Have the Nordic countries really stopped providing care to trans minors?

A media narrative has been circulating for several years about a supposed “restriction,” or even “ban,” that is said to be increasingly common in Europe regarding gender-affirming care for trans minors (as for example in this recent Euronews article). The main European countries said to be leading these restrictions are the United Kingdom, the Nordic countries, and France. However, neither France nor any of the Nordic countries (Denmark, Iceland, Finland, Norway, Sweden) have, unlike England, banned trans-specific care for minors either in practice or in law.

The few texts that are invoked to suggest such a restriction of care in France are a 2022 press release by the French National Academy of Medicine calling for caution, and a 2024 bill (which was not enacted and therefore has no legal effect) aiming in particular to prohibit the prescription of hormones to trans adolescents. It should be recalled here that the applicable legal framework in France is that of ordinary law, namely freedom of prescription, limited by the “established data of science” (Article R4127-8 of the Public Health Code). Yet the most recent scientific consensus, published in 2025 by the learned societies of Germany, Austria, and Switzerland (discussed here on Trans Youth Trajectories), supports the view that gender-affirming care may be prescribed to trans adolescents who express the need for it. As for legal gender recognition in French civil status, it is only possible upon reaching adulthood and, since 2016, without any requirement of prior sterilisation (Law on the Modernisation of Justice in the 21st Century).

This French case illustrates the need for vigilance regarding the narratives circulating on this issue in the media. With regard to the Nordic countries, a recent narrative review published in the Scandinavian Journal of Surgery, written by specialised physicians from Denmark, Iceland, Finland, Norway, and Sweden, sets out to examine access to care and rights for trans people, particularly minors.

Isak Gran and colleagues, the authors of this article, first recall that in all Nordic countries, gender-affirming care is “funded by public resources, covering the entire process, from diagnosis to psychiatric, medical, and surgical treatments,” but that “service structures differ” from one country to another. The situation of minors is approached in divergent ways, oscillating between increased medical caution and a growing recognition of their legal autonomy.

First of all, the authors never speak of a ban. In Finland, for example – the most restrictive Nordic country – minors may receive medical treatment after a thorough assessment: “Puberty blockers and gender-affirming hormones may be initiated only after a comprehensive psychiatric evaluation, generally from early puberty for blockers and from the age of 16 for hormones.” The authors note that “the use of these treatments remains very limited” – but it is neither illegal nor prohibited. Moreover, although the 2023 reform allowed adults to change their legal sex marker “by self-declaration, without medical intervention or sterilisation,” this right to self-determination has not yet been extended to minors.

In Sweden, another example of a restrictive country, it is specified that “according to the latest guidelines [from December 2022], the use of puberty blockers […] as well as gender-affirming hormones is limited to individuals included in a clinical trial, or in exceptional cases.” In the latter situations, these treatments “may be offered when gender incongruence is persistent and a stable psychosocial situation is demonstrated.” This therefore constitutes a regulated limitation, not a removal of access. Yet at the same time, Sweden has, since July 2025, been moving toward a lifting of legal constraints on minors: “individuals aged 16 and over will be able to change their legal gender without a formal diagnosis of gender dysphoria or medical or psychiatric treatment,” although parental authorisation and certification from a healthcare professional remain required until the age of 18. This represents a significant advance in the recognition of minors’ right to self-determination, contrasting with the more limited recognition of their decisional autonomy in medical matters

Norway presents a similar tension. The 2016 law amending legal gender introduced the possibility, “for any person aged 16 or over, to change their legal gender through a simple administrative procedure without medical intervention.” This right is also open to minors aged 6 to 15, this time subject only to parental authorisation (and without any requirement for psychiatric certification). However, while this form of gender self-determination for minors exists at the legal level (a right not recognised in France), at the medical level the authorities have adopted a strongly precautionary approach. “Puberty blockers may be offered from Tanner stage 2, following a thorough interdisciplinary assessment. Gender-affirming hormone treatment is not initiated before the age of 16, and only in exceptional cases where there is a long-standing experience of gender incongruence and a very stable psychosocial situation.” Once again, the authors never speak of a ban; rather, they emphasise that a thorough interdisciplinary assessment remains the key condition for possible access to treatment. Overall, minors are therefore legally free to identify their gender, but medically rather restricted in their access to treatment, which, as in Sweden, creates a gap between legal texts and clinical assessment.

In Denmark, in the medical field, the authors note that “recent years have seen the introduction of more restrictive guidelines, including extended evaluation periods and stricter requirements for multidisciplinary approval.” Nevertheless, care remains available and publicly funded: “At the onset of puberty (Tanner stage 2), puberty blockers may be initiated following a thorough multidisciplinary assessment. From the age of 15, gender-affirming hormone treatment may be started to support the development of the desired gender.” On the legal level, however, and since 2014, “individuals aged 18 and over may change their legal gender without a psychiatric diagnosis,” and “with parental consent, this possibility extends from the age of 15,” again without any diagnostic requirement. This Danish paradox thus mirrors that observed in Sweden and Norway.

In contrast to these Nordic countries, Iceland demonstrates a high degree of legislative and clinical coherence. The 2019 “Gender Autonomy Act” established a model based on informed consent, in which “individuals aged 15 and over have the right to change their sex marker in official registers on the basis of their personal gender identity.” Minors under the age of 15 may also do so, “with parental consent or the approval of an expert committee.” In the medical sphere as well, the country “applies an informed consent model for access to gender-affirming care,” and “psychological assessment may be included, but only with the individual’s consent.” This system is grounded in trust in people’s self-reported identities and breaks with the pathologising models adopted by its neighbours.

This Icelandic philosophy of care is also reflected in practical organisation: “minors requesting treatment are first seen by a social worker, who can refer them to gender-affirming care.” Paediatric endocrinologists may prescribe treatment from the first pubertal stage (“Tanner stage 2”), “with the informed consent of the individual and their parents.” Psychological support remains optional: “it is available but not mandatory, and is offered only if the person expresses a wish for it or if concerns arise.”

Gran and colleagues also emphasise that the Icelandic model does not mean an absence of regulation, but rather a redistribution of roles. Psychiatrists no longer assume the role of gatekeepers, since a psychiatric diagnosis has no longer been required following the depathologisation of trans identities by the World Health Organization (effective in 2022), which “moved conditions related to gender incongruence out of the field of mental disorders in order to reduce stigma and improve access to care.” The physician becomes a pathway guide rather than a judge of legitimacy. This shift – from pathology to autonomy – is emblematic of a modern, human-rights-based medicine, as also articulated by Trans Youth Trajectories in its ethical charter.

Despite significant legal progress for trans minors, which places France behind the Nordic countries (Finland excepted), reconciling self-determination with medical caution remains a major challenge. Iceland represents, for trans adolescents, a rare synthesis of these two imperatives: a system based on informed consent, equitable access, and the depathologisation of care pathways. For Gran and his colleagues, “future priorities should aim to reduce waiting times, strengthen research, and develop inclusive care models.” Their article shows that the Nordic region does not follow a logic of prohibition, but of ongoing reassessment. Despite recent revisions, gender-affirming care for young people remains accessible, subject to conditions of individualised assessment and informed consent.

In conclusion, it can be noted that beyond the Nordic countries, within the European Union the norm is not to ban care for trans minors, but rather to move toward greater accessibility, especially in Western Europe, as shown for example by Transgender Europe’s map on access to puberty blockers (Figure 1). Legal gender recognition for minors is also in effect in a growing number of European countries (Figure 2): in addition to those already mentioned (Denmark, Sweden, Norway, Iceland), these include Belgium, Luxembourg, Switzerland, Spain, Portugal, Germany, Austria, Poland, Estonia, Slovenia, Croatia, Greece, and Malta. When will France follow?