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Tens of thousand passed Rijksmuseum, rear, during the Pride Walk in Amsterdam, Netherlands, Saturday, July 30, 2022, calling for equal rights for members of the LGBTI community in countries where homosexuality is included in the penal code. (AP)
Gender-affirming surgery is not banned for minors in Europe, but is mostly inaccessible
If your time is short.
Europe doesn’t ban gender-affirming care in the way some American states have by enacting laws to restrict access. Rather, care in these European countries is often dictated by health policy and guidelines.
Finland and the United Kingdom’s health policies limit gender-affirming surgeries to people older than 18. Sweden and the Netherlands allow chest surgery at age 16 and genital surgeries at 18. Norway generally does not offer surgical care to minors, but has not banned it.
Experts say that most transgender adolescents aren’t considering surgical care before they turn 18, and that such care is rare even in places where the procedures are legal.
Twenty-two U.S. states have banned gender-affirming care for people younger than 18. An Instagram user said our friends across the pond are doing the same:
"Norway, Finland, Sweden, Holland, and the U.K. have now banned gender transition surgery for minors," read the Aug. 23 post .
But this post and its use of the term "ban" doesn’t accurately portray trans health care in Europe.
In two of the five countries listed, health policy reserves all gender-affirming surgeries for people 18 and older. The remaining three countries have mixed guidelines depending on circumstance and type of surgery. But none of these transgender surgical care limitations in Europe result from legal bans like those instituted in some U.S. states. Rather, they stem from agreed-upon medical guidelines, and in Sweden’s case, sterilization laws.
"The guidelines or recommendations in these policies are simply that — they are non-binding." said Deekshitha Ganesan, a policy officer at trans rights group Transgender Europe. "There are no sanctions for not following these policies to the best of our knowledge."
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PolitiFact found one exception to this in Sweden, where a 1975 sterilization law requires administrative approval for certain genital procedures. The law , which ended a decadeslong eugenics and forced sterilization program, doesn’t explicitly ban transgender care.
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Several European countries are reevaluating their approaches to gender-affirming care for minors, but these changes primarily affect access to puberty blockers and hormone therapy, not surgeries, because minors rarely get surgeries as part of gender-affirming care.
Surgery is often the last step taken in a person’s gender transition and comes after lengthy evaluation and consultation.
"Often many young people are not even thinking about surgeries," Ganesan said.
We looked closer at each country's policies to explain how they differ. Many health systems have never recommended that people younger than 18 be eligible for genital surgery, and those policies have not recently changed.
"Norway does not prohibit gender-affirming treatment for children," said Torunn Janbu, the department director at the Norwegian Directorate of Health, which develops health guidelines for the country.
Although there is no law prohibiting gender-affirming surgeries, the Norwegian Directorate of Health’s most recent national guideline states that surgical "gender confirmation" is generally not recommended before age 18. The guidelines make an exception for breast surgery "in special cases," based on a comprehensive interdisciplinary assessment and parental consent. A March report by the Norwegian Healthcare Investigation Board, an independent government agency, recommended greater regulations on care and a reevaluation of national guidelines.
"Our recommendations do not involve rendering health care services for children and young people illegal, nor do we have specific recommendations concerning surgery," said Anette Bakkevig Frøyland, a senior adviser at the board.
Meanwhile, Janbu said, the Norwegian Healthcare Investigation Board "has no authority to change guidelines or regulations." So Norway generally does not offer gender-affirming surgical care to minors, but the treatment is not "banned."
Swedish health guidelines advise reserving chest surgeries for exceptional cases. And law states that genital surgeries that lead to sterilization are limited to people 18 and older and require government approval.
In 2022, updated national guidelines from the National Board of Health and Welfare, issued caution about hormonal and surgical treatments among adolescents and said care, including mastectomies, should be administered only in "exceptional cases."
"The guidelines are recommendations, and it's up to the physicians to interpret them and make a judgement in each specific case," said Jêran Rostam, an expert in trangender issues at the The Swedish Federation for Lesbian, Gay, Bisexual, Transgender, Queer and Intersex Rights, also known as RFSL.
According to the federation , patients have long been required to be 18 years or older to be eligible for certain genital surgeries. The Legal Council at the Swedish Board of Health and Welfare must approve these surgeries; people younger than 23 need "special circumstances" to get their applications approved.
These limitations exist because, under Swedish law , it’s "illegal" to do surgeries that lead to sterilization without going through the proper bureaucratic channels, Rostam said. These restrictions result partly from a 1975 law enacted after decades of compulsory sterilizations and a large eugenics program. This law limits transgender care today, but doesn’t explicitly ban gender-affirming care.
Additionally, transgender Swedes can apply for a legal change in gender only after they have turned 18.
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The Netherlands, referred to as Holland in the Instagram post, has been a gender-affirming care pioneer since it began treating adults in 1972. When the country’s clinic started treating adolescents in 1997 , it sparked the development of the " Dutch protocol ," which became the global standard for transgender pediatric care.
Mastectomies can be done on patients older than 16, but all other surgeries are reserved for those over 18, according to a statement provided by a spokesperson for Amsterdam University Medical Center , site of the Center of Expertise on Gender Dysphoria. These policies are outlined in the Ministry of Health, Welfare and Sport’s national guidelines .
Finland was one of the first countries to adopt the Dutch method of treating transgender patients, Forbes magazine reported. But in 2020, the Council for Choices in Health Care , which issues recommendations to the government’s Ministry of Social Affairs and Health, released guidelines prioritizing psychotherapy and stating that puberty suppression should be administered on a "case-by-case basis after careful consideration."
Ganesan said that these are recommendations, not mandates. In the same guidelines, the Council for Choices in Health Care states that "surgical treatments are not part of the treatment methods for dysphoria caused by gender-related conflicts in minors."
A 2017 survey by the European Union Agency for Fundamental Rights shows that the 18-year-old age requirement for gender-affirming surgical procedures is not new, but it is unclear whether official law or policy codifies this age limit. The Finnish Ministry of Social Affairs and Health did not answer our questions by publication time.
In 2023, Finland removed its previous requirement to be sterilized to legally change gender, but this applies only to adults.
The United Kingdom’s National Health Service website says that people 18 and older can get masculinizing or feminizing genital surgery and chest surgery if they meet certain criteria , which includes "persistent, well-documented gender dysphoria," letters of referral from doctors, and for genital surgeries, at least 12 months of hormone therapy. These policies are outlined and appear to be enforced by the National Health Service. The U.K.’s Department of Health and Social Care, which supports ministers in developing new health policy, did not respond to our questions about current or future legislation by press time.
Generally, in the U.K., people ages 16 and older are " entitled to consent to their own treatment," and can be referred to adult gender clinics at age 17.
However, because of major gender clinics shutting down and long wait times , access to care in the U.K. remains limited.
An Instagram post said, "Norway, Finland, Sweden, Holland, and the UK have now banned gender transition surgery for minors."
Gender-affirming surgical care in these countries is mostly regulated through guidelines and recommendations, not laws banning care. None of these countries have banned gender-affirming care for minors outright in the way that some U.S. states have. Some countries’ health systems, such as Finland’s and the U.K.’s, appear to limit all surgeries to ages 18-plus. Sweden and the Netherlands have differing guidance for chest and genital surgery, and Norway generally advises against surgeries before age 18.
But experts note that these surgeries are rare among minors even in places where they are legal. The statement contains an element of truth but ignores critical facts that would give a different impression. We rate this claim Mostly False.
Editor’s Note: Google Translate was used throughout the research of this story to translate websites and documents into English. We corroborated our understanding of translated documents with expert sources.
Read About Our Process
The Principles of the Truth-O-Meter
Our Sources
Email interview with Ana Muñoz Padrós, communications and media officer at ILGA-Europe Aug. 30, 2023
Email interview with Torunn Janbu, department director at the Norwegian Directorate of Health, Sept. 5, 2023
Email interview with Deekshitha Ganesan, policy officer at TGEU (Transgender Europe), Aug. 31, 2023
Email interview with Anette Bakkevig Frøyland, senior adviser at the Norwegian Healthcare Investigation Board, Sept. 1, 2023
Email interview with Jêran Rostam, experts on transgender issues at the The Swedish Federation for Lesbian, Gay, Bisexual, Transgender, Queer and Intersex Rights or RFSL, Aug. 31, 2023
Email interview with Cullen Peele, press secretary at the Human Rights Campaign, Aug. 31, 2023
Email interview with a spokesperson from Amsterdam UMC, Aug. 30, 2023
U.S. News and World Report, " What Is Gender-Affirming Care, and Which States Have Restricted it in 2023? " Aug. 31, 2023
Instagram Post , Aug. 23, 2023
Sveriges Riksdag, " Sterilization Act (1975:580) " (translated from Swedish), June 12, 1975 (translated from Swedish)
Indiana International & Comparative Law Review, " Shared History of Shame: Sweden's Four-Decade Policy of Forced Sterilization and the Eugenics Movement in the United States, " 1998
Associated Press, " Norway didn’t ban gender-affirming care for minors, as headline falsely claims ," June 9, 2023
Norwegian Healthcare Investigation Board, " Patient safety for children and young people with gender incongruence " (translated from Norwegian), March 9, 2023
Norwegian Directorate of Health, " Gender Incongruence -- Investigation, treatment and follow-up " (translated from Norwegian), June 9 , 2021
The Swedish National Board of Health and Welfare, " Care of children and adolescents with gender dysphoria ,"2022
The Swedish Federation for Lesbian, Gay, Bisexual, Transgender, Queer and Intersex Rights, " Questions and answers about care for youth with gender dysphoria ," July 4, 2023
The Swedish Federation for Lesbian, Gay, Bisexual, Transgender, Queer and Intersex Rights, " Why Do We Need a New Gender Recognition Act? ," Jan. 27, 2022
The Journal of Sexual Medicine, " Children and adolescents in the Amsterdam Cohort of Gender Dysphoria: trends in diagnostic- and treatment trajectories during the first 20 years of the Dutch Protocol ," Jan. 26, 2023
Hormone Research in Paediatrics, " The Evolution of Adolescent Gender-Affirming Care: An Historical Perspective ," Nov. 29, 2022
The Atlantic, " A Teen Gender-Care Debate Is Spreading Across Europe ," April 28, 2023
Transvisie, " Home Page " translated from Dutch, accessed Sept. 4, 2023
Transvisie, " Hormones and puberty inhibitors " translated from Dutch, accessed Sept. 4, 2023
Transvisie, " Operations for transgender men " translated from Dutch, accessed Sept. 4, 2023
Transvisie, " Transition " translated from Dutch, accessed Sept. 4, 2023
Amsterdam UMC, " About ," accessed Aug 30, 2023
Netherlands Ministry of Health, Welfare and Sport, " Quality Standard Transgender Care " translated from Dutch, 2018
Forbes, " Increasing Number Of European Nations Adopt A More Cautious Approach To Gender-Affirming Care Among Minors ," June 6, 2023
Council for Choices in Health Care in Finland, " COHERE Finland ," accessed Aug. 29, 2023
Council for Choices in Health Care in Finland, " Medical Treatment Methods for Dysphoria Associated with Variations in Gender Identity in Minors – Recommendation ," June 6, 2020
Council for Choices in Health Care in Finland, " Medical treatments for gender dysphoria that reduces functional capacity in transgender people – recommendation ," June 6, 2020
European Union Agency for Fundamental Rights, " Access to sex reassignment surgery ," Oct.19, 2018
Reuters, " Finland to allow gender reassignment without sterilisation ," March 3, 2023
National Health Service, " Gender dysphoria ," May 28, 2020
National Health Service, " Gender dysphoria - Treatment ," May 28, 2020
National Health Service, " NHS Standard Contract For Gender Identity Development Service For Children and Adolescents ," April 1, 2016
National Health Service, " Consent to treatment - Children and young people ," Dec. 8, 2022
National Health Service, " Vaginoplasty Feminising Surgery ," July 27, 2021
National Health Service, " Phalloplasty Masculinising Surgery ," Oct. 20, 2021
BBC News, " NHS to close Tavistock child gender identity clinic ," July 28, 2022
BBC News, " Trans people can wait seven years for NHS initial assessment ," Aug. 2, 2023
Gender Identity Development Service, " Puberty and physical intervention ," accessed Sept. 5, 2023
Sveriges Riksdag," Act (1972:119) on determination of gender in certain cases " (translated from Swedish, 1972
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