WPATH stands for World Professional Association for Transgender Health, the leading international professional association in this field. It draws up treatment guidelines, of which SOC8 is the most recent version. Critics pointed to the flawed methodological basis of those guidelines. In March 2024 internal messages were published in which practitioners acknowledged among themselves that children and young people cannot give informed consent to irreversible procedures.

International developments

Q: Which country was the first to change gender care for young people?

Finland. The Finnish authority COHERE revised the guidelines as early as 2020, before other countries. Psychosocial support became the first choice, and medical procedures in minors are only allowed under strict criteria and after assessment by several disciplines. Sweden followed in 2022, Norway in 2023 and Denmark in 2023 and 2024. In the United Kingdom the Cass Review appeared in April 2024.

Q: Is gender care for young people banned in Europe?

No, there is no general ban, but several countries have severely restricted medical treatment. The United Kingdom bans puberty blockers outside clinical research. Sweden restricted puberty blockers and hormones to a strict research setting and Finland allows them only under strict criteria. Psychosocial support and psychotherapy remain available and come first again in those countries.

Q: What does the international turnaround mean for the Dutch Protocol?

The Dutch Protocol, which was long regarded internationally as the gold standard, is under heavy pressure. Systematic literature reviews in the United Kingdom, Sweden and Finland found independently of each other that the basis for puberty blockers and hormones in minors is weak and that the long-term effects have been insufficiently studied.

In north-western Europe a striking turnaround has taken place in recent years in thinking about gender care for minors. Countries that previously led the way in gender-affirmative treatment have considerably tightened their practice after systematic literature reviews exposed the weak evidence base. Below is an overview of the main developments (2020–2025).

United Kingdom — Cass Review

In April 2024 paediatrician Hilary Cass published her independent final report on youth gender care in the UK. The Cass Review concludes that the evidence base for puberty blockers and cross-sex hormones in minors is "remarkably weak", that social transition is not a neutral intervention, and that the prevailing treatment practice was based too much on activism and too little on solid science. The Tavistock clinic was closed and in 2024 the British government introduced a ban on puberty blockers outside clinical research — since made permanent. See: Cass Review final report.

Sweden — SBU

Sweden was one of the first countries to embrace the gender-affirmative model, but also one of the first to go back on it. The SBU (Statens beredning för medicinsk och social utvärdering) concluded in 2022 that the evidence for hormonal treatment in minors is insufficient. Socialstyrelsen, the Swedish health authority, restricted puberty blockers and cross-sex hormones to a strict research setting. Psychotherapy became central again.

Finland — COHERE

Finland revised its guidelines as early as 2020, before other countries. The Finnish authority COHERE stated that psychosocial support is the first choice and that medical interventions in minors may only take place under strict criteria and multidisciplinary assessment. An important argument: a large proportion of young people with gender dysphoria also have considerable psychiatric comorbidity, which is not resolved by medical transition.

Norway

In 2023 the Norwegian Ukom (Norwegian Healthcare Investigation Board) labelled puberty blockers and hormone treatment in minors as experimental. The existing care model is being revised; here too the leading notion is that the scientific basis falls short.

Denmark

In 2023–2024 Denmark tightened access to medical gender care for minors. A minority of the referred young people still qualify for hormonal treatment; psychiatric screening and alternative explanations are taken more seriously. See: SEGM — Denmark restricts youth transitions.

WPATH Files

In March 2024 Environmental Progress published the so-called WPATH Files: internal messages from the leading professional association WPATH (World Professional Association for Transgender Health). They showed that practitioners acknowledged among themselves that children and young people cannot give informed consent to irreversible procedures, that they were aware of serious side effects, and that the SOC8 guidelines were adjusted under political pressure. Critics (Levine, Abbruzzese, Mason, 2022) had already pointed to the flawed methodological basis of WPATH guidelines.

United States

The US is an exception: while Europe is going back on affirmative care, practice there was until recently actually being expanded. At the same time more than twenty states have passed legislation that restricts or bans medical gender care for minors. The legal landscape is strongly polarised; the federal government has followed opposing lines under different administrations.

What connects these developments

The common thread in north-western Europe: systematic literature reviews (UK, Sweden, Finland) find independently of each other that the scientific basis for puberty blockers and cross-sex hormones in minors is weak, that long-term effects have been insufficiently studied, and that the explosive increase in mainly adolescent girls with gender dysphoria since around 2010 cannot be explained biologically. The explanatory model is shifting towards social, psychiatric and cultural factors — not towards more affirmation.

Dutch gender care, and in particular the Dutch Protocol, which was long regarded internationally as the gold standard, is under heavy pressure in this new light. See also Dutch developments and Science & debate.

All topics

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Photo: Yann Forget, CC BY-SA 3.0, via Wikimedia Commons

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AI-generated

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Which country was the first to change gender care for young people?

Is gender care for young people banned in Europe?

What is WPATH?

What does the international turnaround mean for the Dutch Protocol?