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Nine out of ten are satisfied with gender-affirming treatment
At the same time, many transgender and non-binary individuals end up covering treatment costs themselves. Long waiting times are one reason for this, according to a researcher.
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.
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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.
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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.
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.
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Three out of four participants were under the age of 35.
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.
Many struggle with their mental health
The study also highlights significant mental health concerns. One in three participants reported having attempted to take their own life.
"That's about 12 times higher than in the general population," Bolstad points out.
This is precisely why access to gender-affirming care is important, according to the researcher.
"It's well documented that gender-affirming treatment has a positive effect on mental health and quality of life. The treatment is associated with lower levels of depression, anxiety, and suicidal behaviour," says Bolstad.
Long waiting times and closed doors
Many participants have paid for treatment themselves, despite the existence of a publicly funded option.
"Why do they pay themselves when they could get it covered?"
"We did not directly investigate why participants sought privately funded treatment. But earlier qualitative research points to long waiting times as one important explanation. It simply takes a long time to get help," they say.
Bolstad explains that in the national treatment system, the assessment process alone takes at least one year.
"That's a long time to wait just to have your healthcare needs evaluated," says Bolstad.
Need for critical research
Isak Nathaniel Løberg Jacobsen is a PhD candidate at NTNU and studies trans people.
"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.
"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.
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Translated by Alette Bjordal Gjellesvik
This article was first published in Kilden genderresearch.no. Read the original here.
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