the side effects of puberty blockers and sex hormones is great. This is little affected in the Norwegian guidelines.
– On the one hand: We know that we know too little. We would like to have more knowledge about this. On the other hand, this is a patient and user group that actually exists, that has rights and demands on healthcare services. We also have to take that into account.
Torgersen has noticed that there has been a large increase among biological teenage girls who want treatment.
– We are well aware that this group has increased. We would like to have even better knowledge to be even more confident in the advice that is given.
The divisional director will not follow the Swedes in terms of the requirement for a psychiatric assessment before young people are offered puberty blockers or sex hormones.
– Making it a requirement for the whole group, we believe, violates the principle that everyone must be assessed individually as needed. Gender incongruence is not a psychiatric disorder.
See Trans Interview
Trans
- 17 March 2022
Journalists Sverre Lilleeng and Kirsti Kringstad : NRK News
