Worried Parents were Behind Sweden’s U-turn on Paediatric Gender Medicine

A popular documentary series is often cited as the beginning of the end, but parents were always busy in the background.

In 2012, the Swedish government asked the country’s health authority to develop guidelines on treating gender dysphoria in adults and children. They were concerned that no standard treatment protocol was being used in clinics across the country’s different regions.

 “At that time the focus was very much about the rights issues and making visible the need for care in this group”, Thomas Linden told journalist Lisa Selin Davis in 2022. “There was still a lot of stigma around what had been previously called ‘sex changes’.”

Linden is the healthcare knowledge-based policy director at Sweden’s National Board of Health and Wellbeing (NBHW). The guidelines that were ultimately produced in 2015, said Linden, were broadly welcomed by activist groups, patients and the medical community, as they were the first “to make visible the need for care in a marginalised group.”

The 117-page document contained 37 recommendations and called for the use of puberty blockers and hormones in paediatric patients alongside long-term follow-up data that would feed and refine future policies.

By December 2022, the recommendations for young people had been scrapped. The profile of those seeking care – disproportionately female and suffering from psychiatric conditions – had changed. The number of people looking for treatment had skyrocketed. And parents, the first in line in the fallout, were speaking up.

The Evolution of a policy

Parents of gender-distressed children across Scandinavia had begun networking, publishing research, writing letters, organising meetings, and sharing their harrowing stories. On their side was lesbian artist Tonje Gjevjon, who says she now faces criminal charges in Norway for claiming men cannot be lesbians. Others include Genspect advisors Avi Ring and Marit Ronstad.

They got busy contacting anyone they thought could help, including the management of the Karolinska Institute, the NBHW, the Swedish HTA agency (health technology assessment) and various politicians, insisting on the dangers of puberty blockers and hormones for under 16s. In 2018, they launched Gender Challenge (GENID).

At around the same time, trans activists were lobbying the Swedish government to drop the minimum age for access to trans healthcare to 15 without parental consent and to allow children as young as 12 to change their legal gender. The socialist-led government obliged and put it on the table.

The Trans Train Series

Things began to change when the famous Trans Train documentary was aired in April 2019. Its existence is thanks in no small part to the parents. The shocking series, along with multiple media articles and talk shows presenting the experiences of detransitioners and paediatric gender medicine for a general audience, helped pique the country’s attention.

Later the same year, the country’s health technology assessment body published a literature review in an effort to find an explanation for the explosion in the number of youth gender dysphoria cases. There just hadn’t been enough research, the review concluded. The UK followed a similar path, with the Cass review coming to the same conclusion in 2020.

Karolinska Bows Out

Then in May 2021, the famous Karolinska children’s hospital announced that owing to the risks associated with puberty blockers and cross-sex hormones, they would stop prescribing them to under-18s. The prestigious institute had decided unilaterally that such interventions should only be part of clinical trials operated under strict ethical controls. Other gender clinics in the country followed suit.

Karolinska’s leadership, under pressure from parents and presumably spooked by the scandalous evidence of osteoporosis in minors, had pushed the national authorities to act; in February 2022, the NBHW’s hand made a similar move. Announcing 14 new recommendations, the agency urged restraint in the use of hormones and blockers, but by December of the same year, a new set of guidelines put the final nail in the coffin: psychosocial support that helps young people live with gender distress was to be the first line of treatment.

Following Finland, Ditching WPATH

Finally, parents in Sweden could breathe a sigh of relief as the state accepted what Finland had already concluded: with an evidence base so weak, they had effectively been experimenting on the nation’s vulnerable kids. The country’s health authority had finally ditched the WPATH standards of care, a document co-written by activists that pushes the affirmation-only model of care.

In their new guidelines, the NBHW said that the risks of puberty-suppressing treatments outweigh the possible benefits. They cited a lack of reliable scientific evidence, Lisa Littman’s research on detransitioners and the worrying lack of explanation for the sharp rise in youth gender dysphoria in females. They also called for the shuttering of three of the country’s six paediatric gender clinics.

Unclear Guidelines

However, according to Avi Ring, whose child was treated with “gender-affirming” hormones despite showing signs of mental illness, the new guidelines are unclear as to what the actual practical consequences of gender dysphoria diagnosis should be. “It mentions “psychosocial support” for minors, though it is likely not exploratory psychotherapy because the directives are that clinicians should “affirm” the gender identity of the patient,” says Ring.

A few other recommendations are not clear, he says. First, clinicians are cautioned to be aware of “co-occurring” mental health issues, mainly ADHD and autism. “But there are no instructions as to whether this is to be considered a differential diagnosis, and what treatment should be offered should gender dysphoria be diagnosed.” He also says there are no instructions on who should be responsible for granting ethical approval of research projects and whether it applies only to clinical trials; “research only” is not well defined.

The national centres for minors are to be decreased from six to three, but Ring wonders whether the most extreme clinics might continue to prescribe puberty blockers. He adds that the guidelines are also vague about what constitutes the “exceptional cases”, and mastectomies can still go ahead.

Parent Power

Sweden is not entirely out of the woods; once these adolescents reach 18, they can do what they like. It’s every parent’s worst fear. But the Swedish trajectory shows that people power- or parent power- can be a formidable force against gender ideology in medical, political and cultural institutions.