– Treats fewer people before they turn 18 – NRK Trøndelag – Local news, TV and radio

Senior doctor Anne Wæhre leads the team at Rikshospitalet that treats young trans people.

Children and young people who are investigated come here gender incongruity. Some are in their early teens. In 2022, they took in 268 children who were referred to them for the first time. Of these, a quarter were registered as boys when they were born, while 3 out of 4 were registered as girls.

Wæhre says that they have become more restrictive over the past couple of years.

– As a rule, we tell patients that you must be over 18 before you can start treatment.

What she is talking about here is medication.

Puberty blockers are given to trans children to stop the body from entering unwanted puberty. Gender-affirming hormones are given to change the gender expression of the body. For example, give beard growth and a darker voice at transmasculine.

The goal is to make it easier to live in a body that matches your identity.

Wæhre says they still give medication to some of the patients. But:

– My impression is that vin treats fewer patients before they turn 18. We want them to grow older. We want them to mature and explore their identity over time.

– Aren’t you afraid that many people will then try to get treatment in other ways?

– There is a hope that it will is a common understanding of how important it is to take time and not rush into treatment that is irreversible.

– Many unknowns

In 2020, British health authorities commissioned an independent review linked to the treatment of children and young people with gender incongruity.

The aim was to find out if that treatment was good enough, and what the research said about the effects and safety of the existing medicines.

The report came out last week.

– The rationale for postponing puberty is unclear, with little documentation on the hill gender dysphoria and psychosocial health is affected, writes Hilary Cass, who led the work, in a summary of her report.

– The use of hormones in those under the age of 18 also represents many unknown factors, despite long-term use in the adult transgender population, she continues.

At the same time, she criticizes many of the international guidelines for the treatment of young transgender people.

Does that help?

Senior doctor Anne Wæhre believes that the report from England joins a number of other summaries that have come from Sweden and Finland.

– All of these say in the last year it is low, to very low evidence for the treatment with puberty blockers and oestrogen/testosterone. So does it help with this dysphoria? Does it help mental health, does it improve quality of life and functioning?

Wæhre says they don’t know if the treatment helps.

– And there is little evidence that the treatment does not harm the patients.

Have ruled out a lot of research

Ole-Petter Hamnvik is endocrinologist and associate professor at Harvard medical school.

In addition, he treats Norwegian patients through a collaboration with the Health Center for Gender and Sexuality (HKS) in Oslo. The health center is one of the only ones to provide medical treatment to trans people outside the National Hospital.

He strongly disagrees with the conclusions of the British review.

– JI think that the entire report is characterized by a morbidization of transgender people. It stands in stark contrast to our understanding of gender incongruence, which is a normal variation in gender identity.

He believes that much of the research that shows that medicines work well has been excluded from the report.

Hamnvik says it is both difficult and unethical to create studies where some trans youth receive medication, while others receive a placebo. Therefore, one must look at research that has followed groups of patients over time.

– If you look at all the studies not included in Cass’s research summary, there are at least 20 high-quality studies that have shown that medical treatment for trans youth is safe. That there are minimal side effects, and improvements in mental health.

Experimental treatment

Recently, several countries have changed the treatment given to trans youth.

– Finland has defined treatment as experimental. In Sweden, the National Board of Health and Welfare has said that the risks of gender-affirming and puberty-postponing treatment most likely exceed the expected benefit.

That’s what Ulrich Spreng, specialist director of Health South-East, says. He says that he and the three other subject directors in the health regions have reached a joint decision.

– Medicinal treatment for gender incongruence that applies to children and young people is to be considered experimental.

He believes that the use of medication “can be potentially harmful”, and therefore more knowledge in the area is needed.

He also refers to the British Cass report, and says that today there are relatively few Norwegian trans youth who receive medical treatment.

– The vast majority of patients receive guidance. They get advice. They also receive psychotherapeutic treatment, which means that it is not necessary to delay puberty or provide gender confirmation treatment.

Now Spreng and the other directors have given Anne Wæhre and her colleagues at Rikshospitalet a new task. They will create a research study where children and young people who receive medical treatment will be followed up.

– No changes introduced

The Directorate of Health has not answered questions about who has the authority to decide whether a treatment is experimental or not.

Instead, NRK received this response from department director Torunn Janbu in an e-mail.

– As far as the Directorate of Health is aware, no changes have been introduced to the health service offer. When this is possibly carried out, Hdir will consider revisions/adjustments to the guidelines.

On Friday this week there will be a meeting about the offer to be made in the future. Among others, the health regions, the Directorate of Health and the organizations of Norwegian trans people meet there.