BREAKING: Sweden drastically changes protocol, prioritizes psychotherapy

Genspect has quickly translated the following article from the Swedish publication Lakartidningen.se, which was published February 22, 2022. Please also read SEGM’s quick analysis of this ground-breaking change here, with a more thorough assessment coming soon.

The National Board of Health and Welfare: Young people should only be given hormone treatment in exceptional cases

The National Board of Health and Welfare is now calling for restraint when it comes to hormone treatment in minors with gender dysphoria. According to the authority, treatment should be offered only in exceptional cases outside the framework of research.

By Katrin Trysell

[email protected]

The National Board of Health and Welfare is currently working to update the knowledge support for care of young people with gender dysphoria that was established in 2015. This is happening in stages and now the authority comes with new recommendations regarding puberty blocking  and cross-sex hormone treatment in this group.

The National Board of Health and Welfare therefore calls for restraint with treatment in persons under 18 years of age. According to the authority, the risks of hormone treatment currently outweigh the possible benefits for the group as a whole.

The National Board of Health and Welfare relies, among other things, on a review of relevant studies on the effect and safety of hormone treatment carried out by the Swedish Agency for Medical and Social Evaluation (SBU). In the report, which is published today, the SBU concludes that it is not yet possible to draw any definite conclusions regarding this.

Hormone treatment should henceforth be given within the framework of research, according to Thomas Lindén, head of department at the National Board of Health and Welfare.

“While waiting for a research study to be put in place, our assessment is that the treatments can be given in exceptional cases,” he says in a press release.

According to SBU, based on current evidence, it is also not possible to determine how common it is for people who undergo gender-confirming treatment to later change their perception of their gender identity, interrupt treatment or in some aspect regret it. At the same time, it has been documented that detransition occurs, and there may also be an unknown figure, the National Board of Health and Welfare states.

For the group that regrets or interrupts an initiated treatment, there may be a risk that the treatment has led to poorer health or quality of life, says Thomas Lindén.

According to the National Board of Health and Welfare, puberty blocking or cross-sex hormone treatment should therefore only be offered in exceptional cases outside the framework of studies. The authority has developed criteria that care can be based on in the clinical assessment.

According to the authority, the clinical assessments should be in line with the criteria in the ‘Dutch protocol’. Central to this is that gender incongruity debuted during childhood, persisted over time, and that the development of puberty led to clear suffering.

The National Board of Health and Welfare also writes that these complex multidisciplinary assessments must be made under “an overall operational responsibility within the units that receive a permit to conduct national highly specialized care.”

SBU’S CONCLUSIONS:

The scientific evidence is not sufficient to assess the effects on gender dysphoria, psychosocial conditions, cognitive function, body size, body composition or metabolism of puberty blocking or cross sex-hormone treatment in children and adolescents with gender dysphoria.

There is some support at the group level for the fact that puberty blockers (GnRH) slows down the bone building that can be expected to occur during the following puberty (low reliability) but that the bone density achieved at the start of treatment is maintained (low reliability).

There is some support at the group level for young people who have received puberty blockers, during a cross sex hormone treatment with estrogen or testosterone, to recover bone density (low reliability), but it is not possible to determine whether bone density will eventually reach the level of young people in the surrounding population.

The scientific evidence is not sufficient to assess how often young people after the psychological / psychiatric and medical investigation has been initiated due to psychosocial problems that are considered to be due to gender dysphoria, choose not to start or to voluntarily discontinue puberty or cross sex hormone treatment.

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