Norway has become the latest country to place severe restrictions on the experiment of pediatric medical sex changes after the Norwegian Healthcare Investigation Board released a report deeming puberty blockers, cross-sex hormones, and surgeries for children and young people to be experimental and calling current “gender-affirmative” guidelines not evidence-based and in need of revision.
According to a translation provided by the Society for Evidence-based Gender Medicine (SEGM), the Norwegian Healthcare Investigation Board (NHIB/UKOM) report stresses that future guidelines must rely on a systematic review of the evidence for affirmation and medical intervention for young people suffering from gender dysphoria, rather than just a cherry-picking of the evidence in favour of practice, as is typical of gender-affirming care proponents.
The UKOM report states that all hormonal and surgical interventions performed on young people must be restricted to research settings to ensure clear protocols, safeguarding, and adequate follow-up.
SEGM points out that the existing Norwegian treatment guidelines for youth suffering from gender dysphoria, which were based upon a 2015 report titled ‘The Right to the Right Sex’ closely resemble the World Professional Association for Transgender Health (WPATH) Standards of Care 7 (SOC7) “gender-affirming” model, which states that a child or adolescent must be affirmed in their self-declared transgender identity and views psychological assessments as unnecessary barriers to care. WPATH SOC7 was published in 2012.
Under the current Norwegian guidelines, children may begin puberty blockers at Tanner stage 2, the age of which varies significantly from child to child but can occur as young as age 9. Cross-sex hormones are permitted from age 16, and surgeries from age 18. The UKOM report acknowledged that these interventions are irreversible, risky, and lacking good quality evidence to support them.
The report was critical of the “gender-affirmative” guidelines, and noted the several alarming trends: the dramatic increase in adolescents, especially females, presenting to gender clinics; the high incidence of coexisting mental illnesses observed in this new cohort, and the high prevalence of neurocognitive conditions such as ADHD, autism and Tourette’s.
The new recommendations bring Norway in line with Sweden, Finland, and England. These nations have also pivoted away from the affirmative medical model of care and back to a focus on psychotherapeutic support for gender-dysphoric youth following systematic reviews of the evidence that showed it to be of extremely low quality.
But the Norwegian recommendations go one step further than their predecessors. The UKOM reports explicitly states that young adults are also still in a state of development and therefore are also at risk for erroneously undertaking a medical sex change. The report points to the fact that the age of consent for sterilisation in Norway is 25.
UKOM says that the right to medical care does not include the right to experimental treatments and as an experimental intervention, sex change procedures will be subject to heightened scrutiny concerning informed consent, eligibility criteria, and the evaluation of outcomes.
This proposed model appears to mirror the recommendations made by Dr. Hilary Cass in the interim report of the Cass Review, the independent review of England’s pediatric gender service. Norwegian youth will receive care at local gender clinics with multidisciplinary support, in the same way that England’s youth will when the Tavistock gender clinic closes its doors later this year.
