Nordic countries differ sharply in transgender care — and report a higher regret rate than is often stated

In the Dutch debate on transgender care, the Nordic countries are often mentioned together as an example of a sensible, scientifically grounded approach. A new review study in the Scandinavian Journal of Surgery, written by a group of surgeons and doctors from Sweden, Finland, Norway, Iceland and Denmark themselves, paints a different picture: the five countries actually differ considerably, both in who is given access to medical transition and in how they deal with uncertainty about the consequences. What the same review says about surgery can be found in the article on surgery in the five Nordic countries.

Five countries, five different answers

All five countries provide publicly funded transgender care, but the way that care is organized varies considerably — from centrally managed gender clinics to a more decentralized range of services. The countries are not moving in lockstep legally either: recognition of a different gender identity based on self-declaration has now been introduced in Denmark, Finland, Iceland and Norway. Sweden relaxed its law as of July 1, 2025: changing one’s legal gender is possible from the age of sixteen, but a statement from a doctor, psychologist or other designated healthcare professional is still required, and the National Board of Health and Welfare decides on the application. Sweden therefore does not have full self-identification. That may sound like a common approach, but the authors also describe how clinical practice — who qualifies for puberty blockers, hormones or surgery — is organized differently in each country and has become considerably more cautious than it was a decade ago.

More cautious approach to late-onset gender dysphoria

What stands out is how Finland and Sweden deal with young people whose gender dysphoria develops only after puberty: in both countries, this group generally does not qualify for medical transition during adolescence. This is a direct consequence of the systematic reviews that Sweden and Finland previously commissioned on the strength of the evidence for puberty blockers and hormones in minors, which found that the evidence was weak. How this policy shift unfolded, and how the United Kingdom followed, is described on transtijd.nl. Denmark, Norway and Iceland use more cautious wording, but the overall tone of the study there too is one of restraint rather than automatic referral. There is no ban anywhere — the care is still available — but the broad assumption that ‘the Nordic countries’ follow one uniform, generous approach does not hold up under closer reading of this review.

The 2.2 percent regret rate reported in their own research

Perhaps the most striking passage in the review is a reference to earlier research by co-author Cecilia Dhejne, who is affiliated with the Karolinska Institute. In her long-term Swedish study of people who underwent gender-affirming surgery between 1960 and 2010, 2.2 percent later filed a legal application to reverse that transition. The authors themselves cite this figure, in an article explicitly not written to discredit transgender care. It therefore stands in stark contrast to the figure of ‘well below 1 percent’ that is commonly cited in Dutch information and reporting about regret and detransition — and that figure moreover concerns only people who take the formal legal step, not everyone who experiences regret without ever officially recording it.

For Dutch readers, the conclusion is twofold. First, there is no ‘Nordic model’: the five countries chose five different, partly contradictory answers to the same uncertainties that Dutch transgender care also struggles with. Second, even researchers working at the heart of this field acknowledge, in their own professional journal, a regret rate considerably higher than the figure generally used in the Netherlands to downplay the issue. An overview of the studies can be found under detransition figures. How the 2020 Finnish guideline informs one person’s decision-making can be read in COHERE Finland and Me on mijngender.nl.