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Transgender people given a clean bill of health in Sweden and Denmark

Sweden is following Denmark’s example and will no longer consider trans persons mentally ill.
‘This is an important change,’ says Lukas Romson, gender equality consultant and trans expert in Sweden.
Other Nordic countries will continue to classify transgender people as mentally ill.

According to Lukas Romson, the change is symbolically important and will influence the view of transgender people in both healthcare and the rest of society.

‘There are those who think we are nuts and that we can’t be taken seriously, and they often base their arguments on the psychiatric diagnoses,’ he says.

 Lukas Romson, , gender equality consultant and trans expert Photo: Carolina Hawranek

Earlier this year, the Swedish National Board of Health and Welfare published a press release stating that health care providers should no longer consider transgendered people mentally ill. Exactly how the change will be implemented remains unclear, but the decision is well in line with the ongoing international work within World Health Organization, WHO. In the draft of the next edition of the International Classification of Diseases (ICD) manual, the transgender diagnoses (transsexualism and other gender identity disorders) have been moved from the psychiatric diagnoses to a new chapter.

The updated manual, ICD-11, will be adopted by WHO next year, but Danish policymakers seem to have considered the issue more urgent than that. The Danish parliament decided unanimously already last year that the psychiatric transsexuality diagnosis should be removed. The change went into effect in January this year and Denmark thereby became the first country in the world to declare transgender people healthy.

‘The removal of the diagnosis was an important step, but it is mainly a symbolic measure,’ says trans activist Charlie Hedman.

He is involved in the Trans Political Forum, which has worked hard together with for example Amnesty International Denmark to have the diagnosis removed. Despite the fact that transgender people in Denmark are no longer classified as mentally ill, access to gender-affirming medical treatment still requires a psychiatric evaluation, something Charlie Hedman is critical of.

‘We still have to undergo IQ and personality tests, and we still have to answer strange questions, like whether we think about our parents when we masturbate and whether we enjoy setting things on fire,’ he says.

Reduced quality of transgender medical care

Danish transgender care has received sharp criticism, including from Amnesty International Denmark. The Danish Health Authority is currently developing new guidelines for healthcare providers. Charlie Hedman wants the transgender care to be based on informed consent so that the patients can have the final say about their treatment. In practice, he says, Denmark had such a system until just a few years ago. Back then, trans persons could receive care from their local doctors, but in 2014 the care was centralised to Sexologisk Klinik in Copenhagen. He claims that this led to marked deterioration of Danish transgender care: the evaluation periods have become longer, it has become harder to get treatment and many people feel they are not treated well.

‘Those with money get their surgeries done in other countries. That’s what I did. I went to Germany.’

Foreseeing concrete effects

Lukas Romson foresees concrete effects of Sweden’s initiative not to consider transgender people mentally ill.

‘It may make it easier to get a job in for example law enforcement and the military, occupations where people with a psychiatric diagnosis risk being disqualified,’ he says.

For the same reason, it may become easier to be approved for international adoptions, since many countries do not allow people with psychiatric diagnoses to adopt their children, he adds.

‘There’s a lot happening in the Nordic countries right now. And it’s happening very fast,’ he says and mentions for example Norway’s new gender identity law, which went into effect last year.

The law has made it easier for people to change their legal gender and the fact that it includes both children and adolescents makes it stand out both in the Nordic region and internationally. In the other Nordic countries, people under age 18 have no possibility to change the legal gender.

Other Nordic countries staying passive

There are no indications that Norway, Finland and Iceland are about to remove the transgender diagnoses anytime soon. In Norway, the transgender movement is hoping this will change with the publishing of ICD-11.

 Charlie Hedman, trans activist

‘We won’t push the issue until then, since we want to be sure that a change won’t lead to a degradation of the transgender care,’ says Luca Dalen Espseth, adviser at the Norwegian Organization for Sexual and Gender Diversity.

Charlie Hedman is disappointed that the development in Denmark has not led to any changes in Danish healthcare, although he is still hopeful. The abolition of the psychiatric diagnosis requires a change, he says.
‘We are not mentally ill and now that this is confirmed, we must be seen as people with agency and the right to decide over our own bodies.’

Updated 23 January 2020