Denmark (2023)
Since 2016, Denmark has had a nationwide service providing counselling, assessment and treatment for minors experiencing gender distress. It is provided by the Sexologisk Klinik and departments at Rigshospitalet and Bispebjerg Hospital in Copenhagen. On 3 July 2023, clinicians from this team described how the service has developed in Ugeskrift for Læger, the journal of the Danish Medical Association.
The main article on this subject is Gender care in Denmark.
What it says
The number of referrals rose from 97 in 2016 to 352 in 2022; 70 per cent involved young people aged 11 to 18 who were registered female at birth. According to the authors, this has led to a more cautious approach, as in Sweden and Finland: hormone treatment is now offered to far fewer young people than before. The duration of the gender distress and the psychosocial situation are important factors in the decision. Those who do not meet the criteria are offered counselling. In principle, surgeries are not performed before the age of 18.
How the assessment works
The authors are Mette Vinther Hansen, Annamaria Giraldi, Katharina Maria Main, Jonas Vrublovsky Tingsgård and Mette Ewers Haahr. They describe three pathways: a watchful-waiting pathway for young children, a reflection pathway for young people who do not currently meet the criteria for treatment, and a standard assessment pathway for young people whose gender distress began in childhood and whose circumstances are stable. The standard pathway includes at least five consultations at the Sexologisk Klinik, a psychiatric assessment and an information session about hormones. Puberty blockers may be prescribed from Tanner stage II to III. Short-term gender distress or an unstable psychosocial situation is a reason not to start hormone treatment.
Uncertainties according to the authors
The article points to major differences between countries in co-occurring psychiatric problems: 75 per cent in Finland compared with 33 per cent in the Netherlands. Frequently reported diagnoses include depression, anxiety, autism and ADHD. The authors refer to reports from young people and adults who regret permanent physical changes caused by hormones, and note that no systematic records are kept of how often treatment is discontinued. Long-term data are particularly lacking for young people whose gender distress began after the onset of puberty. They advocate a service that can be adapted and for international cooperation. The neighbouring countries’ similar approach is covered in this archive under Finland (2020) and the SBU report from Sweden.
Why it is included in this archive
This is not about a ban or limiting care to clinical studies by the Danish Health Authority, but about a more cautious practice within the existing service. See also the overview of policy by country and the page about young people.