Gender-affirming surgery is not banned for minors in Europe, but is mostly inaccessible

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." 

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."

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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.

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.