Not treating trans people is irresponsible

Not providing care to young trans people can have disastrous consequences. It would be irresponsible to try to limit the access to care which, for many people, is crucial to being able to live a good life.

August 20, 2020

A protest banner for trans people’s rights says: “I don’t want to die waiting for trans care.” The banner is indicative of the biggest problem trans people in need of gender affirming care are currently facing. Further limiting care would have a catastrophic impact on trans people’s health and well-being.

And yet, Trine Vikinge believes that care should be limited (SvD Debatt 15/8). It’s starting to sound like a broken record, but unfortunately, it needs to be said one more time: Trans people with gender dysphoria need care to feel good. Unfortunately, it’s not easy to gain access to care today. The queues are long, and it usually takes at least three years for an adult from accessing care to getting a new legal gender and approval for genital surgery (for those who request it). For people under the age of 18, it usually takes significantly longer. To say otherwise is being dishonest.

The article contains a number of errors and misleading information. Vikinge writes that the medications used in hormone treatment in gender dysphoria aren’t approved for that particular use. She makes it sound like such treatment is experimental. It is true that the manufacturers who sell the medication haven’t applied for using it in this way. It might be because the patient group isn’t big enough for it to be lucrative. Doctors can still prescribe medication if it has been used for a long time and with good results. Trans people have been able to get hormone treatment in Sweden for over 40 years and with good results. It’s not a new or experiential treatment.

Vikinge claims that the side-effects of hormone treatment are unknown. This too isn’t entirely true, she herself lists a number of them in her text. There are countless research articles on the subject and new research is being published all the time. The National Board of Health and Welfare also lists potential side-effects in its information material for healthcare. It comes across clearly that all patients must be given information about what effects and possible side-effects hormone treatment can have, and that the patient and their parents (if the patient is under 18 years old) have understood them before treatment is initiated.

Vikinge also writes that SBU’s literary compilation about treatment of gender dysphoria in children and adolescents shows that the scientific basis for care is weak, but conveniently forgets to mention that the report only compiles research about children under the age of 18. SBU also haven’t fact-checked the studies in the report. SBU claims that research about children and adolescents with gender dysphoria is ongoing, in Sweden as well as the rest of the world. Contrary to what Vikinge says there’s a scientific consensus that gender-affirming care helps ease gender dysphoria and that an overwhelming majority of trans people feel better after gaining access to gender-affirming care than before. As recently as this summer, the Public Health Agency of Sweden wrote in a new research report that completed medical transition is a factor that protects against suicidal thoughts and attempted suicide in trans people. But more research is needed, especially regarding youth – research that has been difficult because the patient group historically has been small.

We would welcome the thorough follow-up of the gender-affirming care that Vikinge requests with open arms. But many of the units who provide care in gender dysphoria are already conducting research to improve care, and a new patient register has been put in place to enable tracking over time.

Everybody, regardless of age, has the right to care according to the Health and Medical Service Act. Vikinge doesn’t even think that trans people who are of age should have the right to gender-affirming care. Our legislation gives youth the right to make decisions in issues that concern themselves, even before the age of 18. This is obviously something Vikinge wants to change. Or is it only young trans people she believes shouldn’t be able to influence their own care?

To not provide care can have disastrous consequences. There’s still no research about not providing care in gender dysphoria; such research would be deeply unethical. We know that trans people of all ages in countries where there’s no gender-affirming care will do anything to access hormones or surgery. The reason being that you need care to feel good about yourself. We would rather see that care is administered in a safe and controlled way within healthcare.

Not providing care would mean that all those trans people who are satisfied with their care would have to live in a body they don’t feel comfortable with. Trine Vikinge and others opposed to gender-affirming care want the care to be stopped entirely or be postponed. And this is what is irresponsible – trying to limit the access to care that is essential for people’s ability to live a good life.

The opinion article was published in Svenska Dagbladet August 20, 2020

Frank Berglund, vice president of RFSL
Jêran Rostam, president of RFSL Ungdom