Gender Treatment, Gender Incongruence | Great uncertainty about gender treatment for minors: – Being labeled as transphobic

– I am worried about the treatment of young people with gender incongruity both here in Norway, outside of the national treatment service, and the clinics around the world where they have been much more lax about starting treatment from the time the children are 16 years old than we have been, says Anne Wæhre.

She is the leader of the team that accepts young trans people at Rikshospitalet, and the one who will now lead the work on researching gender treatment in minors in Norway.

Nettavisen visits the senior doctor in her office at Rikshospitalet in Oslo. Around 200 children and young people come here every year, for which they are investigated .

Now a new study from England shows that gender confirmation treatment children and young people have received has no scientific evidence that it works.

Weak children became throwing balls

The report from England has been prepared by pediatrician Hillary Cass and is described as “historically thorough” by Wæhre. The conclusion is startling:

• The medical treatment of children and young people is “built on a failing foundation”
• The public health system has failed a generation of vulnerable children

– We have failed them because the research is not good enough, and we do not have good data, she tells The Guardian.

In his review, Cass believes that the debate environment about gender-affirming treatment is toxic.

– The toxicity of the debate is perpetuated by adults, and that in itself is unfair to the children who are caught in the middle of it. The children are being used as a throwing ball, and this is a group we should show more compassion for, says Cass to The Guardian.

– Until now, it has been difficult to talk about the cautious line, because then we are labeled as transphobic, says Anne Wæhre, who has repeatedly been accused of being too restrictive and transphobic.

The report concludes much of the same as the National Commission of Inquiry arrived at last year.

– Has lacked good studies

In Norway, children up to the age of 16 have been treated for gender dysphoria since 2002. Puberty-delaying treatment can also be given to children under the age of 11 and 12.

For many years, young people have been treated, among other things, at Rikshospitalet. The treatment is based on what since 2006 has been the “gold standard” for gender confirmation treatment, according to Wæhre.

“The Dutch protocol” is a study with around 70 young people who were researched. Wæhre describes that several thorough literature reviews today believe that the study is small and that the quality of the findings is uncertain. Nevertheless, this became the standard for treatments in Norway and abroad.

– What is a pity is that the “Dutch protocol” has never been followed properly, when it has been so widespread and has been practiced so differently.

See what the Norwegian Directorate of Health and Oslo municipality respond further down in the matter.

Several countries are tightening

Following the Norwegian Ukom study and Cass’s own findings, the four health organizations have decided to tighten up the treatment for gender incongruity.

– Medicinal treatment for gender incongruity that applies to children and young people is to be considered experimental, says Ulrich Spreng, specialist director at Health South-East, to NRK.

He believes that the use of medication “can be potentially harmful”, and therefore more knowledge in the area is needed.

– Finland has defined treatment as experimental. In Sweden, the National Board of Health and Welfare has said that the risk of gender-affirming and puberty-delaying treatment most likely exceeds the expected benefit, he says to the state channel.

An experimental treatment means that it requires a clinical study. The commission for the clinical study has been given to Oslo University Hospital, which is the health authority to which Rikshospitalet is subordinate. This means that gender confirmation treatment of children can now only be done at OUS, in connection with the study.

Now Wæhre hopes that the Nordic countries, as well as England, can collaborate on a larger study and a joint protocol for puberty-delaying treatment.

FRI: – Very worried

Viljar Eidsvik, head of the organization FRI, has not read the Cass study, but emphasizes that he has read the Ukom report that came out last year.

He believes the austerity is the wrong way to go.

– We are worried about everyone who is now left without gender confirmation treatment. They receive no follow-up from Rikshospitalet if they are rejected there. We are concerned about this group’s health services, he tells Nettavisen.

He points out that there is a lot of research that shows that gender-affirming treatment helps many children and young people.

– Our concern is that Norway is tightening on too bad and wrong grounds. We have a lot of research that shows that trans people get better as a group with treatment. No research shows that denying them treatment improves their situation, he says.

They now fear that the tightening will lead to more people starting self-medication, instead of going through other players.

– It is unsustainable and wrong and will result in many people being left without the necessary healthcare. We will probably see a further increase in self-medication and an increase in pain as a result of a lack of access to gender-affirming treatment. he stated to Klassekampen earlier.

Believes the authorities gave in to pressure

In 2014, Wæhre’s department suddenly noticed a huge increase in referrals to their department. The same was noted by several Nordic countries, including Sweden and Denmark.

In 2011, the department had 19 biologically born girls who were referred to them for investigation. In 2023, they had 187 referrals.

– At the same time as this increase, there has been a human rights and equality battle to get this treatment. It was a group of patients who had had a difficult time for many years. When this increase came, we thought we had to be careful, stop and inform the outside world about this increase, says Wæhre.

On average, Rikshospitalet provides puberty-delaying treatment to a small minority. Little is known about treatment in other countries, but it has been described that in some countries more than half receive the treatment, according to the superior.

Wæhre believes the Rikshospitalet’s austerity did not fit in well with how the health authorities chose to handle the situation.

She believes the authorities gave in to pressure when they chose to create a guideline that is unclear as to where treatment can take place, where supervisory authorities cannot stop treatment provided outside the national treatment service.

– It is still like that, young people can receive treatment at the Gender and Sexuality Health Center in Oslo municipality. We find that both Oslo municipality and the directorate are anxious to come to terms with LGBTQ activism. They are afraid of being labeled transphobic. In England, Hillary Cass has been advised not to use public transport, after she came up with the report.

– You have repeatedly received criticism for being restrictive, do you regret anything?

– I think it has been important to be a clear voice for caution. At the same time, there are many parents and young people who find it very stressful to experience the discussion as it has become. That there are such hard fronts and it becomes difficult to manoeuvre.

– The fact that we actively went out and talked about our unrest in 2018 meant that we are more stable today.

The Children’s Ombudsman: – Shares the concern

The children’s ombudsman in Norway made a statement in connection with last year’s Ukom report on gender treatment for children and young people.

They have not read Cass’s study in detail, but note that it is in line with what the Norwegian report showed last year.

– We have shared Ukom’s concern that the current guideline has not been sufficiently standardized for the health service and may therefore leave room for interpretation. It worries us as we are in danger of children not getting equal help, says Head of Department at the Children’s Ombudsman, Ivar Stokkereit.

– We are reacting to the fact that the current guideline is not based on a systematic summary of knowledge and asked the ministry a year ago to revise the guidelines. We are impatient on behalf of the children, and expect that this must now be a priority.

The Directorate of Health: – Doesn’t recognize us

Nettavisen has submitted the criticism from Anne Wæhre to the Directorate of Health. Department director Torunn Janbu points out that in the guidelines for drug treatment of children under the age of 18, they take place in the specialist health service.

– The Norwegian Directorate of Health works for better health service provision for people with gender incongruence, in collaboration with the health service across levels, professional environments and patient – and user organisations. The Directorate of Health does not recognize Anne Wæhre’s description, she writes in an e-mail to Nettavisen.

Oslo municipality has also been submitted to the criticism from Wæthre. Municipal superintendent Miert Skjoldborg Lindboe denies that the municipality has given in to pressure.

– We do not recognize ourselves in the claim that Oslo municipality gave in to pressure. Oslo municipality recently participated in the Directorate of Health’s dialogue conference on gender incongruity together with representatives of national and regional specialist healthcare services and patient associations. There is professional disagreement about both treatment and guidelines nationally and internationally, he says.

– It is most appropriate to resolve the disagreements through interaction and dialogue with the parties concerned, the municipal superintendent will participate in this work. The dialogue conference with the Directorate of Health ended with a broad consensus that we must strengthen this dialogue and Oslo municipality looks forward to participating in further dialogue.

Lindboe says that Oslo municipality has confidence that the national health authorities and the specialist health service assess the guidelines for treatment based on the consideration of providing sound health services to the target groups.

– Correspondingly, we expect the specialist health service to have the same view of the municipality’s offer, he adds.