– People may snore that gender-confirming treatment is life-saving, but it is. Oliver Ottesen (24) talks about the need for regional services for trans people. For the past seven years, he has changed his name, been examined for gender incongruence, received testosterone injections and had surgery to remove his breasts. The breast operation was performed at St. Olav’s hospital in Trondheim. But everything else happened at Rikshospitalet in Oslo. He thinks it was cumbersome to travel eight hours for each consultation. – I have spent several months together traveling for treatment. This has resulted in lost income and money. Oliver Ottesen (24) wants a decentralized medical service for trans people. Photo: Marthe Svendsen / NRK In 2020, he and other trans people were told that regional centers for gender incongruence would be established. They’re still waiting. Major disagreement National guideline for gender incongruence came two years ago. It states, among other things, this: According to the division director in the Norwegian Directorate of Health, Johan Georg Torgersen, hormone treatment and puberty-postponing treatment for those under 18 is one of the tasks that the specialist health service should take care of. – Our opinion is that treatment should be given at these regional centers. The guideline is structured on the basis that hormone treatment should also be given there. At the end of April, Oliver Ottesen demonstrated in Trondheim, together with several others, for the offer they are waiting for. Ottesen believes the regional centers should include assessment, hormone treatment and surgery. Others disagree. According to the Norwegian Directorate of Health, most people with gender incongruence in childhood will later in life have a gender identity that matches the biological gender. For many, it goes over, they think. The organization Harry Benjamin Resource Center (HBRS) believes several regional centers are useful. But: – They should not give medical treatment. They should help people explore their identity, says board chairman Mikael Bjerkeli Scott. HBRS only wants two national centers. Not one like now. They want the two to take care of all medical treatment, so that the professional environment and competence is strengthened. – It’s not easy. Hormones and surgery do not solve everything, says Scott. The patient organization for gender incongruence (PKI) will have regional centers in each county. They believe everyone should provide medical treatment and some surgery, such as breast removal or augmentation. Talk therapy alone is not enough, says PKI leader Isak Bradley: – Systematic changes are needed. The first step is a comprehensive implementation of the national guideline – which is almost two years old – so that young people have a good and dignified offer where they live. Today’s offer for people with gender incongruence For those who need medical treatment to confirm their perceived gender, there are two major alternatives in Norway: The National Treatment Service for Gender Incongruence (NBTK) at Rikshospitalet accepts patients from all over the country. They were for a long time the only ones who on a large scale gave sex-confirming hormones and surgery to people with gender incongruence. Last year, NBTK had 2381 children and adults for assessment, treatment or follow-up. That was 25 per cent more than in 2020. They stand for a conservative approach to who should receive treatment. Among other things, a psychiatric examination is required before treatment can begin. They want everyone to try to live out their gender identity in real life, before they get treatment. They do not provide treatment to non-binary. Transgender people living in Oslo have another treatment offer, namely at the Health Station for Gender and Sexuality (HKS). A study on sex-confirming hormones was published earlier in May. Portuguese researchers from the European Society of Endocrinology wanted to find out what hormone therapy does to the quality of life of transgender people. 142 adults participated by answering questions online. Everyone had been on hormones for at least a year. The researchers believe the answers show that gender-confirming hormones are positive for self-confidence, well-being and family relationships. Will not decide The Hurdal platform, on which the government bases its policy, states that they will strengthen the offer to people with gender incongruence. They are working to create the regional offerings. State Secretary Karl Kristian Bekeng will not say whether the government wants gender-confirming hormones to be given there. – We do not have to decide whether it should be one or the other. It is not a political question what is the right medical treatment. – You want a more decentralized offer. But you do not want to say what that offer should be? – We do not say exactly what will be offered at the various locations. It is a professional debate that takes place within the hospitals and it is also about what you have the competence and personnel for, says Bekeng. Offers in place in one region Bare Helse Sør-Øst has so far established regional centers. They opened three offers in 2020. One is subject to the Hospital in Vestfold and is located on Nøtterøy. Here come adults with gender incongruence. In addition, they provide advice to child and adolescent psychiatry, GPs and health stations. The regional center for gender incongruence is located at DPS Vestfold on Nøtterøy. Photo: Sverre Lilleeng / NRK This offers discussion groups, guidance and help with getting wigs, penile prostheses and compression vests that hide the breasts. Not hormone therapy. – Part of the point is to give patients an arena to explore gender identity. For some patients it is sufficient, says psychologist Martin Rosmo Hansen. At the same time, he emphasizes that most of their patients want medical treatment. At the center in Vestfold, people with gender incongruence get help to get penile prostheses. And breast prostheses and other equipment. There are also group discussions with them. Here is a conversation room. Patients in need of hormone treatment or operations are referred to Rikshospitalet. Not because the center does not want to prescribe hormones, but because they do not currently have the expertise or resources. – Some went so far as to say that such a center would not have the right to life. That hormone therapy was the only thing that was relevant for this patient group. Hansen believes their waiting lists show that the center is an important supplement. Martin Rosmo Hansen is a psychologist specialist at the Regional Center for Gender Incongruence in Vestfold. Photo: Sverre Lilleeng / NRK Health South-East also established two centers under Akershus University Hospital. One is located at DPS Nedre Romerike in Lillestrøm. It’s for adults. The other is located at BUP Kongsvinger. It is for young people under 18. First and foremost, the centers will build up professional competence and establish professional networks, explains Øystein Kjos. He is division director for mental health care and substance abuse at Akershus University Hospital. – It is reported that there is relatively little competence about this growing patient group. Now they conduct a basic investigation and have exploratory conversations about gender experience and identity. Some are referred to Rikshospitalet. Kjos says they work closely with them. The centers do not offer hormone therapy. There are no plans for that either. – Not surgery either. It is completely out of the question. What is happening in the rest of the country? Helse Nord The University Hospital in Northern Norway (UNN) will establish the regional center in the north. It is still under planning, but something has been clarified: It should be for patients up to 23 years. It must be located in the child and adolescent clinic under the child and adolescent psychiatry. They must offer advice. Non-puberty-delaying treatment or sex-confirming hormones. Chief physician Hans Petter Fundingsrud points out that less than 10 percent of the country’s population lives in northern Norway, and that the patient group is very small in the region. Those who need medical treatment should be referred to Rikshospitalet, he says. Fundingsrud believes that developments in Sweden, Finland and England indicate that we should be careful about giving medicines. – This is experimental treatment where you sterilize young people. You have to be aware of what you are doing, says the superior. Chief physician Hans Petter Fundingsrud at the University Hospital in Northern Norway. Photo: Ida Louise Rostad / NRK Helse Midt – We must aim for it to be in place by the autumn of 2022 at the latest, says director Runa Heimstad at St. Olav’s hospital in Trondheim. The offer must be for all age groups. It will be located under the children and youth clinic at St. Olav, and several different specialists will be connected. They will improve their competence to be able to start hormone treatment and puberty-delaying treatment, in collaboration with Rikshospitalet. – We will not do anything that is irreversible without an agreement with Rikshospitalet, says Heimstad. Health West The goal is to establish a regional center this year. It should be for patients over 18 years of age. It is planned to add a medical department at Haukeland Hospital in Bergen. It will not include sex reassignment hormone therapy or surgery right away. The reason is that the doctors there must gain the experience they believe is needed. – We think we will eventually engage in hormone therapy. But then in collaboration with the national treatment service for gender incongruence. Maybe they are the ones who will start the treatment, and then we can follow up, says senior adviser Carina Paulsen Mæland. So what does the Norwegian Directorate of Health say about the plans? Johan Georg Torgersen emphasizes that the health trusts are responsible for building the competence needed to be able to provide hormone treatment. – In its guideline, the Norwegian Directorate of Health assumes that competence is decentralized. Then we understand that it takes time to build up the competence. Rikshospitalet refers to Sweden Kjersti Gulbrandsen heads the department for gender identity assessment of adults (AKV) at Rikshospitalet. She believes giving new patients puberty blockers, hormones and surgery are highly specialized tasks. These should not be decentralized, she believes. She refers to Swedish experiences. – They have seen a strong need for centralization and a closer connection to the surgical treatment sites. Because patients have received arbitrary follow-up in their process up to, and after, surgery. She calls for a thorough, scientifically based guideline for how assessment and treatment should be done. In addition, she wants a national quality register. Head of department Kjersti Gulbrandsen at Rikshospitalet is worried that too much can be decentralized. Photo: Sverre Lilleeng / NRK With decentralization, she fears it will be more difficult to do research in the area. – It’s like painting walls in a house without a foundation. In recent years, the service has experienced capacity challenges. But Gulbrandsen says the increase in the number of patients has been compensated with more positions. The waiting time is three to six months, which they consider acceptable. – Our concern is that we overdiagnose and mistreat people – people who may not have received treatment. Time will tell. Many live far away from Rikshospitalet. According to Gulbrandsen, half of their consultations take place on video, which the patients are positive about. The environment at Rikshospitalet supports the establishment of a similar highly specialized service in one of the other health regions. Other regional centers can be important supplements, says Gulbrandsen. For example, to coordinate treatment, or help those who do not fall under the offer at Rikshospitalet. – They have not had any specific offer of follow-up locally or regionally. If there could be a place to refer them to, it’s great for patients.
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Health services for transgender people / people with gender incongruence in Norway will be better – NRK Trøndelag
