Norwegian doctors/gatekeepers stop transgender kids from getting the treatment they need

The Norwegian newspaper Aftenposten covers the challenges faced by transgender youth in Norway regarding access to gender-affirming medical treatment in a new article.

Photo of Stina's shoes from Aftenposten.
Photo: Charlotte Førde Skomsøy

It focuses on the case of "Stina," a 13-year-old who was denied puberty blockers by Rikshospitalet, Norway’s national medical institution for gender treatment. Instead, she sought treatment at the Health Station for Gender and Sexuality (Helsestasjon for kjønn og seksualitet, HKS) in Oslo, which granted her access to the medication.

Cis-normative gatekeepers

The article confirms what many trans people have argued for a long time: Public institutions for transgender health often become gatekeepers serving a cis-normative society.

Although the doctors see themselves as progressive and supportive, their internalized transphobia make them set up strict rules for who qualifies as a "real trans person".

Norwegian trans people will tell you that as far as Rikshospitalet is concerned, it helps to live up to the gender stereotypes of accepted femininity and masculinity if you want hormones and surgery.

This is ethically problematic, as these doctors - all of them cis people - have put themselves up as both judges and prisoners, claiming the power to decide whether a trans person should be living their lives as themselves or not.

Would they deny cis kids treatment?

Imagine the situation reversed: What if someone forced a cis kid to go through puberty as a gender not their own?

Indeed, boys with unusual breast growth, pubertal gynecomastia, will get surgery if needed, in spit of the risks involved. Girls with hyperandrogenism (excess androgens like testosterone) may get an enlarged clitoris, excess body hair, and - later in life - male-pattern baldness. Do they get medication? You bet!

Caution, the consequences be damned

The increasing anti-trans activism world wide has also inspired Rikshospitalet to urge "caution", claiming that we do not know enough about the effects of various treatments.

We should point out that the same hospital provides a lot of treatments were there may be doubt about side effects but they still treat the patients, given that no treatment will lead to even worse results.

In the case of transgender kids, the unwanted transformation caused by puberty will have a much more detrimental effect on the patient than using puberty blockers while waiting for the youth to be old enough to decide for themselves.

Last year the health authorities decided that puberty blockers are seen as "experimental", in spite of them having been used to save transgender kids the world over for a long time.

Stina has her own IKEA Blåhaj, a transgender symbol used by trans youth world wide.

HKS, the pro-trans alternative

While Rikshospitalet has become increasingly cautious with providing puberty blockers and gender-affirming hormones to minors, HKS takes a more affirmative stance, emphasizing the severe mental health impacts of denying treatment to trans youth.

Stina’s family experienced two vastly different approaches between Rikshospitalet and HKS. After years of medical evaluations and consultations with Rikshospitalet,

Stina was denied puberty blockers, leaving her feeling unheard and deeply distressed. Ultimately, her family relocated to Oslo to access treatment from HKS, which they found to be more empathetic.

The mother feels that Rikshospitalet's approach exacerbated her daughter's problems. Mandatory evaluations at various stages delayed the process, reinforcing the feeling of not being believed and the fear of not receiving the medication in time.

When puberty began, the distressing emotions took over. Stina was unable to attend school.

"The pressure became too great, and life became too difficult," says the mother to Aftenposten.

"We did everything Rikshospitalet asked us to do. We attended meetings for years and went through difficult evaluations. Yet, my daughter did not receive the treatment she needed to feel well," she says.

"From being a deeply depressed child with no prospects for the future, I now have a teenager who looks at life with optimism. The struggle was tough, and the outcome was life-changing," says the mother.

To receive treatment at HKS, Stina had to move to Oslo. The health station is only available to Oslo residents.

For the rest of the country, Rikshospitalet is the only place authorized to offer medical treatment for gender incongruence to individuals under 18 years old. Stina had been followed up there since she was six.

The mother adds:

"All people have the right to bodily autonomy. Therefore, each individual should be able to decide what feels right for them after Rikshospitalet has provided the necessary information about the effects and side effects of the treatment in question."

Ingun Wiik of HKS tells Aftenposten that she believes that the current treatment offered by Rikshospitalet resembles conversion therapy. Her view is that the treatment process there is aimed at convincing the patient that they are the gender they were assigned at birth.

Aftenposten's headline: "'Stina' was born with a boy's body.
When puberty hit, she was denied medicine."

Rikshospitalet wants to close down HKS

Note that leaders at the National Treatment Service for Gender Incongruence (NBTK) at Rikshospitalet have tried to get HKS closed down.

Back in 2023 Christine Marie Jentoft and Inge Alexander Gjestvang of the national LGBTQ organization Fri commented:

"If the leadership is so concerned about treating transgender individuals, perhaps they should focus on other patient groups they feel more confident working with? It does not inspire trust in a leader when the main focus is the fear of making mistakes."

For more on the trans clinic of the Oslo University Hospital (Rikshospitalet), see our article: What Transphobic Norwegian Doctors can Teach Us about the Diversity of Transgender People