Norway has gone from having 4 requests a year from people who wanted to undergo gender transition treatment, between 1975 and 1990, to having between 400 and 600 patients a year, between the years 2018-2021.
The greatest growth in demand has occurred among adolescents and young adults who, being women, identify with the male sex.
These striking data have been provided by the Norwegian Healthcare Investigation Board (NHIB). This independent state-owned company is responsible for analyzing serious incidents or other malfunctions in Norwegian health and care services.
On March 9, the NHIB published a report on the safety of minors with dysphoria where it warned of the lack of “scientific evidence” that gender reassignment treatments have in minors.
It details that research on the treatment is “deficient” and the long-term effects “are not well known.” In addition, the instability of minors’ gender incongruity is noted, since they are not “fully developed bodily, mentally, sexually, or socially.”
Risks to patient safety
There is not only a pattern in relation to a greater demand by women than by men. It has also been seen that 75% of minors who are diagnosed have a high prevalence of mental illnesses or cognitive disorders (such as ADHD/autism or Tourette syndrome) prior to the diagnosis of dysphoria.
The report criticizes the fact that the national professional guidelines for the treatment of gender affirmation in minors with dysphoria do not have specific requirements for their evaluation or for the initiation of therapy. This translates into a risk to patient safety, since they lack the principle of prudence.
Likewise, the report warns of the long list of side effects underlying this practice in male-to-female treatment: appearance of liver disease, negative psychological reactions, increased thrombotic risk or arterial hypertension. And in female-to-male treatment: increased red blood cells, scarring, edema or infertility resulting from both surgical procedures and hormonal treatment.
Safety of treatments
The study that originated the report is motivated by the numerous notifications to the Commission, presented by the relatives of the minors, who question the safety of the treatments offered to children and adolescents diagnosed with dysphoria.
Some of the recommendations set forth by the aforementioned commission are the revision of the guidelines that establish a safe framework for treatment, the strengthening of the knowledge base, defining the treatment as experimental and treating it as such when offering it to children with dysphoria.
The NHIB exposes the need to increase the level of evidence on the approach to gender dysphoria and to organize the services offered based on this knowledge.
Bioethical assessment
As we have published in previous articles, in recent years there has been an exponential increase in people initially declared to be transsexuals who show their regret after starting the sex reassignment process.
The accumulation of data on the side effects associated with these treatments has promoted that in the countries in which these interventions began, their health policies have been reconsidered and the procedures by which these cases are addressed have been drastically modified.
The problems were due to the inability to solve the basic problems that frequently underlie the dysphoria symptoms, the long-term persistence of serious associated problems and the irreversibility of the interventions.
This change has led to more prudent and conservative positions pending the availability of new evidence on the suitability of the proposals applied in gender transition processes.
Julio Tudela and Paloma Aznar
Bioethics Observatory – Institute of Life Sciences
Catholic University of Valencia
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