Several members of the Republican party, such as Missouri’s Attorney General Andrew Bailey, have referenced these countries to justify the implementation of new laws in 21 states controlled by the GOP, which restrict or ban medical care for minors.

A review by POLITICO discovered that the state of healthcare for transgender individuals in Europe is more complex than what Republican critics like Hunt and Bailey suggest. While there are debates about the recipients and timing of care, only Russia has completely outlawed it. Some European countries are reevaluating their standards for gender-affirming care, with the goal of making eligibility stricter, but also increasing research on minors.

The approach of Europeans, whether they choose to maintain it, expand access, or impose more limitations, will have an impact on the nature of the discussion in the United States.

Kellan Baker, executive director of the Whitman-Walker Institute, a research center focused on LGBTQ health policy, expressed concern about the deliberate misinterpretation of events in Europe by some in the U.S. This misinterpretation is motivated by ideological and political factors.

Here is a summary of transgender healthcare in four frequently mentioned European countries by Republican opponents of gender-affirming treatment.

United Kingdom

The United Kingdom is currently at the center of a contentious discussion surrounding transgender healthcare, particularly in comparison to other western European countries.

In July of last year, the National Health Service of the country made the decision to close down the Gender Identity Development Service at the Tavistock clinic in London. This was the sole provider of gender-affirming care for minors in England and Wales. The reason given by the NHS was an internal review that revealed concerns over the fast pace at which children were being referred, resulting in an overwhelming increase in patients.

However, the British government has not prohibited gender-affirming care for minors and is intending to establish new clinics that have rigorous eligibility requirements.

The refusal of treatment for children by Republicans can also be seen as a discussion about poor management and medical guidelines.

The NHS stated that the Tavistock clinic will be shutting down, but also mentioned plans to enhance and extend services for children and young individuals struggling with gender identity and gender dysphoria all over the nation. These new services aim to cater to the comprehensive needs of patients, as stated by the health service.

In September 2021, the Court of Appeal, a level below the Supreme Court, made a decision in a legal dispute regarding the treatment of minors. They ruled that doctors, rather than judges, should have the authority to determine if minors can give consent for gender-affirming care.

Currently, the NHS has postponed the shutdown of the clinic until March 2024 and is still providing care for current patients, but not accepting new ones.

The NHS has intentions to establish two additional clinics in different regions within the next six months.

As stated by the National Health Service (NHS), the clinics will adhere to rigorous protocols. A team of specialists in pediatric medicine, autism, neurodisability, and mental health will assess each case.

The English division of NHS is currently reviewing a proposed policy that would restrict the availability of puberty-suppressing hormones to minors, except for those participating in research studies or in extraordinary circumstances.

France

Republican critics of gender-affirming care often cite France as justification for limiting or outlawing such care for minors.

The French National Academy of Medicine’s guidelines have been emphasized as proof that even a country typically regarded as one of the most progressive in Europe is worried about the increase in transgender healthcare.

The academy cautioned about the genuine danger of overdiagnosis and emphasized the importance of careful evaluation of patients.

French physicians providing services for transgender individuals stated that the guidelines are not hindering accessibility. Minors can receive hormone therapy with consent from their parents at any age, and breast removal surgery can be performed at age 14. However, hormone therapy is typically prescribed at around 15 or 16 years old, and breast surgery is typically done after the age of 16. This information was shared by Dr. Laetitia Martinerie, who works in the pediatric endocrinology and diabetology department at Robert-Debré University Hospital in Paris.

Ten years ago, Martinerie’s department became the pioneering facility in France to offer medical services for transgender youth. It is currently the largest center of its kind in the nation.

The academy advised that physicians obtain parental consent and exercise caution when prescribing these remedies, as they may cause adverse effects such as bone weakening and sterility.

The recommendations also stress the importance of having a group of doctors from relevant fields involved, providing psychological support for the patient, and fully informing them of the consequences of irreversible surgeries.

According to Martinerie, our services have not been altered as we have always offered comprehensive care from various fields of study.

Sweden

Sweden was the pioneer in permitting individuals to legally change their gender in 1972, but has recently modified its qualifications for gender-affirming treatment for minors. However, it has not prohibited it.

In 2019, the discussion in Sweden intensified after SVT, the national broadcasting company, aired a series addressing concerns about transgender healthcare for children. One aspect of the program highlighted criticism towards the Karolinska University Hospital in Stockholm for potentially rushing children into treatment and not properly evaluating their mental well-being.

In response to growing public pressure, the hospital made the decision in May 2021 to discontinue prescribing hormones to minors. They stated that such treatments should only be used in clinical trials.

The Karolinska hospital stated that there is insufficient evidence regarding the lasting effects of treatments, and there has been a recent increase in patients, specifically teenagers who were assigned female at birth.

A year and a half after the Karolinska decision, the National Board of Health and Welfare, a Swedish government agency, updated its guidelines on gender-affirming care for minors. It stated that puberty blockers, hormones, and mastectomies should only be used in “exceptional cases,” as the risks are likely to outweigh the benefits. In addition, the board said, mental health care should be offered to patients when doctors are assessing them.

The board advised doctors to search for a prolonged and consistent experience of gender dysphoria since childhood, as well as distress triggered by the beginning of puberty.

In reality, Karolinska and other clinics in Sweden still have the freedom to determine which cases meet the criteria, according to Edward Summanen, the project manager at Transammans, the largest transgender organization in Sweden.

Summanem stated that, based on our observations, numerous young individuals who identify as transgender are able to obtain gender-affirming treatment, although they may face lengthy waiting periods.

Norway

In the previous year, Norway gained attention when one of its independent organizations suggested classifying gender-affirming treatment for minors as “experimental.” However, even after a year and a half, these suggestions have not been put into action.

According to trans organizations, the guidelines presented by the Norwegian Healthcare Investigation Board would have greatly hindered young trans individuals from accessing treatment.

Up to this point, the Norwegian Directorate of Health, the governing body responsible for establishing official guidelines, has not implemented the board’s suggestion.

The directorate has chosen to keep the current regulations in place, which permit children to be prescribed puberty blockers after they have already started puberty and to begin hormone therapy at the age of 16. Although most surgical procedures are not permitted for minors, there are exceptions for chest surgery in specific circumstances.

According to Torunn Janbu, the director of specialized health care services at the Norwegian Directorate of Health, there are currently no revisions being made to the guidelines.