A new Norwegian study shows that over 90 per cent of those who receive gender-affirming treatment are satisfied with the result.

Still, about half of those who have undergone gender-affirming surgery paid for it themselves. The same is true for one in three individuals who have begun hormone therapy.

"Gender-affirming treatment is medically necessary for those who need it," says Silje-Håvard Bolstad, a PhD candidate at the University of Agder's Department of Psychosocial Health.

The figures come from a national survey of 579 transgender and non-binary people.

"The findings suggest that public healthcare services should become more accessible, and that significant barriers still exist within the system," says Bolstad.

Limited local knowledge

Internationally, there has been extensive research on the health of trans people. Norway has lagged behind in building knowledge in this area.

Norway performs well in global comparisons regarding rights and attitudes towards LGBTQ+ people.  However, research cited by Bolstad and colleagues shows that 12 to 18 per cent of the population still hold negative views of trans people.

In a 2018 survey on the living conditions of queer people in Agder, more than half of trans people reported having mental health problems. Only a small portion said they were open with their GP about their gender identity. 

A national survey from 2021 also shows that many have experienced discrimination. About 40 per cent of trans people reported having experienced negative comments in the workplace over the past five years.

Despite this, there has been limited research in Norway focusing on transgender individuals’ own experiences with gender-affirming care.

"There has been a need for more knowledge in this area," says Bolstad.

The treatment is associated with lower levels of depression, anxiety, and suicidal behaviour.

 

High participation, including non-binary individuals

International research on gender-affirming treatment has also had its limitations, according to the researcher.

"Older studies, in particular, often failed to recognise that gender is not limited to two categories: trans man and trans woman", says Bolstad.

Understanding the health challenges faced by non-binary individuals was therefore a key objective of the new study, according to Bolstad. Non-binary people are individuals who do not identify exclusively as female or male.

The new study is based on data from TransNor, an anonymous survey conducted in the summer of 2023. It was widely distributed through social media, organisations, healthcare services, and at pride events.

Among the respondents, roughly one third identified as men or trans men, another third as women or trans women, and nearly 30 per cent as non-binary.

"The high level of participation is a clear strength. Norway is a small country, and trans people make up a small part of the population", says Bolstad.

Three out of four participants were under the age of 35.

“How would you explain the high proportion of young participants?”

“It’s difficult to say anything for certain about that,” says Bolstad.

Satisfied with treatment outcomes

Participants were asked a range of questions about both treatment and mental health. Out of the 579 respondents, nearly six out of ten reported having received hormone therapy, while around three out of ten had undergone surgery. 

Those who had received treatment were asked how satisfied they were with the results. Among those who had undergone hormone therapy, 93 per cent said they were very or fairly satisfied with the results. For surgery, 96 per cent were satisfied.

"This aligns with earlier research showing that most people are satisfied with the outcome of gender-affirming care. It also suggests that trans people are capable of making good decisions for themselves and their own health," says Bolstad. 

Mange sliter psykisk

Studien tegner også et alvorlig bilde av den psykiske helsen. Én av tre oppgir å ha forsøkt å ta sitt eget liv.

– Det er rundt tolv ganger høyere enn i den generelle befolkningen, påpeker Bolstad. 

Nettopp derfor er tilgang til kjønnsbekreftende behandling viktig, ifølge hen. 

– Det er godt dokumentert at kjønnsbekreftende behandling har positiv effekt på psykisk helse og livskvalitet. Behandlingen er forbundet med mindre depresjon, angst og selvmordsatferd.

Lange ventetider og stengte dører

Mange av deltakerne har betalt for behandling selv, til tross for at det finnes et offentlig finansiert tilbud.

– Hvorfor betaler de selv når de kan få det dekket?

– Vi undersøkte ikke direkte hvorfor deltakerne har oppsøkt privatfinansiert behandling. Men tidligere kvalitativ forskning forskning peker på at lange ventetider er én viktig forklaring. Det tar rett og slett lang tid å få hjelp, sier Bolstad.

Bolstad forklarer at i den nasjonale behandlingstjenesten er utredningstiden minimum ett år. 

– Det er lenge å vente for å få utredet behov for helsehjelp. 

Non-binary people turned away

Earlier qualitative research has highlighted a lack of trust in public healthcare services as an issue. This is supported by a 2018 survey from Agder involving 154 transgender and non-binary participants, where 40 per cent described the healthcare system’s understanding of gender diversity as inadequate.

“There is also evidence that non-binary individuals have been denied treatment,” says Bolstad.

They note that the public treatment service previously stated on its website that non-binary people were not eligible for care, although that wording may have been removed later.

“What was the reasoning?”

“It was attributed to a lack of research and insufficient knowledge about non-binary people,” says Bolstad.

“How does your research fit into this discussion?”

“Our findings show that non-binary individuals do report a need for treatment, and many have actively sought and received it.”

“At the same time, we show that non-binary people who have received hormone therapy or surgery are no less satisfied with the outcomes than others.”

How the healthcare system understands gender concerns all of us.

 

Need for critical research

Isak Nathaniel Løberg Jacobsen is a PhD candidate at NTNU. His PhD project examines how transmasculine individuals understand and experience issues related to reproduction and the body.

Bilde

"There is little Norwegian research on transgender people's encounters with other healthcare services, and there is a significant need for more knowledge in this area," Jacobsen writes in an email.

He emphasises the need for both qualitative and quantitative studies going forward.

"Especially research that examines prevailing cisnormative assumptions within the healthcare system," he says.

By this, he refers to the assumption that there are only two genders: women and men.                                                                                                                                        

“Concerns everyone”

He highlights healthcare-seeking behaviour as a key issue going forward – specifically, whether transgender individuals avoid seeking medical care. 

“International research shows that many avoid healthcare services, particularly those perceived as strongly gendered, such as gynecological exams.”

At the same time, Jacobsen stresses the importance of recognising two perspectives at once.

“The needs of transgender people are not limited to a small group. How the healthcare system understands gender concerns everyone.”

Still, the consequences are not evenly distributed.

"Transgender people are more often and more severely affected when they challenge traditional views of gender and the body. This is something both Bolstad's research and other Norwegian and international studies clearly point to," he says.

Translated by Alette Gjellesvik/forskning.no