Norwegian Investigation Board Recommends Caution

In March 2023, Ukom, Norway’s healthcare investigation board, published a report on the patient safety of children and adolescents with gender incongruence. After Finland and Sweden, Norway became the third Scandinavian country where an official body questioned the treatment of minors.

The conclusions

According to Ukom, the evidence base for treating minors is insufficient. The board found that Norway’s 2020 guideline was not based on a systematic assessment of the evidence and that the number of referrals—particularly of teenage girls—had risen sharply.

The recommendations

Ukom recommended revising the national guideline on the basis of a systematic literature review. Puberty blockers and hormones for minors should be considered experimental treatments, with the additional safeguards that this entails.

The status of the report

Ukom is an independent investigation board and does not set policy itself. The report is an advisory document for the Norwegian health authorities.

What Ukom is

Ukom is Norway’s healthcare investigation board, established in 2019. The board investigates serious incidents and risks to patient safety, comparable to an aviation accident investigation board. It does not assign blame, but makes recommendations to improve the safety of healthcare. Ukom began its investigation after receiving reports from parents, patients, and healthcare professionals concerned about care for young people with gender incongruence.

The background

Specialist care for these young people in Norway is provided by a single national service at Oslo University Hospital. The number of referrals to that service rose from a few dozen per year around 2010 to hundreds per year around 2020, with a clear majority of teenage girls. In addition to the national service, providers had emerged that prescribed hormones outside specialist care. Ukom pointed out that the 2020 guideline allowed for varying interpretations, making it unclear who was responsible for what.

What happened to the report

In foreign media, the report was sometimes portrayed as a Norwegian ban on puberty blockers. That is incorrect. The Norwegian health authority said it would study the recommendations, but the guideline was not immediately withdrawn and the national service in Oslo continued to treat young people. The report did, however, permanently change the debate in Norway: the question is no longer whether the evidence base is sufficient, but what should happen now that an official body has established that it is not.

Denmark

During the same period, Denmark also adopted a more cautious approach, although it was not preceded by a separate report. In 2023, the clinic in Copenhagen reported that only a small proportion of referred young people were receiving hormonal treatment, compared with more than half a few years earlier. More information is available on the page about gender care in Denmark.

Significance

The Norwegian report differs from the steps taken in Finland and Sweden because it does not establish policy but is a safety investigation. Ukom focused not primarily on whether the treatment works, but on whether patients are adequately protected as long as this has not been established. That perspective is also useful for other countries. According to the board, experimental treatments require stricter standards for information, consent, and outcome recording than ordinary care. Offering the treatment as ordinary care when the evidence base is lacking deprives patients of that additional protection.

A comparison from 2026 shows that the Nordic countries differ substantially from one another; see the differences in transgender care between the Nordic countries. With the Norwegian report, three Scandinavian countries had called their approach into question within three years; see also Finland in 2020 and Sweden in 2022. More information is available on the page about gender care in Norway.