Swedish health board wants doctors to stop prescribing life-saving puberty blockers
A placard says “protect trans kids” during the trans march on the streets of Toronto during Pride month. (LightRocket via Getty/ Anatoliy Cherkasov/SOPA Images)
A Swedish government agency has recommended that puberty blockers be withheld from trans youth, despite overwhelming evidence that the treatment is “life-saving”.
The National Board of Health and Welfare, also known as the Socialstyrelsen, is Sweden’s equivalent of the UK’s NICE. It is responsible for issuing public health advice and its guidelines inform – but do not necessarily dictate – clinical practice.
In new guidelines on puberty blockers and hormone therapy for trans youth published on Tuesday (22 February), the Socialstyrelsen advised that blockers should only be prescribed in “exceptional cases” and claimed their use is backed by “uncertain science”.
Researchers in 2020 found that puberty blockers can be “life-saving” for trans youth, drastically decreasing their chance of suicide, depression and anxiety.
Thomas Lindén, head of knowledge-based policy at the Socialstyrelsen, said that the agency was unable to “draw any definite conclusions about the effect and the safety of [puberty blockers] based on scientific knowledge”, and claimed that “the risks… outweigh the possible benefits”
Only in so-called “exceptional cases” should puberty blockers be given, he said. But “psychosocial interventions, child psychiatric treatment and suicide prevention measures” should be provided by clinicians.
Logo for the office of the Swedish National Board Of Health And Welfare. (Michael Campanella/Getty Images)
In Sweden, organisations commissioning and delivering services are expected to take Socialstyrelsen recommendations into account when planning and providing healthcare.
Clinicians are expected to be familiar with the advice and take it into account when exercising clinical judgement – it does not, however, override individual responsibility for what treatment is best for their patients. The guidelines also help decision-makers allocate resources and formulate their own specific guidelines.
This means that while Socialstyrelsen’s judgments play a big part in what healthcare is available to Swedes, individual providers may supply alternatives or tweak the guidelines to suit particular patients.
Socialstyrelsen also approves all requests to change gender markers on identity documents in Sweden
Swedish health board cites ‘junk science’
Lindén said that Socialstyrelsen officials had requested the Swedish Agency for Health Technology Assessment (SBU), a healthcare watchdog, to provide it with all “relevant studies on the effect and safety of hormone treatments“.
When combing through the compiled research, SBU concluded that more research into puberty blockers must be done. This is despite puberty blockers already being well-studied – a 2021 study found their use helps trans teens feel happier.
Among the evidence that the Socialstyrelsen cites is an American study vastly debunked as “junk science” by activists and healthcare professionals.
The 2018 analysis by Lisa Littman on detransitioners (people who renounce their trans identities and return to the gender they were assigned at birth) sought to prove the existence of “rapid-onset gender dysphoria“.
The debunked term coined by Littman claims a “social contagion” is responsible for young people identifying as trans, rather than, say, growing acceptance of gender diversity.
No major healthcare organisations recognise rapid-onset gender dysphoria. Littman’s research was, within a week, pulled by the journal PLOS One.
However, Lindén came to the conclusion: “It is 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 the treatment or in some aspect regret it.”
A 50-year longitudinal study in Sweden that found of 767 trans people, just two per cent expressed regret following gender-affirming surgery. Studies in Britain and the Netherlands found similar rates of 0.47 per cent and 1.9 per cent respectively.
Conversely, around 20 per cent of people who have undergone knee replacement surgery come to regret it, researchers found.
The same study which confirmed the majority of young trans people feel happier and more comfortable after being prescribed puberty blockers also found that 98 per cent continued on to hormone replacement therapy.
