Gender-affirming healthcare in Sweden

What is gender-affirming care?

Everyone is assigned a gender at birth, based on how doctors interpreted our bodies at that time. If the gender you were assigned at birth doesn’t align with your gender identity, it can cause discomfort or distress. This is called gender dysphoria, which is also a medical diagnosis.

Gender-affirming care is a process that some trans people go through, where different treatments reduce gender dysphoria and help the body align more closely with one’s identity. This can include hormone therapy, surgery, hair removal, or voice training. Binders, wigs, and prosthetics can also be part of gender-affirming care.

What gender-affirming treatments someone needs varies from person to person. All care and treatment should be voluntary — you should not feel pressured to accept treatment, just because it’s available. There are also many trans people who don’t want any gender-affirming medical care at all. For them, changing their name or pronouns, for example, might be enough.

Sex change – an outdated term

An older term for gender-affirming care is “changing sex” or “having a sex change.” Many trans people today consider this misleading, as it implies moving from one gender to another. Even though some might feel their gender identity has changed, many trans people feel they have always been a different gender than they were assigned at birth, but lacked the words or ability to express it. The goal of the care is also not to change a person’s gender identity, but to help their body align with it.

It’s always up to each individual which words they prefer to use about themselves. Some trans people feel okay with terms like sex change. However, we recommend using gender-affirming care as a default term.

Referral — how to access gender-affirming care in Sweden

To access gender-affirming care in Sweden, the first step is a referral to a gender dysphoria assessment team. There are such teams in six locations: Alingsås (Lundströmsmottagningen), Linköping, Malmö/Lund, Umeå, Uppsala, and Stockholm (Anova).

You can usually get a referral via mental health services, using a standard referral form. Sometimes you first need to contact your primary care provider to get a referral to the mental health services, who then refer you to a gender-dysphoria assessment team. Youth clinics and child & adolescent mental health services (BUP) can also help with referrals for those under 18.

The person writing the referral should not make their own diagnosis — that’s done by the specialist teams. Being a minor, having had private or overseas care, living with a disability or having other diagnoses should not be a barrier to getting a referral. 

If you’re not a registered resident or don’t have a residence permit in Sweden, it can be difficult to access gender-affirming care, because it is not considered emergency care. Exceptions may apply if you’re under 18 or already on hormone replacement therapy.

Waiting times vary but can sometimes be up to four years for a first meeting with the assessment team.

Sometimes you can contact gender-affirming care directly

There are certain situations where you can go straight to a gender-affirming care team in Sweden. For example:

• If you have an ongoing treatment from abroad that needs to be taken over by a Swedish provider.
• If you experience problems after having had private care or care abroad
• If you experience that the gender-affirming care you previously received no longer feels right for you

Assessment and diagnosis

To receive gender-affirming care in Sweden you must undergo an assessment by one of the teams specialising in gender identity and gender dysphoria. The assessment team usually consists of a doctor, counsellor and psychologist.

The assessment includes, among other things, conversations about your gender identity. You will also take standardised tests and fill in rating scales and questionnaires, for example about your general mental health. How long the assessment takes varies depending on the individual and the team’s resources. It is common to have contact with the team for at least a year before receiving a diagnosis.

The aim of the assessment is to:

• Help you explore your gender identity
• Determine whether you experience gender dysphoria, as in distress caused by your assigned gender not matching your identity
• Investigate whether there are other factors, other than gender dysphoria, which might be causing you to feel this way
• Review your care needs and inform you about treatment options

If the team concludes you have gender dysphoria, you receive a gender dysphoria diagnosis. This does not mean you are ill, it means you need care.

After receiving your diagnosis, you continue to meet with the team for a while, and you might start some treatments in the meantime. Some people come out as trans to those around them when starting treatment; others wait until they have completed some or all of the treatments they want. Many have already been open about being trans before seeking gender-affirming care.

Common treatments

Depending on your health and needs, you may have access to different treatments and surgeries. No treatments are compulsory, you decide together with the team what is right for you. 

If you are under 18, there are restrictions — for example, hormone replacement therapy or surgical treatment for minors is rare and only given in exceptional circumstances. To remove the gonads, you must normally be at least 23, but exceptions are made from 18.

Hormone replacement therapy (HRT)

Hormone replacement therapy is usually either testosterone or oestrogen. The effects are similar to puberty. Some changes are permanent, others reversible if treatment stops. To maintain the full effects, HRT is usually a lifelong treatment.

How people respond to the treatment varies widely — it depends on genetics, health, age and more. You cannot predict exact effects, and it takes time to reach the desired results.

Testosterone 

Testosterone is usually given as an injection every 10–12 weeks or as a daily gel. Common effects include a deeper voice, facial hair, more muscle mass, increased body hair, and cessation of menstruation (making pregnancy more difficult but not impossible). Testosterone can make mucous membranes more fragile, so you may need lubricant or prescribed creams.

Oestrogen 

Oestrogen is usually given as tablets, gel or patches. If you have testicles, you also take tablets to lower testosterone. Common effects include more body fat, less muscle, softer skin, breast growth, and less hair loss on the head. Erectile function may decrease — talk to your hormone doctor if you want to preserve it.

Puberty blockers

For those under 18 who have not completed puberty, puberty blockers can temporarily stop unwanted puberty. When stopped, the body’s own puberty resumes, or you can begin desired hormone treatment. These are now offered only in exceptional circumstances or research contexts.

Self-medicating with hormones, or DIY HRT

In Sweden, hormone replacement therapy is provided through the public healthcare system, and a diagnosis of gender dysphoria is required in order to access these hormones. Those who receive HRT have regular check-ups, and the dosage is determined individually.

Some people self-medicate with hormones. Since hormones can affect the body in various ways (for example, changing blood values and liver function), there are risks to taking hormones without medical supervision. If you take hormones without consulting healthcare professionals, you should therefore be aware of the risks and potential side effects, and try to monitor your blood values.

Surgeries

Mastectomy or breast agumentation

Testosterone does not make breasts disappear. Instead, the breast tissue is removed surgically. This operation is called a mastectomy. Often, several procedures are required, depending on the method and what your body looks like. 

People who are treated with oestrogen usually develop breasts, but it is also possible to have breast augmentation with implants. The healthcare system usually waits at least a year after starting hormone treatment to see how much breast growth occurs from the hormones before considering implants, if needed.

There are different techniques for chest surgery. The method is decided by the surgeon in consultation with you. Factors that come into play include what your body looks like as well as your desired outcome. For mastectomy, some people prefer to have several smaller surgeries to minimise visible scarring, while others prefer a larger operation to achieve a flat chest as quickly as possible. For breast augmentation, the surgeon must follow guidelines on implant size. Most implants will need to be replaced later in life.

It is also possible to undergo either mastectomy or breast agumentation without a diagnosis. In that case, the operation is performed at a private clinic, and you will need to pay for it yourself.

Bottom surgery

There are different types of bottom surgeries available for trans people in Sweden. From a penis and scrotum, a vagina, clitoris and labia can be created. This is usually done in stages through multiple operations. After surgery, you need to use dilators regularly if you want the vagina to retain its shape and size. When you have sex after surgery, you may need to use lubricant.

The clitoris usually enlarges from testosterone treatment, and from this tissue a small penis can be constructed. Another option is to create a larger penis using tissue and skin from another part of the body, such as the groin, forearm or thigh. There are several different methods, and a scrotum can also be created. Which type of surgery is most suitable, and whether to retain the vagina, uterus and ovaries, is decided in consultation with a doctor. Some people choose a penile prosthesis instead of a constructed penis. 

For people who keep their vagina but have changed their legal gender to male, reminders for cervical screenings will no longer be sent automatically. You must therefore book regular check-ups yourself. The recommendation is to have a smear test every three years.

Oestrogen treatment is thought to slightly reduce the risk of prostate cancer, but to what extent is unclear. There are no automatic reminders for testing, so both healthcare providers and patients can raise the issue. Relevant factors include family history, age and symptoms. If you were born with a prostate but have changed your legal gender to female, it is recommended that you inform healthcare staff, if necessary, that you still have a prostate.

Having biological children as a trans person

Some treatments within gender-affirming care can mean you are no longer able to get pregnant or produce sperm. That’s why you can be offered various forms of fertility preservation treatment when undergoing gender-affirming treatments, to make it easier to have biological children if or when you choose to. Please note that eggs and sperm that are frozen can only be used in ways permitted by the laws and regulations on assisted reproduction in force at the time you wish to use them.

People with testicles can get help to freeze and store sperm, to keep the possibility of becoming a biological parent in the future. This is easiest to do before starting hormone treatment, or during a break in hormone treatment. The sperm can later be used for insemination or IVF. Surrogacy abroad may also be an option.

People with ovaries can get help to freeze and store eggs or embryos (fertilised eggs), which can later be used either to become pregnant themselves, or to help a partner or co-parent get pregnant. Surrogacy abroad may also be an option. To collect eggs, you need to take a break from, or delay starting, any testosterone treatment and instead take oestrogen to stimulate the ovaries to mature many eggs at once. It is also possible to freeze ovarian tissue.

A person born with ovaries who wants to become pregnant needs to pause any testosterone treatment before and during the pregnancy. It varies from person to person how soon periods resume. There isn’t enough evidence yet to say for certain whether testosterone treatment affects the ability to become pregnant, but many people are able to conceive after pausing hormone treatment.

Changing your name and legal gender

Changing your name and legal gender is not done through gender-affirming healthcare in Sweden, but because many trans people want to do this as part of their gender affirmation, we’ve included information about it here.

How to change your name in Sweden

If you’re over 18, you can choose at any time to change, add, or remove your given names. The same applies if you’re under 18, as long as all legal guardians consent to the name change.

You can find the name change application form on the Swedish Tax Agency’s website. You’ll also need to get a new form of ID after changing your name. There are no restrictions on choosing or combining traditionally female, male, or gender-neutral names, regardless of your gender identity or legal gender.

How to change your legal gender

From 1 July 2025, anyone aged 16 and over who feels that their legal gender is incorrect can apply to have it changed in Sweden. For people under 18, a legal guardian’s consent is required.

To apply, you’ll need a certificate from a healthcare professional. Four licensed professional groups within the Swedish healthcare system can issue such a certificate:

• Doctors
• Psychologists
• Psychotherapists
• Counsellors

Learn more about the new Swedish Legal Gender Recognition Act.