Norway considers classifying hormone treatment for transgender children as experimental treatment

Helsetopper will now assess whether hormone treatment of transgender people under the age of 18 should be defined as experimental treatment. If that happens, there will be stricter requirements for giving this type of treatment to children.

All treatment will then be moved to the specialist health servicethe specialist health serviceThe specialist health service is responsible for hospitals and other services that do not fall under the municipal health and care service. Run by the four regional health organizations.. This means that private actors and municipal services, such as the Health Center for Gender and Sexuality (HKS), can no longer offer treatment with puberty blockers and hormones to children and young people.

HKS is under Oslo municipality and offers, among other things, follow-up for children and adults who want gender confirmation treatment.

I 2021 ga HKS sex-affirming hormonessex-affirming hormonesTreatment with testosterone for people registered as a girl at birth, and treatment with estrogen for people registered as a boy at birth. to 100 young people and adults. Head of department at HKS, Ingun Wik, has told NRK that six out of ten patients who come for health care have been turned away at Rikshospitalet.

May be change

Recently, the debate surrounding gender confirmation treatment for children has flared up following a report from UKOM earlier this year. The commission believes that healthcare needs to be made safer, and that knowledge about hormonal and surgical treatment is too poor.

Figures from the National Hospital show that the number of children and young people who want gender confirmation treatment has never been higher. In particular, the increase has been large among biologically born girls.

VG has previously told how a plastic surgeon removed the breasts of two women under the age of 18 – without the diagnosis of gender incongruence being sufficiently clarified.

Director of Health Bjørn Guldvog in the Directorate of Health tells VG that they have started work to look at the treatment these children receive – and that there may be national changes.

The directorate is now in dialogue with the specialist directors of the health institutions and the National Treatment Service for Gender Incongruence (NBTK) at Rikshospitalet to develop the health service.

Among other things, it is being considered whether hormone treatment, puberty blockers and surgery for children and young people under the age of 18 should be classified as experimental treatment.

– There has been a large increase, and this means that the professional community, as I understand it, is unsure whether the practice that has been established over several years should still be the same, says Guldvog.

Experimental treatment

The fact that a treatment is experimental means that the treatment’s effect and safety have not been well enough documented to be part of the normal offer in the health service.

– As a patient, you no longer have the same right to treatment, says Guldvog.

The health service will make an individual assessment of each patient. It will also entail stricter follow-up:

– The treatment must be carried out with associated research, a clinical protocol, which follows each individual patient through the course, and which can explain how things have gone when you arrive at different times after the treatment has taken place, he says.

The treatment will not be able to be offered anywhere other than where it is permitted to carry out the experimental treatment.

– In order for this to be sound and sustainable over time in Norway, we believe that assessment and initiation of puberty-delaying and hormonal treatment before the age of 18 is a function that should be in the specialist health service. And that is what we are working to achieve, says Guldvog.

Side effects

There is still some uncertainty related to the side effects of hormone therapy in children and young people, especially in the long term. In Sweden, there have been reports of patients developing osteoporosis in adulthood.

Guldvog says that these side effects are largely reversible, if you choose to stop treatment.

– Like all other treatment, there are side effects with this type of treatment, but this must be weighed against the effect of the treatment – and the burdens the patient may have by not receiving treatment, he says.

– Is it safe to give children and young people medication when you do not fully know the long-term effects?

– It may be, but here I do not want to discuss the justification in relation to individual cases. A doctor has a responsibility to take the best interests of the child or the best interests of the patient into account.

– Is the director of health concerned that someone may have sustained permanent injuries?

– I am always concerned that the health service may have given treatment on the wrong basis. But we have not received reports that many people have suffered injuries after the treatment.