Norway Agency: Revise Gender Transition Guidelines Because ‘Research-Based Knowledge Is Insufficient’
A Norway government watchdog agency has recommended the country revise its gender transition guidelines for youth after a review found the standards were based on inadequate scientific evidence.
The Norwegian Healthcare Investigation Board (NHIB, abbreviated UKOM in Norwegian) said in its March report that “research-based knowledge for gender-affirming treatment (hormonal and surgical), is insufficient and the long-term effects are little known.” The lack of evidence-based knowledge is “particularly true for the teenage population where the stability of their gender incongruence is also not known.” At the same time, it noted a recent “marked increase” among teenagers, especially girls, seeking treatment for gender dysphoria.
NHIB launched the review after receiving multiple reports last year of young patients’ family members who questioned “the soundness of treatment,” insufficient follow-up, a failure to investigate other possible diagnoses, lack of information, and a lack of parental involvement.
The review found a concerning lack of scientific research related to treating minors with gender transition procedures. Among these gaps were “unsettled questions related to puberty blockers in young people,” including the “effects on cognitive development, “unexplained side effects,” and “long-term effects.” The report indicated some evidence showing that puberty blockers could cause “slower height growth,” “slower increase in bone density,” and higher “risk of disease.” Nor did research show whether youth who received gender transition procedures experience “long-term satisfaction,” live to “regret it,” or need “surgical re-operations.” “Documentation about treatment effect, side effects and prognoses is missing or weak,” it summarized.
It found a particular dearth of high-quality, long-term studies, especially on youth. The review criticized available research:
“As a rule, there is no control group in the studies. Lack of control groups means that effects are often measured against population data. Effects are often assessed at group level, and not at individual level, so that unwanted effects for some patients can be masked by improvement in the rest of the group. There are often small samples, and patient dropouts can greatly affect the results.”
Of long-term studies, “those that do exist” began “before the described increase in teenagers with gender incongruity seeking treatment,” of whom “a large proportion have mental illness, developmental disorders, or other conditions that were not described in previous studies,” making the previous conclusions “not necessarily transferable.”
The review also found that “The national professional guideline for gender incongruence does not follow the Guide for the development of knowledge-based guidelines published by the Norwegian Directorate of Health,” which prescribe “concrete” recommendations that “help healthcare personnel and patients to make good decisions” and “contribute to reducing unwanted variation as well as promoting good quality in health and care services.” Instead, Norway’s national guidelines for treatment of gender incongruence “provide too much room for interpretation regarding who can do what, how, where, and when.” The review said this consequently “created room for uncertainty and divergent expectations” and “a risk of both under-, over- and incorrect treatment of children and young people.”
The independent agency’s report contained several recommendations. It suggested the Directorate of Health “revise the national professional guideline” to “among other things, be based on a systematic summary of knowledge.” It recommended “that puberty delaying treatment [puberty blockers] and hormonal and surgical gender confirmation treatment for children and young people are defined as experimental treatment.” And it proposed “necessary measures” for a “national quality register” that would enable the state-run health care system to track and control the quality of care provided to young people with gender dysphoria.
“It’s encouraging to hear about people following the science,” said Dr. Jennifer Bauwens, a clinical psychologist and current director of Family Research Council’s Center for Family Studies, on “Washington Watch.” “This isn’t new for those of us who’ve been following this. … We’ve been raising for some time. So it’s nice to actually see people who are doing scientific reviews say the same thing.” FRC President Tony Perkins agreed, “It’s an encouraging sign that it’s already unraveling. That’s why you have all of these nations stepping back.”
The Norway report comes as relatively progressive European nations including the United Kingdom, France, Finland, Norway, Australia, and Sweden scale back approvals of gender transition procedures for minors. According to a January review of the U.S. and 11 European countries, the U.S. already had the “most permissive” policies regarding the “legal and medical gender transition of children.” However, following Nebraska’s law signed Monday, 15 U.S. states this year (and 18 total) have enacted at least some guardrails to protect minors from the harmful consequences of gender transition procedures.
That same report found that Norway allowed puberty blockers for minors as soon as puberty begins to manifest and allowed cross-sex hormones from age 16, or age 18 if the treatment was considered irreversible. Norwegian minors can change their gender markers in the civil registry from age six with parental consent, and from age 16 without parental consent, although “male” and “female” are the only recognized genders.
The European countries retreating from gender transition procedures for minors “are not known as being bastions of conservatism,” Perkins pointed out. Yet “here in the United States, we have not only the Biden administration, which is driven by political ideologues, [pushing this], but you’ve got medical associations here in the United States doing the same.” In April 2021, the American Medical Association described gender transition procedures for minors as “medically necessary,” in a letter to the National Governors Association criticizing Arkansas’s enactment of the SAFE Act, the first bill to protect minors from gender transition procedures.
U.S. medical organizations “are dependent on us trusting what the science tells us,” responded Bauwens. “In other words, whatever they want to dictate to us, as long as they have a peer-reviewed publication … that means then their point is proven.”
“These organizations are supporting mutilation of children based on the idea of consensus,” Bauwens argued. “They get in a room together. They all know each other. They’re all doing the same work to promote ‘transgender [supposed] health.’ And they vote on these practices [and] then they turn around to the public, and they say, ‘Well, we are using evidence-based care.’”
In 2021, the American Medical Association House of Delegates passed a resolution to “oppose any and all criminal and other legal penalties” for “gender-affirming care,” citing clinical practice guidelines from the World Professional Association for Transgender Health (WPATH), The Endocrine Society, and The American Academy of Pediatrics (AAP).
“When they say that they’re using evidence-based care,” continued Bauwens, they’re relying on a fundamental principle of evidence-based practice that “if we don’t have good science, basically we use the best available science.” But then, she alleged, they “take it a step further and say that the science is settled.”
Bauwens said the medical community’s claim that the science is settled “can’t stand for very long.” Already, she pointed out, “we’re seeing people who have detransitioned come out and speak against the harms.” Norway is the latest country to reevaluate its practice of providing gender transition procedures to young people.
Joshua Arnold is a staff writer at The Washington Stand.