Karolinska 2021 — Swedish policy change

Karolinska Universitetssjukhuset in Stockholm — an internationally leading institution in transgender adolescent care — decided in March 2021 to offer hormone treatments to minors only as part of clinical research.

The main article on this subject is Gender care in Sweden.

2021 decision

Karolinska Universitetssjukhuset in Stockholm — an internationally leading institution in transgender adolescent care — decided in March 2021 to offer hormone treatments to minors only as part of clinical research. The decision followed an internal evaluation and concerns about a rapid increase in referrals, particularly among adolescent girls.

Rationale

The hospital referred to systematic reviews conducted by SBU (the Swedish Agency for Health Technology Assessment and Assessment of Social Services), which concluded that evidence for the effectiveness of puberty blockers and cross-sex hormones in young people is limited and that the risks have not been sufficiently examined.

Subsequent policy

In 2022, the Swedish health authority Socialstyrelsen published national guidelines that confirmed this cautious approach. Finland had already preceded Sweden in 2020 with the recommendation by PALKO; in Norway, the investigative board Ukom advised caution in 2023.

What the decision means

The policy took effect on 1 April 2021 and applies to the Astrid Lindgren Children's Hospital, which is part of Karolinska. Since then, young people under sixteen have no longer received puberty blockers or hormones for gender dysphoria. For sixteen- and seventeen-year-olds, these treatments are available only as part of approved clinical research. Young people who were already receiving treatment were assessed individually. In doing so, the hospital explicitly referred to the Dutch Protocol, which it had followed until then. A discussion of the sources behind the decision, including the uncertainty surrounding informed consent, is available at transethiek.nl.

Lead-up

The decision did not come out of nowhere. In 2019, Swedish public broadcaster Sveriges Television aired the documentary Trans Train in its investigative programme Uppdrag granskning, covering the rapid growth in the number of young patients and people who regretted their treatment. That same year, SBU published a literature review showing how little research had been conducted into the treatment of young people. A bill to lower the age limit for legal gender change and surgery was put on hold following criticism.

Significance

Karolinska was the first major university hospital to distance itself from the Dutch treatment model. This gave the decision significance far beyond Sweden: it did not come from politicians or activist groups, but from the doctors who had provided the treatment for years. The 2022 national guideline is included in the timeline; Sweden's policy as a whole can be found under policy by country.

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