One in three people in Norway (32.5%) who have started hormone treatment, and half (49.5%) of those who have undergone gender affirming surgery, have obtained treatment entirely through private funding. That is the findings of a new survey involving 579 trans and non binary individuals from across the country.
“Even though publicly funded treatment is available, many still choose to pay for care themselves. It’s striking, especially given that the participants were largely young people with low incomes,” says Silje-Håvard Bolstad, doctoral research fellow at the Department of Psychosocial Health at the University of Agder.
At the same time, the survey shows that many of those with unmet needs for treatment could not afford to pay for it privately. For hormone treatment, this applied to around 46 per cent, and for surgery around 66 per cent.
Long waiting times and fear of being turned down
In Norway, publicly funded gender affirming medical treatment is available at Oslo University Hospital.
The study did not specifically investigate why some people choose to seek treatment outside the public healthcare system, but Silje-Håvard Bolstad points to several possible explanations:
- Long waiting lists
- Assessments that takes at least one year
- Fear of being rejected after a lengthy assessment process
- Lack of knowledge about gender diversity within the health care system
- Non binary people being denied treatment
- Insufficiently individualised treatment options
Also, fifty eight per cent of participants in the study had experienced discrimination within the healthcare system, either in connection with gender affirming treatment or when seeking other forms of care.“Some of those seeking gender affirming treatment may have low trust in the public healthcare services, and therefore choose to pursue private treatment instead,” Bolstad says.
Satisfied with treatment
The survey also shows that the vast majority of those who have received treatment are satisfied with the results: 93 per cent of those who received hormone treatment and 96 per cent of those who underwent surgery.
Thirty five per cent of trans men in the study had completed most of the gender affirming changes they wanted. The corresponding figures were 18 per cent for trans women and 16 per cent for non binary people assigned female at birth.
Among non binary people assigned male at birth, none had completed most of the changes they wanted.
“Non binary people may have different goals for their transition than what is typical among trans men and trans women. Some may not want extensive medical treatment, but instead prefer social changes or more moderate medical interventions,” the researcher explains.
Bolstad emphasises that trans people are a diverse group. “The findings highlight how important it is to tailor gender affirming treatment to individual needs.”
Many report mental health difficulties
Fewer than half of the participants (47 per cent) reported having good general health, compared with 68 per cent in studies of the general population.
“The survey aligns with much of what previous research has shown. The proportion experiencing mental health problems at a level requiring treatment was almost four times higher than in the general population. One in three has attempted suicide at some point in their lives, which is twelve times higher than what is found in studies in studies of the general population,” says Bolstad.
Studies from many countries show that access to gender affirming treatment can reduce mental health difficulties and prevent suicide among trans people.
“When we know that this group experiences significant mental health challenges, and that gender affirming treatment leads to improvement, it is deeply concerning that they face so many barriers to accessing care, and that the public treatment services are so limited and difficult to reach,” Bolstad says.
About the study
- One of the largest studies of trans people in Norway
- 579 trans and non binary people took part
- 214 trans men, 195 trans women, 136 non binary people assigned female at birth, and 34 non binary people assigned male at birth
- Conducted June–September 2023
- 75 per cent of participants were under the age of 35
- Examined participants’ needs for gender affirming healthcare, their experiences with the health service, and their mental and physical health
- Some participants had undergone gender affirming treatment, some had unmet treatment needs, and some did not want to persue treatment
The results are published in the journal BMC Public Health
Glossary:
Trans person: An individual who identifies with a gender different from the one recorded at birth. A trans woman identifies as a woman but was assigned male at birth, and a trans man identifies as a man but was assigned female at birth.
Non binary: People who identify with a gender other than the categories of man or woman, who identify with both categories, or who experience their gender identity as fluid and changing over time. The term may also refer to individuals who do not identify with any gender category at all.
Gender affirming treatment: Various medical and physical interventions carried out to improve the alignment between a person’s gender identity and their gender expression.
Source: Store norske leksikon