Gender-affirming health care needs, barriers to care, and health and wellbeing in a broad nationwide sample of transgender people in Norway

Abstract

Background: Transgender people report increased prevalence of mental distress and suicide attempts compared to the general population. Gender-based minority stressors such as discrimination and victimization are positively associated with mental health problems while social and medical gender transition is inversely associated with mental health problems. Barriers to accessing gender-affirming health care is reported by transgender people in many countries, including Norway which has a state-funded public health care system. The aim of the current study was to examine gender-affirming health care needs, barriers to care and health and wellbeing in a broad nationwide sample of transgender people in Norway.

Methods: A nationwide sample with 579 transgender participants completed an anonymous online survey during June-September 2023. Chi-square tests and ANOVA were used to examine differences between gender identity groups.

Results: Having obtained gender-affirming health care was more common among trans men and trans women as compared to nonbinary people. Participants generally reported being satisfied with the outcomes of gender-affirming hormonal and surgical treatments. Having obtained treatment entirely through private funding was reported by 32.5% of those using hormones and 49.5% of those who had obtained surgery. Not being able to afford hormones or surgery was reported by 45.9% and 65.5% among those with unmet treatment needs. Compared to trans men and trans women with unmet needs, nonbinary people with unmet needs were less likely to be under assessment or on a waiting list to obtain treatments. Of the total sample, 36.7% reported suicide attempts, 74.8% reported mental distress above clinical cut-off and 12.5% reported being satisfied with life.

Conclusions: Transgender people in Norway reported high levels of mental distress and suicidality. Despite being young and with low income, a large proportion had obtained gender-affirming medical treatments entirely through private funding. Transgender people in need of gender-affirming health care could benefit from increased access to care through the state-funded public health care system in Norway.

Keywords: Barriers; Gender incongruence; Gender-affirming; Health; Health care; Nonbinary; Transgender.