SBU report (Sweden, 2022)
On February 22, 2022, the Swedish SBU, the government institute that evaluates medical and social interventions, published report 342 on hormone treatment for gender dysphoria in children and adolescents. It is a systematic review of the available research, commissioned by the Swedish health authority Socialstyrelsen.
The main article on this subject is Gender care in Sweden.
What it says
SBU concludes that the scientific evidence is insufficient to assess the effects of puberty blockers and sex hormones on gender dysphoria, psychosocial outcomes, cognition, and metabolism. There is some support for the finding that puberty blockers delay the expected development of bone mass. SBU does not make recommendations itself and does not weigh the risks against the benefits.
Consequences
Socialstyrelsen made that assessment. On the same day, the authority announced that the risks of puberty-blocking and gender-affirming hormone treatment for young people under eighteen currently outweigh the potential benefits for the group as a whole. According to Socialstyrelsen, treatment should take place within a research setting and, outside such a setting, only in exceptional cases. The final knowledge support document was published on December 16, 2022; the timeline records this under Sweden restricts hormonal treatment for minors. A year earlier, Karolinska University Hospital had already revised its own policy, as described in Karolinska 2021. See also policy by country and young people.
Limitations of the evidence
There are no randomized controlled studies in this field. The available research consists of observational studies that measure participants before and after treatment. SBU was unable to determine how often young people choose not to start treatment or stop voluntarily. The report identifies a number of knowledge gaps: coordinated Swedish data collection, randomized studies, longer follow-up, and research into young people who stop taking puberty blockers without going on to use sex hormones. The report served as the basis for revising the guideline that Socialstyrelsen had issued in 2015.
Three reasons given by Socialstyrelsen
Socialstyrelsen gave three reasons for its revised assessment. The evidence supporting effectiveness and safety is uncertain. Care has not been systematically monitored and evaluated, even though this was recommended in 2015. And it is unknown how often people later change their gender identity, stop treatment, or experience regret. Department head Thomas Lindén also pointed out that the number of diagnoses has risen sharply, particularly among thirteen- to seventeen-year-olds and young people registered female at birth.
Significance for the Netherlands
The Swedish assessment is regularly cited in the Netherlands, including in the 2023 parliamentary questions about the Dutch Approach. The article on systematic reviews in gender care explains how the report relates to other assessments.