International developments
In Northwestern Europe, a striking shift has taken place in recent years in thinking about gender care for minors. Countries that were previously at the forefront of gender-affirmative treatment have sharply 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 reverse course. 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 strict research settings. Psychotherapy was placed back at the centre.
Finland - COHERE
Finland revised its guidelines back in 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. A key argument: a large share of young people with gender dysphoria also have considerable psychiatric comorbidity, which is not resolved by medical transition.
Norway
The Norwegian Ukom (Norwegian Healthcare Investigation Board) classified puberty blockers and hormone treatment in minors as experimental in 2023. The existing care model is being revised; here too the guiding notion is that the scientific underpinning falls short.
Denmark
In 2023-2024, Denmark tightened access to medical gender care for minors. A minority of the young people referred are still eligible 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). These showed that practitioners acknowledged among themselves that children and young people cannot give informed consent for irreversible interventions, that they were aware of serious side effects, and that the SOC8 guidelines were adjusted under political pressure. Critics (Levine, Abbruzzese, Mason, 2022) had earlier pointed out the flawed methodological basis of WPATH guidelines.
United States
The US is an exception: while Europe is reversing course on affirmative care, practice there had until recently been expanding. At the same time, more than twenty states have passed legislation that restricts or bans medical gender care for minors. The legal landscape is highly polarised; the federal government has followed opposing lines under different administrations.
What connects these developments
The common thread in Northwestern Europe: systematic literature reviews (UK, Sweden, Finland) find independently of each other that the scientific underpinning of 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 long served as the international gold standard, is under heavy pressure in this new light. See also Dutch developments and Science & debate.