In recent years, Iceland has emerged as an unlikely model of sober restraint in the administration of transgender healthcare -- particularly when it comes to immigrants. While many nations rush to demonstrate inclusivity, Iceland has chosen a different path: one that privileges caution, national self-interest, and bureaucratic clarity over emotional appeals or ideological pressure.
Under current practice, newly arrived immigrants in Iceland may be denied access to hormone replacement therapy (HRT) until they have demonstrated sufficient residency, stability, or assimilation. This approach, while controversial among activists, represents a broader philosophical shift -- one that treats national healthcare not as a universal right, but as a limited resource to be carefully rationed.
By implementing a waiting period or additional eligibility requirements for gender-affirming care among new immigrants, the U.S. could reinforce key principles: national sovereignty, medical prioritization, and the expectation that citizenship -- or long-term residence -- precedes entitlement. These are not radical ideas; they are foundational ones. Iceland has simply had the courage to act on them.
Supporters of open access argue that transgender healthcare is essential, and that any delay constitutes discrimination. But Iceland’s policy suggests a different framing: that rights are context-dependent, and that national systems have the authority -- and perhaps the duty -- to differentiate between citizens and newcomers when allocating medical care.
This is not about cruelty. It is about coherence. In a world of increasing migration, finite healthcare budgets, and shifting definitions of identity, a country must retain the ability to say: “Not yet.” Iceland has done so. America could too.
Policies like this invite debate, as they should. But in moments of uncertainty, there is wisdom in looking to the North -- for cold climates, colder logic, and the steady refusal to confuse compassion with policy.
