What’s Going on With Gender-Affirming Care in Europe?
Claims that Norway, Sweden, Finland, and the UK have acted to restrict access to gender-affirming care are the latest misleading tactic in the fight against this necessary treatment.
by Evan Urquhart
Europhilia is the latest mania in anti-trans activism, with opponents of trans rights invoking statements from anti-trans politicians or fringe scientists who also live in Europe as proof that anti-trans positions are imbued with the authority of European-ness. This argument, that people in Europe have questioned, restricted, or opposed gender-affirming care for youth and therefore such questions simply must be justified, makes no actual sense. There’s nothing magical about Europe! Those invoking Europe’s magical legitimizing properties often imply that the countries mentioned have conducted impartial medical reviews, but if that were the case why not present those findings?
In truth, each European country mentioned exists within an atmosphere of political pressure to limit gender-affirming care, related to, and not unlike, the atmosphere of right-wing activists poisoning the discussion that the US has. The situation in Europe is not unique, and Europeans are not uniquely objective arbiters by dint of their nationality.
(Each European country has a different health care system, a different political environment, and a different situation both for trans rights broadly and for gender-affirming care for minors specifically. For readers seeking information on a specific country, we’ve inserted hyperlinks allowing you to skip directly to the country you’re most interested in: United Kingdom Sweden Finland Norway)
In America, western European politics are often seen as more functional, more evolved, more reasonable than our home grown variety. While there’s a grain of truth to that, when it comes to gender-affirming care the centralized, highly regulated European systems have often led to neglect in the area of gender-affirming care because trans people are a stigmatized minority with very little political power. The norm in Europe has therefore been long wait times for patients seeking gender-affirming care, as well as lengthy and often highly invasive assessments before treatment is provided. For the wealthy, the lines are often skippable by paying out of pocket for specialized services. Restrictions, guidelines, and concerns about national healthcare treatment in all of the countries mentioned have not suggested imposing any restrictions on this alternative for more affluent Europeans.
In broad strokes, anti-trans activists have succeeded in increasing concerns about gender-affirming care for youth in Europe just as they have elsewhere. This has resulted in warnings and calls for further research, but not in outright bans. In many of the affected countries it’s unclear if much has changed on the ground for patients attempting to navigate the lengthy, onerous process of accessing gender-affirming treatments in their countries.
By far the most respectable place that Europhilic transphobia has appeared was in a piece by Frieda Klotz that appeared in the Atlantic late last week. Titled “A Teen Gender-Care Debate Is Spreading Across Europe,” the piece repackages the talking point that there simply must be something wrong with gender-affirming care if Europeans are concerned in news story clothing, misrepresenting and obfuscating freely as it goes. Claiming there has been an “about-face” by several European countries, Klotz fails to explain the details of what’s gone on in any of the countries under discussion. She also conveniently neglects to mention that the situation in Europe has been influenced by political opposition to LGBTQ+ rights just as much as the US has been.
In this piece, we will attempt to correct the Atlantic’s oversight, providing a snapshot of what is actually happening with gender-affirming care for youth in the European countries mentioned by Klotz in the Atlantic article.
United Kingdom
Long referred to as “TERF Island” by the trans community, the moral panic over trans rights became established in the UK even before the current obsession in the US right. Years of sustained, intensifying activism against trans rights in the UK have only recently begun to bear fruit politically, with a right-wing Tory government attempting to dismantle all human rights protections for trans people, in violation of international law that protects them.
In the UK, debate has centered around the Gender and Identity Service clinic at Tavistock Centre. Often referred to simply as Tavistock, the GIDS clinic is part of a larger facility specializing in mental health in London. This clinic is the only location where treatment for gender dysphoria could be obtained for anyone under 18 in all of Wales and England. As awareness of treatments for gender dysphoria grew the GIDS clinic became overwhelmed, and wait times for youngsters suffering from gender dysphoria stretched for years. While it is supposedly slated for closure, no efforts have been made to create any replacement. Gender-dysphoric youth in the UK remain without good options for treatment in the NHS system.
The very real issues with the GIDS service, combined with years of anti-trans activism and a vicious anti-trans streak in the UK tabloid press resulted in an independent review led by pediatrician Hilary Cass. This review produced an interim report that recommended closing the GIDS clinic and creating multiple regional centers where young people with gender dysphoria could be treated in a timely fashion, allowing any co-occurring mental health issues to be addressed. In the intensely anti-trans political environment of the UK, however, the review has not succeeded in prompting the creation of high quality regional centers that treat youth individually and cut down wait times, and the GIDS clinic remains open with wait times of three years or higher for a first appointment.
Unlike all the other countries, there is some evidence that puberty blockers may have been prescribed quickly by some providers at GIDS. However, this cannot be understood separately from the evidence of excessively long wait times and overwhelmed staff, also were among the key findings of the Cass Interim Report. Most press accounts, including the Atlantic piece, conveniently neglect to mention this context. Instead the focus has been on the psychological distress many young patients at GIDS experienced, omitting the fact that every single one of the gender dysphoric patients at Tavistock had waited multiple years without receiving any help or therapy in the meantime. Gender dysphoria is known to cause severe psychological distress when left untreated.
screenshot from the Atlantic
Contrary to the misleading way the Atlantic’s author presents the UK findings, the primary failure at Tavistock was of the NHS refusing to provide sufficient resources to meet the needs of GIDS patients. This is perfectly clear when you read the Interim Cass Report in full, but it presents an inconvenient complication for those with an ax to grind against gender-affirming care.
Sweden
As in many other places, a rising far-right party, once considered beyond the pale, has recently gained political influence in Sweden. And, as in the US and the UK, activists opposed to transgender acceptance have sought for years to turn Swedish public opinion against gender-affirming care for youth. In 2019, a series of documentaries featuring detransitioners and anti-trans activists introduced the moral panic over gender-affirming care to the Swedish public.
(What follows is a summary of a lengthy explanation by a Swedish-French individual who wrote about developments in Sweden for Health Liberation Now! That piece is the most accurate English-language explanation we’re aware of.)
In Sweden, healthcare is administered regionally. In somewhat the same way that US states can have drastic differences in access to healthcare, the different regions can diverge greatly in Sweden. When it comes to gender-affirming care for youth, long wait times and lengthy evaluations were the norm even before the current moral panic, but there had been movement in the direction of increasing access to treatment for gender dysphoric youth.
The first sign that anti-trans activism was making headway in limiting access to gender-affirming care came abruptly, when the hospital serving gender dysphoric patients in Stockholm, Karolinska Sjukhuset, announced in 2021 that it was ending the provision of medical treatments for gender dysphoria. This happened in the immediate wake of a decision in the UK, which briefly ended the provision of gender-affirming care for minors in that country. Although patients in the UK were able to resume treatment after the case was reviewed, the Swedish hospital did not revisit its decision. Even then, the ban was not total, as room was made for patients with exceptional circumstances.
Hospitals which provided care in other regions were caught unawares, with some moving to restrict care and others continuing to provide care normally. Then, in 2022, the National Board of Health and Welfare released updated guidelines, limiting treatment outside of the aforementioned exceptional circumstances. In practice, this means young people whose gender dysphoria began in early childhood and has remained stable are still able to access treatment, but youth who present in adolescence are not allowed to access medical transition.
In the English-language press, the claim has frequently been made that Sweden acted to end all medical treatment for gender dysphoria. This is not the case, and has never been the case. However, as in other countries, Sweden has been influenced by reactionary fearmongering around gender-affirming care, resulting in official guidelines that warn against providing treatment too easily or swiftly. That being said, Sweden already had a fairly strict evaluation process which was coupled with long wait times. While treatment is more restricted now, it is not clear in practice how many young people who would have previously been able to access care are now barred from doing so. In Sweden, it was the hopes that treatment would soon be expanded that were dimmed, even more so than there being a change in the treatment available.
Finland
The biggest news out of Finland relating to transgender rights in the past year has been the decision earlier to remove a requirement that trans people undergo sterilization before being recognized legally as a different gender in Finland. This makes it particularly odd that Finland is being used as an example of European countries that are just now coming to question their provision of gender-affirming care to minors. Minors in Finland have never had meaningful access to puberty blockers or hormonal treatments for gender dysphoria. They continue not to have that access.
In the Atlantic piece, support for the inclusion of Finland is very limited. Every mention of Finland comes within a sentence referencing at least one other country, except one. That sentence states “new treatment guidelines put out in 2020 advised against the use of puberty-blocking drugs and other medical interventions as a first line of care.”
The article conveniently leaves out any information about what the guidelines were before or how these treatment guidelines have impacted the treatment of gender dysphoric youth in Finland. Puberty blockers and other medical interventions have never been a “first line of care” in the treatment of gender dysphoria, with social transition being preferred as a first step because it is cosmetic and social and therefore entirely reversible. In Finland, provision of puberty blockers and other medical treatments seem to have been so rare as to be almost nonexistent. This has not changed.
We spoke with a trans person from Finland who explained further. They said that, for LGBTQ+ activists in Finland, the big push had been to remove the requirement that trans people be sterilized. In service of that goal, a separate push to allow access to gender-affirming care for minors had been placed on the back burner. “..in the old legislation, gender-affirming care was strictly for folks aged 18 and up. I know of a few individuals who sought out gender-affirming care at age 16-17, but had to wait until age 18 before getting access to testosterone blockers and HRT. And by the looks of it, this will still remain the case for now, as far as I'm aware.”
This person also said that the most recent election in Finland would be a coalition with a far-right party, making it unlikely that further improvements are imminent.* All things considered, it does not seem likely that access to gender-affirming care for youth has been significantly reduced in Finland, because access does not seem to have been meaningfully available in the first place.
Norway
Like Sweden and Finland, Norway has long imposed significant barriers to accessing gender-affirming care for youth. And, as with other countries, Norway has been targeted by anti-trans activists spreading doubt and misinformation about gender-affirming care for youth.
It is against this background that the concerns expressed in a March report by Norwegian health authorities ought to be understood. The concerns did not represent any new limitation on care but rather a justification for continuing with the current limitations, which are extensive. This is not made clear by the Atlantic’s author, who once again devotes only a single sentence to justifying the claim that Norway has fresh concerns about the provision of gender-affirming care to minors.
screenshot from the Atlantic
The sentence references a report by a national investigatory board in Norway, which can be found here. The lengthy report, when read in full, does not recommend any new limitations on care. Instead, it reads primarily as a response to patients who are frustrated with the current lack of access. A full section of the report discusses a “gap in expectations” between patients and parents who believe their right to health care includes a right to access gender-affirming care, and the way the right to healthcare is interpreted in Norwegian law, limiting access to treatments that are deemed experimental for patient safety. It is clear that this report’s intent is to justify continuing limitations which large numbers of patients and parents have complained are too strict, but it does not seem to be introducing new limitations. There are no new findings in the document, or any evidence that gender-affirming care has been provided erroneously or with excessive haste in Norway.
Conclusion
From the beginning, the national health apparatuses of most European countries have taken a cautious approach to gender-affirming care for both young people and adults, with heavy gatekeeping, understaffed clinics, and long wait times. At the same time, private health care options have allowed wealthy trans people and their families to access gender-affirming care in a more timely manner. None of this has changed substantially in recent years in any of the countries mentioned by anti-trans activists.
Political efforts by activists to sow fear and doubt about gender-affirming care have not been confined to the US and the UK. Instead, they have been playing out in parallel throughout Europe, and beyond. Exactly how activist efforts to limit care have played out is unique for every country, but no country exists in a vacuum. The existence of activism to limit care in Europe does not ultimately have any bearing on the medical evidence, and none of the countries mentioned have introduced any new evidence calling into question the efficacy or safety of gender-affirming care for minors. Instead, they have issued reviews of the available evidence holding gender-affirming care to standards not used for other treatments as a way of justifying their refusal to make gender-affirming care more accessible to patients who need it.
*CORRECTION: An earlier version of this article stated that the new government of Finland was a coalition with a far right party. The new government is expected to be such a coalition, after the right won the most recent election. However, as of this writing the government has not been formed yet and the previous center-left government remains in a caretaker position.
