Sweden Restricts Hormonal Treatment for Minors

In February 2022, the Swedish health authority Socialstyrelsen published new guidelines for the care of minors with gender dysphoria. Since then, puberty blockers and sex hormones have only been recommended in exceptional cases or as part of research.

The ruling

According to Socialstyrelsen, the risks of puberty blockers and hormones for the group as a whole outweigh the potential benefits. The authority pointed to uncertainty about the long-term effects and the significant changes in the group seeking treatment.

The SBU report

The guidelines are based on a literature review by the Swedish institute SBU. It concluded that the scientific evidence for hormonal treatment of minors is insufficient. See the SBU report in the archive.

Karolinska led the way

In Stockholm, Karolinska University Hospital had already decided in 2021 to stop prescribing blockers and hormones to minors outside a research setting.

The background

Sweden's reconsideration began with a political debate. In 2018, a proposal was put forward to lower the age for gender reassignment surgery to fifteen, without parental consent. This prompted opposition from doctors and parents, after which the government commissioned an assessment of the scientific evidence. In 2019, Swedish public broadcaster SVT aired the first episode of a documentary series about gender care for young people. It featured young adults who regretted their treatment, and later also a young person who had suffered serious skeletal damage after using puberty blockers for years. Swedish parents of young people with gender dysphoria are united in Genid.

The figures

In 2020, Socialstyrelsen found that the number of gender dysphoria diagnoses among girls aged thirteen to seventeen had increased approximately fifteenfold between 2008 and 2018. A large proportion of these young people also had other diagnoses, such as autism, ADHD, depression or anxiety disorders. The authority could not explain the reason for the increase.

What is still possible

Treatment has not been banned. According to the guidelines, it may be considered for young people who meet the criteria of the original Dutch protocol: the dysphoria began in childhood, has been persistent and is accompanied by clear distress. The aim is for treatment to take place within scientific research going forward, so that outcomes can be documented.

Separate legal and medical matters

Medical caution is separate from legal recognition. In 2024, the Swedish parliament passed a law lowering the age for changing legal sex from eighteen to sixteen and simplifying the procedure. Sweden thus shows that a country can simultaneously restrict medical treatment for minors and expand the options for legal recognition.

Significance

Sweden has a long history in this field: in 1972, it became the first country in the world to pass a law allowing legal sex changes. The country also has population registers that allow patients to be followed for decades. A frequently cited Swedish registry study from 2011 showed that, in the long term, people who had undergone gender reassignment surgery had a clearly higher mortality rate and more psychiatric admissions than the rest of the population. The researchers stressed that this does not mean the surgery was the cause, but it does show that care must not stop after treatment. Against this background, the uncertainty surrounding treatment for minors weighed heavily in Sweden.

Sweden had adopted the Dutch Protocol early on and is known for its progressive policies. The fact that this particular country reversed course on the treatment attracted considerable international attention. Norway followed a year later; see the Norwegian Ukom report. More information is available on the page about gender care in Sweden.