Gender-affirming surgery in the Nordic countries—advancing equitable,evidence-based care

Gender-affirming surgery has evolved from a once controversial field into an established component of reconstructive plastic surgery in the Nordic countries. The three narrative reviews in this mini-theme issue together provide the most comprehensive account to date of gender-affirming care in this regional context: its history, current organization, and surgical practices.^1–3

The review on gender-affirming healthcare offers an essential overview of how Denmark, Finland, Iceland, Norway, and Sweden have transitioned from highly medicalized systems toward models centered on self-identification and patient autonomy. ¹ Despite national variations, all Nordic countries provide publicly funded gender-affirming treatment, including psychosocial support, hormone therapy, fertility consultation, and surgery. Yet, challenges remain; prolonged waiting times and unequal access for non-binary individuals have led some to seek cross-border or private care, highlighting systemic gaps in equity and capacity. ⁴

Persistent inequities are also evident in cancer screening. Transgender men are often excluded from breast and cervical screening programs despite having residual risk, while transgender women may lack access to appropriate breast and prostate cancer screening. Inconsistent national guidelines, reliance on legal gender markers, and gaps in provider knowledge contribute to missed opportunities for prevention and early detection. These barriers are compounded by stigma, discomfort, and a lack of understanding within healthcare settings, which may discourage individuals from seeking preventive care altogether.^5,6

The two surgical reviews address the core components of gender-affirming breast and genital surgery.^2,3 Gender-affirming breast surgery, whether chest masculinisation or breast augmentation, is among the most frequently requested procedures and remains a cornerstone in alleviating gender dysphoria and enhancing quality of life. Similarly, genital gender-affirming surgery represents the most technically complex, yet also the most transformative aspect of care, aligning anatomy with gender identity and improving psychosocial and sexual well-being.

Together, these reviews illustrate that outcomes depend not only on surgical precision but also on holistic preoperative assessment, informed consent, and multidisciplinary follow-up. In this regard, the recently published prospective cohort study by Gran et al. demonstrated significant postoperative improvements in health-related quality of life and gender congruence following gender-affirming mastectomy. ⁷

Despite progress, several unmet needs persist. Long waiting times, limited surgical capacity, and fragmented care pathways delay treatment and risk exacerbating distress. Standardized national registries with patient-reported outcomes and national guidelines should be prioritized to ensure continuous quality monitoring and enable cross-country comparisons. There is also a pressing need for structured training in gender-affirming surgery within reconstructive plastic surgery education. Discussion of regret and detransition should also be approached carefully, grounded in evidence and with an emphasis on comprehensive preoperative evaluation and postoperative support.

Future directions should include expanding multidisciplinary clinics, improving accessibility for non-binary individuals, and strengthening collaboration between plastic surgery, psychiatry, endocrinology, and primary care.

Ultimately, gender-affirming surgery is not merely about anatomy, but about enabling individuals to live authentically and healthily. By combining scientific rigor with collaboration, the Nordic countries can continue to lead in delivering equitable, person-centered care for all gender-diverse individuals.