Sun 27 Feb 2022 — 4 min

Socialstyrelsen (The Swedish National Board of Health and Welfare) published guidelines on the 22nd of February 20221, advising that prescription of puberty blockers and other hormonal treatment to trans persons under the age of 18 should stop, citing a "lack of quality evidence" meaning that "the risks [of hormonal treatment] outweigh the benefits at present". The guidelines then state that going forward hormonal treatment should only be supplied on an exceptional case by case basis until a research study is put into place, for which there is no timescale. In the full report published alongside these guidelines it specifies that provision of hormonal treatment for exceptional cases should be based on "dutch protocol", an outdated model that requires patients to "meet all the points in the DSM-IV-TR criteria for gender disorder, [to] have suffered from lifelong extreme gender dysphoria, [be] psychologically stable and live in a supportive environment.2

Whilst the guidelines published are not legally binding, hospital boards in Sweden are obliged to take publications from Socialstyrelsen into account when making decisions for best practice. Additionally clinicians are extremely unlikely to want to go against the advice of Sweden's main health authority.

The full report, which is supposed to be an analysis of high quality literature around treatment of trans children and adolecents, cites Littman's 2021 study of detransitioners, which has been thoroughly debunked as junk science with several metholodgical issues3, as a reason to stop providing hormonal treatment to transgender youth. The report also cites Kenneth Zucker's 2021 report which has similarly been criticised for poor methodology and lack of follow-up data4,5. Zucker himself was fired from the GIC he worked at in 2015 after reports he was practicing conversion therapy there6. It is unclear what the criteria for the inclusion/exclusion of relevant literature was.

In place of puberty blockers and hormonal treatments, which are considered international best practice for trangender youth, the report advises transgender youth should be given access to psychosocial interventions, child psychiatric treatment and suicide prevention measures. Some concern has been raised over whether in practice this may entail conversion therapy, as Sweden has no legal definition or ban of it.7

The publication of these guidelines is a continuation of denial of treatment to Swedish trans youth which started last April with Karolinska University Hospital, the largest youth GIC, in light of the Keira Bell vs. Tavistock ruling8. In response to this, two more of the country's six youth GICs followed suit9 despite the ruling being overturned in September 202110. This new guidance is likely to mean the 3 GICs still providing puberty blockers and hormonal treatment will stop doing so.