Sweden urges caution on puberty blockers, transgender surgeries in updated health guidance

Children wait for their teacher at a preschool in Sweden. | Reuters/Kai Pfaffenbach

A Swedish health board's updated treatment guidelines for gender dysphoric youth emphasize a more cautious approach to treating minors with the condition, appearing to coincide with a hospital's recent steps to cut back on providing puberty blockers to trans-identifying children.

On Dec. 16, Sweden's National Board of Health and Welfare (NBHW) released its updated knowledge support for gender dysphoric children. In the announcement, NBHW noted that treatment for such individuals "has been characterized by both deficiencies in accessibility and a lack of knowledge about the results of the care."

"It is important that children and young people who suffer from gender dysphoria are taken seriously, treated well and offered adequate care," Thomas Lindén, head of department at the National Board of Health and Welfare, stated.

The board emphasized that there has not been "sufficient" follow-up and documentation to assess the effect of prescribing puberty-blocking drugs and cross-sex hormones to minors with gender dysphoria.

NBHW's updated knowledge support notes a need for data that proves patients benefit from such care, calling for a study that compares these measures to patients that received different care. 

The need for follow-up was highlighted in a 2015 knowledge support, according to NBHW, but since then, "very little knowledge has been added."

NBHW recommends caution when it comes to the surgical removal of breast tissue for gender dysphoric minors.

The report calls for ensuring such measures are done "within the framework of research," and pending a study assessing the surgery's effectiveness, it should only be done in "exceptional cases." 

Lindén stated that the uncertainty surrounding measures such as "hormonal treatment" for gender dysphoric minors "speaks for caution at the moment." 

"Young people who suffer from gender dysphoria need to be able to quickly receive an investigation and be offered adequate care measures, based on the health and medical services' assessments of the care needs," the guidance reads. "Good psychosocial care is fundamental."

The updated knowledge support also cites an "unexplained increase" in the number of people, particularly minors, receiving a diagnosis of gender dysphoria as another reason for caution regarding hormonal and surgical interventions for minors. 

In February, the board reported that between 2008 and 2018, the rate of teen girls ages 13 to 17 diagnosed with gender dysphoria grew by approximately 1,500%. 

"In summary, it is important to emphasize that care also continues to ensure that children and young people who suffer from gender dysphoria are taken seriously, treated well and offered adequate care measures," the report reads. 

According to NBHW, the board plans to update the knowledge support for adults with gender dysphoria. 

Sweden's National Board of Health and Welfare and Lindén did not immediately respond to The Christian Post's request for comment.

As The Christian Post reported, Karolinska University Hospital, a prominent Swedish hospital, stopped prescribing cross-sex hormones or drugs that suppress puberty in April. The hospital outlined the policy change in a March statement, highlighting the increased scrutiny of these measures due to a high volume of patients undergoing them. 

"These treatments are potentially fraught with extensive and irreversible adverse consequences such as cardiovascular disease, osteoporosis, infertility, increased cancer risk, and thrombosis. This makes it challenging to assess the risk/benefit for the individual patient, and even more challenging for the minors and their guardians to be in a position of an informed stance regarding these treatments," the statement read. 

The new Swedish guidance comes as the United Kingdom's National Health Service is overhauling how it responds to gender dysphoric youth. 

In July, the NHS announced that it will be shutting its gender identity clinic at the Tavistock and Portman Trust in light of recommendations from an independent review by Dr. Hillary Cass. The doctor stated in a July 19 report that there was a need to move away from the sole provider model and develop services regionally to meet the needs of patients. 

Cass' report was critical of the reliance on experimental drugs and hormones to treat gender dysphoria.

"We do not fully understand the role of adolescent sex hormones in driving the development of both sexuality and gender identity through the early teen years, so by extension we cannot be sure about the impact of stopping these hormone surges on psychosexual and gender maturation," Cass wrote. "We therefore have no way of knowing whether, rather than buying time to make a decision, puberty blockers may disrupt that decision-making process."

The NHS's proposed new guidelines warn doctors against being quick to encourage gender dysphoric to change their names or pronouns during what may be a "transient phase." The guidelines advise that doctors take a more watchful approach when caring for minors who claim to identify as the opposite gender. 

The World Professional Association for Transgender Health (WPATH) states that European health authorities are only conducting more studies and collecting more information. The organization was critical of the NHS' interim service specification for "Phase 1" services following Cass' report, arguing that they "place unnecessary barriers in their way."

"This document quotes selectively and ignores newer evidence about the persistence of gender incongruence in children," WPATH's Nov. 25 statement reads. "Many older studies regarding the stability of gender identity enlisted children who did not have gender incongruence or gender dysphoria, but rather, had culturally non-conforming gender expression. The findings of these older studies should only carefully be applied to children and young people who are presenting to gender identity clinics seeking gender-affirming treatment."

In 2020, the Finnish Health Authority issued guidelines calling for therapy to be the first line of treatment for gender-dysphoric youth and urged caution regarding surgical or hormonal interventions.

Samantha Kamman is a reporter for The Christian Post. She can be reached at: Follower her on Twitter: @Samantha_Kamman

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