Gender Care in Sweden
Sweden was one of the most progressive countries in pediatric gender care for a long time and adopted the Dutch Dutch Protocol as a blueprint. Since 2019, the country has radically abandoned that approach. In 2021, Karolinska University Hospital stopped routinely prescribing puberty blockers to minors, and in 2022, Socialstyrelsen issued national guidelines that almost entirely restrict hormone treatment for minors to research settings. Since then, Sweden has been regarded internationally as one of the first countries, after Finland, to openly distance itself from the gender-affirmative model.
More on this site: SBU report (Sweden, 2022) and Socialstyrelsen (Sweden).
Related topics can be found in Karolinska 2021 — Swedish policy change.
The Karolinska decision (2021)
Astrid Lindgren Children’s Hospital, part of Karolinska University Hospital in Stockholm, was Sweden’s leading center for pediatric gender care for decades. In April 2021, the board published a groundbreaking guideline stipulating that puberty blockers and cross-sex hormones could henceforth be prescribed to minors only as part of approved scientific research, apart from a few carefully considered exceptions.
The immediate cause was twofold: a 2019 SBU overview showed that the evidence was weak, and possible physical side effects in treated young people raised concern, including reduced bone density, and Karolinska concluded that the claim that puberty blockers are “fully reversible” could not be upheld. The hospital decided that from then on it would prescribe these drugs to minors only within approved research, with a few exceptions.
The SBU report (2019, 2022)
Statens beredning för medicinsk och social utvärdering (SBU), Sweden’s institute for the systematic evaluation of medical evidence, published an initial report on hormonal treatment for gender dysphoria in minors in 2019. Its conclusion: the scientific evidence is weak; most studies have methodological shortcomings, and reliable long-term data are lacking. A follow-up evaluation in 2022 confirmed that the evidence base had not substantially improved since then. Socialstyrelsen advised that treatment should preferably be given within research.
National Socialstyrelsen guidelines (2022)
Based on the Karolinska decision and the SBU reports, Socialstyrelsen, Sweden’s national health authority, published new national guidelines in December 2022. The full English summary is available via Socialstyrelsen. SEGM summarized the policy shift as Sweden ends use of Dutch protocol.
The core message: for minors, the risks of hormonal treatment outweigh the potential benefits in almost all cases. Psychotherapy and treatment of comorbid conditions, such as depression, autism, and trauma, should take priority. Hormonal interventions are permitted only in exceptional cases, after extensive multidisciplinary assessment, and preferably as part of clinical research.
Reasons for the policy shift
In addition to the scientific evidence, several specific signals played a role. The Swedish documentary series “Trans-tåget” (“The Trans Train,” SVT 2019) showed how many adolescent girls with underlying mental health issues had been placed on hormones after short treatment pathways. Detransitioners such as Mikael Wallin testified about missing diagnostics and the difficulty of expressing doubts within the affirmative culture. At the same time, the number of referrals rose explosively—from a few dozen to hundreds per year, particularly among adolescent girls—raising questions about social contagion. The parent network GENID also drew attention to this group.
Current situation
For minors, medical gender care in Sweden is de facto limited to research protocols and highly exceptional individual cases. Psychological care, family counseling, and treatment of comorbidities take priority. For adults aged 18 and over, hormone therapy and surgery remain available through specialized clinics, but the diagnostic threshold has also been raised there. A 2026 overview shows that surgery for gender dysphoria in the Nordic countries is almost universally reserved for adults. genderzorgnederland.nl discusses what Sweden’s reversal means for the Netherlands.
International impact
Sweden’s policy shift was the first in a series of Northern European changes, followed by Finland, Norway, Denmark, and the United Kingdom. The Cass Review explicitly cites the SBU evaluations as consistent with the findings of the University of York. Sweden has therefore become one of the cornerstones of the international reassessment of pediatric gender care.