Norwegian pediatric guidance on gender treatment is unsafe, says review

The Norwegian Medical Investigation Committee (Ukom) reported earlier this month that Norway’s national guidelines for the treatment of people with gender inequality and gender dysphoria are inadequate, protecting patients and empowering health professionals. It needs to be revised to guide properly.One language version is planned for April.

Ukom found that guidelines published by the Norwegian Health Directory in 2020 did not provide a sufficiently clear framework for patient assessment, treatment and informed consent, said Ukom Medical. Director Stine Marit Moen said. This leaves a lot of room for interpretation among clinicians and creates undue variability in care.

The Board received notifications of concerns from patients’ families, clinicians, and others, prompting investigations and reports. “We are concerned that there may be undertreatment, overtreatment, and inadequate treatment, and that the degree of variability and interdisciplinary involvement in protective measures may pose a threat to patient safety,” said Moen. Told. BMJ.

The report found insufficient evidence for the use of pubertal blockers and heterosexual hormone treatments in young people, especially teenagers who are increasingly seeking medical services and being referred to specialized care. Ukom defines such treatments as utprøvende behandling, or “treatments under trial,” Moen said.

While national principles apply to the conduct of investigational treatments, these principles do not apply to the treatment of gender inequality or dysphoria, Moen said. The Council recommended that these principles be followed and that the Norwegian authorities record the results of all treated young people in a national medical registry. “This will enhance surveillance, reduce undue variability in patient care, and deliver higher quality care,” said Moen.

Unlike other guidelines issued by the Norwegian Ministry of Health, the 2020 guidelines on treating gender inequality and dysphoria were not based on a systematic review of evidence.

“At the time, it was important to serve people with gender inequality and discomfort and to state that they had a right to medical care,” said Moen. “However, it is our job to evaluate from a medical point of view and patient safety, and the guidelines fall short in this regard.”

Ukom recommends that updated guidelines should be based on new commissioned reviews or existing international up-to-date systematic reviews, such as those conducted in 2021 by the National Institute for Health and Care Excellence, UK. increase. The Commission has issued several other reports since its inception in 2020. Its recommendations are not binding, but Moen expects the report on the treatment of gender inequality to have an impact.

“Norway, like many other Western countries, has seen a marked increase in referrals to specialized health services for teenagers, and no one knows why. The stability of gender dysphoria in young people is unknown, and evidence of the long-term effects of gender-affirmation therapy on this young population is inadequate,” said Moen. “This is not just a matter of rights, but of the requirements of our healthcare system to ensure the best and safest possible treatment for all.”

The Norwegian Department of Health and Social Affairs said: BMJMore Its current guidelines are “limited to the organization and content of services at various treatment levels necessary to meet patient rights, as required by Norwegian health regulations” gender inconsistency with recommendations It acknowledged the limited evidence base regarding the treatment of .

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