Gender dysphoria assessment in Sweden

Anyone who wants to be able to undergo gender-affirming healthcare or change their legal gender needs a gender dysphoria diagnosis in Sweden. You can get that diagnosis by undergoing an assessment. Here you can read more about the various steps in the gender dysphoria assessment, how to get a referral and some things that are good to know about the assessment before it begins. 

Remember that even though many trans people experience gender dysphoria, that doesn't mean everyone does. Anyone who does not experience gender dysphoria and does not want to change their body does not need to undergo a gender dysphoria assessment.

Other terms for gender dysphoria assessment are gender assessment and gender identity assessment. Since it is not one's gender or gender identity that is investigated, but whether one has gender dysphoria and what one's need for treatment looks like, gender dysphoria assessment is a better term

In this text, we use medical terms for internal genitalia that one is born with.

What is gender dysphoria?

Gender dysphoria means that you suffer from or experience obstacles in your everyday life because the gender you were assigned at birth does not match your gender identity. Gender affirming care is a way of treating gender dysphoria to reduce it. The care consists of various treatments, for example hormone therapy and various types of surgeries. They can help you change the body so that it better matches the gender you feel as, your gender identity. You can read more about gender dysphoria here. 

Gender dysphoria assessment step by step

The following steps are included in an assessment.

• Referral for assessment
• First appointment
• The role of the psychiatrist/physician
• The role of the counsellor
• The psychologist's role
• Emotional process for some
• Diagnosis
• Referrals to gender affirming treatments
• New legal gender and genital surgery
• Continued contact with some caregivers
  
• General information about gender dysphoria assessments that's good to know

1. Referral for gender dysphoria assessment

To get to a gender dysphoria team and start a gender dysphoria assessment in Sweden, you need a referral. Referral rules look different for different teams. On the list of assessment teams, you will find contact details for the various assessment teams. You can also find out what regulations they have for who can write a referral.

• Some teams take referrals from, for example, doctors at a health center, a school counselor or school nurse or someone at a youth clinic.
• For some teams, you need a referral from a psychiatrist, i.e. a doctor who specializes in psychiatry and works, for example, in general psychiatry or at a BUP clinic (child and youth psychiatry).

Previously three teams offered the opportunity to self-refer - ANOVA in Stockholm, Lundströmmottagningen in Alingsås and the team in Linköping. However, this was removed in 2024.

If you need a referral from a psychiatrist:

There are different ways of contacting a psychiatrist.

• If you already are in contact with psychiatry, you can contact them directly.
• If you are under 18 years of age, you can send a self-referral to BUP. At bup.se you can find BUP receptions near you.
• If you are of the right age to visit the youth clinic, you can go there. They can in turn refer you on to a psychiatrist. At umo.se, the online youth centre, you can find youth centres near you.
• In some regions you can book an appointment directly with a general psychiatric clinic. In others, you need to go through primary care. Then you first turn to, for example, a healthcare clinic. For some healthcare clinics you need to call, while with others, you can make an appointment via 1177 Vårdguiden's e-services (requires bank ID). Tell them how you feel and that you want a referral to undergo a gender dysphoria assessment. Emphasize that you want to see a psychiatrist. At a healthcare clinic you usually see a doctor, who then refers you to a psychiatrist.
• It can take a few months before you get an appointment with a psychiatrist. This is depending on how long the queue is. At the first meeting, you get to tell them a little about yourself, how you feel, how long you've felt that way, and so on. But it is not the psychiatrist's task to carry out an assessment. They, in turn, must send a referral to an assessment team. You usually see the psychiatrist 1-2 times before the referral is sent.

Which team is the referral sent to?

If you receive a referral from the healthcare system, the most common thing is that you are assigned the assessment team that is closest to where you are registered. If there is an assessment team in the region in which you are registered, you will be referred there. Otherwise, you will be referred to the assessment team in a region with which your home region has an agreement.

Since 2015, there is a new patient law that makes it possible to choose to undergo a gender dysphoria assessment anywhere in the country, regardless of where you live. On the other hand, the trips to and from the team are usually not paid for if you want to be assessed by a team other than the one in your home region or with which your home region has an agreement. In order to receive travel compensation, you need a so-called out-of-county referral (also known as “Utomlänsremiss” in Swedish), if there is no assessment team in the region you live in.

Waiting times

Once the referral is sent, it will take some time before you receive a summons to the assessment team. It may be good to check that the referral has reached the team if you do not receive confirmation that the team has received it.

The waiting times can be different for different teams. They can also vary depending on things like how many people are being assessed by a team at the time or if someone in the team quits, is on sick leave or on parental leave. Right now, most teams have a waiting time of around 2-4 years for a first visit.

If you need support while you wait, you can turn to, for example, student health, a youth clinic, BUP, health center, general psychiatry (if you already have a contact there) or the special LGBTQI clinics that are available in certain locations. Some RFSL branches have their own counsellors.

On RFSL Utbildning's website, you can see if there is a clinic near you in Sweden that is LGBTQI-certified. Some regions also have their own LGBTQI training for their clinics. Those clinics often have some kind of LGBTQI- or rainbow logo on their website.

2. First meeting for gender dysphoria assessment and team composition

The assessment team sends out a summons by post with information about the date, time and place of an initial meeting. At the first meeting, you often meet the psychiatrist who will be responsible for your assessment. However, different teams do it in different ways. Sometimes, for example, it is a counsellor or coordinator that you meet first. At your first meeting, you should receive information about what the assessment includes and roughly what timeframes you can expect.

The assessment team usually consists of a psychologist, a counselor and a psychiatrist. The assessment may differ slightly between the different teams. However, work is underway to make care equal throughout the country. Both which elements are included and how long the assessment takes are currently different depending on where you do your assessment. It may also differ based on individual needs. About 12 months is a common time of assessment for adults before the team can make a diagnosis. However, it may take a shorter or longer time. If you yourself or the assessors are unsure whether gender affirming treatment is really what you need to feel as well as possible, the assessment may take longer. It can also take longer if you yourself need time for reflection between each step of the assessment process.

The team makes an assessment of whether you are mentally stable enough to undergo assessment and treatment. Feeling unwell is no obstacle to starting an assessment. If you feel very unwell, however, you may need to take a break from the assessment. Sometimes you may need other help and support to be able to complete your assessment. It is good if you tell the assessment team how you are feeling. This is so that you can get the best help possible.

3. The role of the psychiatrist/doctor

The psychiatrist, a doctor specialising in mental health, is usually the one who has the main responsibility for your assessment. They ask questions about your gender identity. You usually get to tell them how you feel about yourself, your gender identity and your body. You may also answer questions about your physical and mental health.

The questions can be about diseases in your genetic family, how often you drink alcohol and whether you feel depressed or anxious. These questions help the doctor assess whether you may need support and help in addition to gender affirming care. The doctor can also tell you about how different gender-affirming surgeries are carried out and what hormone treatment means and how it affects the body. Once you have been diagnosed, you will also see different specialists who can who can give you more detailed information. This could be a plastic surgeon, an endocrinologist (hormone specialist) or a gynaecologist.

4. The counsellor’s role in the gender dysphoria assessment

The counsellor is responsible for the social assessment. In this process, you are asked to map your life and your social contexts. That is, your employment and your relationships with, for example, family and friends.

You get to tell the counsellor about yourself, your feelings and your thoughts. You also get to answer questions about how you feel in different situations, such as at home and at school or at work. With the counsellor, you can also bring up things that you think are important to talk about.

Meetings with loved ones

The counsellor is usually in charge of the meetings with loved ones, sometimes together with the doctor. It is a meeting for you and those closest to you (friends, partner, family or others who you think are close to you) where you discuss together what the assessment means for you and how your relatives can best support you. Relatives who wish can also get the opportunity to have individual conversations with the counsellor.

In the best case, the sessions can improve relationships that have been full of conflict. You usually get to define yourself who are your close relatives and who you like to invite to the sessions. Not everyone has a good relationship with their family of origin or has friends with whom it feels good to talk about their gender identity or their transition. It is important that you can feel as safe and secure as possible during your assessment. If your relatives do not support you or even oppose your transition, of course you do not have to let them be part of your assessment.

However, it is good to try to find some context outside the assessment where you feel safe and self-evident. It doesn't have to be family or friends you hang out with on a daily basis. It could instead be, for example, a leisure park or Facebook group.

5. The psychologist's role in the gender dysphoria assessment

You may see a psychologist who will conduct a psychological assessment. This means that you may fill in forms with questions that may be about how you feel and how you view yourself and your life. Then you discuss your answers. The forms and sessions are there to find out how you experience gender dysphoria and your well-being in general.

6. An emotional process for some

A gender dysphoria assessment can stir up a lot of emotions and bring up memories of things that happened earlier in one's life. Some feel that the assessment takes a lot of energy or that you feel worse during the assessment than you did before. Some instead think that it is interesting to analyse and gain more knowledge about oneself. The assessment can then help one process past experiences.

Regardless of how you experience the assessment, many people think it's nice to have someone to discuss and vent with. It can be about what you think of the assessment or different feelings that come up in relation to it. It may be good to talk to a professional or someone close to you with whom you feel safe.

During the assessment, you may be asked questions about sex and sexuality. Some feel that such questions are too intimate and private or that the questions are not relevant. For example because you do not want to have sex, because you are satisfied with your sex life or because trans simply does not say anything about sexuality and sexuality doesn't say anything about trans.

The healthcare providers may ask about sex and sexuality because they are important parts of life for many. Therefore you will have the opportunity to talk about sex and sexuality during the assessment, if you want to. How you feel about sex can also say something about what your dysphoria looks like, what your expectations are for gender-affirming treatment or what your needs are in close relationships. But it should always be voluntary to talk about sex during the assessment. It should be a possibility, not a must.

7. Diagnosis

Once you have gone through all the steps of the assessment, the assessment team can make a diagnosis. The psychologist, the counselor and the psychiatrist make assessments and together they decide which diagnosis to make. If you are a binary trans woman or trans man, you are most often diagnosed with “Transsexualism”. If you are non-binary, it is common to be diagnosed with “Other gender identity disorders”. While the assessment itself is ongoing, it is instead common that “Gender identity disorder, unspecified” is stated as the reason for the visit. You can read more about different gender dysphoria diagnoses here .

If you are under the age of 18, you can sometimes receive a preliminary (temporary) diagnosis early in the assessment. It's a diagnosis that says it's likely you have gender dysphoria. Towards the end of the assessment, the team can then make a definite diagnosis.

It is unusual for people over the age of 18 who have undergone an assessment not to receive a diagnosis of gender dysphoria. When that happens, it's usually because you yourself have also come to the conclusion that you don't need gender affirming treatment. If you have been denied a diagnosis, you may be able to get a second opinion, a new assessment, with another gender dysphoria team. You can also turn to the Swedish Patient Advisory Board with a complaint. You can read more about what you can do if you are not satisfied with the care at 1177.se.

8. Referrals to gender affirming treatments

Once the diagnosis has been made, the responsible assessor will send referrals to other healthcare providers. This could be endocrinologists (hormone doctors), speech therapists or surgeons. If you receive a referral for hair removal, in some regions you may receive a list of different hair removal clinics that you can choose from. In other regions you will be referred to a specific clinic.

Most gender affirming treatments are available regardless of which gender dysphoria diagnosis you have received. However, they may differ slightly depending on how your gender dysphoria manifests itself. The treatments available are, for example, voice training, voice surgery (to make the voice higher pitched), hormone therapy, hair removal and top surgery (mastectomy or breast augmentation). The exceptions are gender affirming genital surgery and removal of gonads (ovaries or testicles). You can only access these treatments if you have been diagnosed with transsexualism. You can read more about different treatments here.

It is your own needs that will determine which treatment(s) may be relevant. The National Board of Health and Welfare says: "No one should miss out on the care they need or receive care that is not suitable." People with the same diagnosis do not necessarily have the same needs. Some people want all the treatments they can get. Others only want one or a few types of treatment.

9. New legal gender and bottom surgery

Until July 1, 2025, it is the National Board of Health and Welfare's legal advice that decides whether you can change your legal gender, undergo gender-affirming genital surgery and remove gonads. When you can apply to change your legal gender varies. Talk to the person responsible for your assessment about what applies to you.

There is no requirement to change legal gender or undergo genital surgery. No one should be forced into gender-affirming care or physical interventions that they do not want. There is also no requirement that you undergo genital surgery or gonad removal in order to change your legal gender. However, today you are not allowed to undergo gender reassignment surgery or gonad removal due to gender dysphoria unless you have changed your legal gender. This will be changed when the new legal gender recognition law is impkemented in July, 2025.

So called real life experience, where one was expected to live openly in accordance with your gender identity, has been a part of the assessment process. This was previously a requirement for trans people to be able to change their legal gender (which determines for example which gender marker is in your passport) as well as for receiving bottom surgery. However, Sweden will implement a new legal gender recognition law July 1, 2025. There therefore won’t be the same requirement to have lived openly in accordance with your gender identity in order to being able to change your legal gender or to receive bottom surgery. 

However, you can still be supported by the team about thoughts and challenges in living openly with your gender identity and in deciding whether continuing treatment is the right decision for you.

Applying for a new legal gender, gender affirming surgery and gonad removal under the current law (until July 1, 2025)

You apply by filling in and sending in a form to the Swedish National Board of Health and Welfare. You also need to send a special medical certificate, written by your assessor, and an identity document. Some teams want you to come in for a meeting with the doctor when the certificate is written. Some teams fill in all the paperwork with you and submit the application with you as well. Find out what applies to your particular team.

In order for the application to be approved, certain rules apply. You must have been diagnosed with transsexualism and must have been in contact with an assessment team for at least two years. You must be 18 years of age. It is not a requirement that you must be a Swedish citizen, but you must be registered in Sweden. If you are a registered partner, as in if you are in a registered partnership that you entered into before the Partnership Act was abolished, you need to convert the partnership into a marriage before submitting the application. The last requirement is because people of different legal gender cannot be registered partners. However, you may be married.

Once you have your change approved, you will receive a new social security number. You may undergo gender-affirming genital surgery and/or gonad removal if you wish and your team refer you to a surgeon. You apply for a permit for genital surgery and removal of gonads on the same form as for a change of legal gender. Read more about changing your legal gender here , and you can read more about genital surgery here.

10. Continued contact with certain care

If you undergo hormone therapy, you will often have contact with an endocrinologist (hormone doctor) for the rest of your life. You need to undergo regular tests to see if, for example, you need to change your medications or change your dose. In some places, the endocrinologist is in the same premises as the assessment team.

Your endocrinologist can sometimes also help you with referrals or tell you about other healthcare providers. This could be, for example, if you got skin problems from the hormone treatment and need to see a dermatologist, if you need to take a cytology test (to check if you have cell changes on the cervix) or a PSA test (a blood test to assess the risk of prostate cancer).

Both top surgery and genital surgery often involve multiple procedures. You may then need to be in contact with the surgeon's office for a longer period of time. Even if you are no longer in contact with your assessment team.

If you have previously received a diagnosis but want a referral to gender-affirming treatments that you previously didn’t want, you should first contact the person who was your responsible assessor or the team where you did your assessment. It could be, for example, if after a few years of hormone treatment, you feel that you want to see a speech therapist again or because it now feels appropriate to undergo surgery that you previously did not want.

Some assessment teams offer follow-up meetings or send out questionnaires at regular intervals to see how you have experienced the care and how you feel afterwards. Participation in these interactions and surveys is completely optional.

General information about gender dysphoria assessment that is good to know

• You need to be registered in Sweden in order to undergo a gender dysphoria assessment and gender affirming treatment in public health care and to change your legal gender.
• You do not have to be a Swedish citizen to undergo the assessment.
• There is no lower age limit for when you can get a referral for a gender dysphoria assessment, even if you are under 18 you can get a referral to one of the assessment teams.
• Gender dysphoria assessment is covered by the maximum health bill. Therefore, you only need to pay up to a certain amount for visits to the gender dysphoria assessment team and in other health care. Read more about current levels of the maximum health bill here.

For you as an asylum seeker

Persons under the age of 18 who seek asylum can receive a gender dysphoria assessment and gender affirming treatment on the same terms as persons under the age of 18 who are registered in Sweden. Some assessment teams for adults receive referrals from asylum seekers over the age of 18, but do not start an assessment until you have been registered in Sweden.

You don't have to be sure

You don't have to be sure who you are and whether you want to change your body (and if so how) to start a gender dysphoria assessment. The assessment can help you figure out who you are and what exactly you need. There are also no requirements on what you are expected to do or not do regarding your body. It is entirely up to you whether you want to have the gender affirming treatments offered and, if so, which ones.

You also do not need to contact a gender dysphoria clinic directly. Many people first turn to a counsellor at a youth clinic or health centre, or a call centre for LGBTQI people. This can help them to find out who they are and what they need. If you feel very unsure about your gender identity or your needs for care, it may be good to first have contact with a counsellor or psychologist before turning to a gender dysphoria assessment team.

The aim of the assessment is for both you and the assessment team to be as convinced as possible that it is gender affirming care that you need in order to feel as good as possible now and in the future. Some people are very sure even before they come to the assessment. Some become certain during the assessment itself. Others when they get a diagnosis or start hormone therapy.

Gender dysphoria assessment is part of the general health care in Sweden. The assessment is carried out in special teams (gender dysphoria team, assessment team or gender identity team) which are part of specialist psychiatry. They can be found at university hospitals in several locations in the country. Some teams have contact with healthcare providers in other locations who can administer part of the assessment process.