SWEDEN – TRANSGENDER HEALTHCARE

About

SBU, the State’s Committee for Medical and Social Evaluation, is an authority that is tasked with making independent evaluations of methods and efforts in health and medical care, dental care, as well as methods and efforts in social services and the field of functional disabilities/disability…

Updated knowledge support for care for gender dysphoria in young people

SOCIALSTYRELSEN – 26 December 2022

The National Board of Health and Welfare publishes today a final and updated knowledge support for gender dysphoria care for young people. The support emphasizes the need for equal access to care and the importance of increased knowledge about the results of care. “It is important that children and young people who suffer from gender dysphoria are taken seriously, treated well and offered adequate care,” says Thomas Lindén, head of department at the National Board of Health and Welfare.

The National Board of Health and Welfare has in stages updated the knowledge support for gender dysphoria care for young people. Parts of support and investigation as well as recommendations on hormone treatment of young people have been updated in the past, and today the updated knowledge support is published in its entirety.

The knowledge support aims to promote good and equal care for young people with gender dysphoria. At the same time, it can be stated that for several years the care has been characterized by both deficiencies in accessibility and a lack of knowledge about the results of the care.

– The National Board of Health and Welfare therefore wants to emphasize the importance of decision-makers in the health care regions acting for improvement in both issues, and that this needs to happen in the near future. 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. Good psychosocial care is fundamental, says Thomas Lindén, head of department at the National Board of Health and Welfare.

From the past, the National Board of Health and Welfare, based on, among other things, data from SBU, the State Agency for Medical and Social Evaluation, has determined that systematic documentation and follow-up of the care is not carried out to a sufficient extent and that the scientific data is insufficient to assess the effects of puberty-inhibiting and gender-opposite hormone treatment of children and young people.

– The need for good clinical studies is clear based on the knowledge gaps that SBU lists. Follow-up and evaluation was something we emphasized already in the knowledge support in 2015, and since then very little knowledge has been added. It is important that the health care regions work to ensure that systematic documentation and follow-up of care at national level is realized and that clinical studies start, says Thomas Lindén.

– There is a need for data that can provide a coherent picture of the patient group, and follow-up of patients who are offered different care measures.

Review of remaining recommendations

Since the updated recommendations on hormone treatment were published in February, the National Board of Health and Welfare has reviewed and updated the remaining treatment recommendations. In the knowledge support, the National Board of Health and Welfare makes recommendations regarding things that care should offer to young people with gender dysphoria when they are judged to be indicated, such as sexological counseling and treatment, voice and communication treatment, hair removal and fertility preservation measures.

– The expected patient benefit from the measures is assessed as large and the risks as comparatively small. It is important that these measures are also documented for follow-up to enable an increased and collective knowledge of the patient group and care, says Thomas Lindén.

There is also a recommendation regarding breast surgery (surgical removal of breast tissue). Similar to the hormonal treatments, the assessment is that such treatment should continue to be given within the framework of research, and that pending a research study it can be given in exceptional cases, according to the criteria found in the knowledge support

– As with the previously presented recommendations on hormone treatment, among other things, the uncertain state of knowledge speaks for caution at the moment, says Thomas Lindén.

– 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.

Facts

• Gender dysphoria means mental suffering or a reduced ability to function in everyday life, which is caused by gender identity not matching the registered gender
• A couple of years ago, the National Board of Health and Welfare began work on updating the knowledge support for care of children and young people with gender dysphoria, and now the completed support is published as part of a government assignment. In the next step, the authority will update the knowledge support for adults.
• The update of the knowledge support for gender dysphoria care for young people has been done to take into account new knowledge and the changes in the care area that have taken place since the support was published in 2015, and to give recommendations for good care based on today’s conditions.
• Several factors have pointed towards increased caution in offering hormonal and surgical treatment: insufficient scientific evidence, an as yet unexplained increased number of people receiving the diagnosis, especially 13-17 years and with registered gender female at birth, less uniform experience-based knowledge among participating experts than 2015, and the documented occurrence of detransition.
• The National Board of Health and Welfare has previously decided that care for gender dysphoria will become national highly specialized care and will be conducted at three units.

The National Board of Health and Welfare’s new guidelines for care for gender dysphoria more reasonable

MATTS REIMER – 13 December 2022 – Läkartidningen

SAVED ENGLISH TRANSLATION

Sweden Pulls Way Back from Gender-Affirming Care for Children

WESLEY J SMITH – 27 December 2022 – National Review

As the Biden administration and deeply ideological publications such as the New England Journal of Medicine push for treating children with gender dysphoria with nothing but affirmation — and castigate mental-health treatment for gender dysphoria, considering it equivalent to “conversion therapy” — less politicized institutions in other liberal societies are hitting the brakes.

Sweden’s national board of health just updated its guidelines on the care of children with gender dysphoria, and “caution” is its new watchword. It declares that extended psychosocial explorations are key. From its announcement (Google translation):

Young people suffering from gender dysphoria need to be able to quickly receive an investigation and be offered adequate care measures, based on the health-care system’s assessments of care needs. Good psychosocial care is fundamental, says Thomas Lindén, head of department at the National Board of Health and Welfare.

Contrary to the Biden administration’s and gender activists’ assertions that the science is settled — there is a paucity of studies on the best approach to caring for gender-dysphoric children (my emphasis).

The National Board of Health and Welfare has previously, based on, among other things, data from SBU, the Swedish National Agency for Medical and Social Evaluation, concluded that systematic documentation and follow-up of care does not take place to a sufficient extent and that the scientific data is insufficient to assess the effects of puberty-inhibiting and gender-sensitive hormone therapy of children and young people.

The need for good clinical studies is clear from the knowledge gaps listed by SBU. Follow-up and evaluation was something we emphasized already in the knowledge support in 2015, and since then very little knowledge has been added. It is important that the health- and medical-care regions work to ensure that systematic documentation and follow-up of care at the national level is realized and that clinical studies can start,” says Thomas Lindén.

The board also wants to cut back on what activists call “top surgeries,” that is mastectomies of children:

There is also a recommendation regarding breast surgery (surgical removal of breast tissue). Similar to the hormonal treatments, the assessment is that such treatment should continue to be given within the framework of research, and that, pending the onset of a research study, it can be given in exceptional cases, according to the criteria contained in the knowledge support.

“As with the previously presented recommendations on hormone therapy, the uncertain state of knowledge suggests caution at present,” says Thomas Lindén.

The Swedes also note the explosion in cases and the “detransition” phenomenon:

Several factors have pointed towards increased caution in offering hormonal and surgical treatment: insufficient scientific evidence, a yet-to-be-explained increase in the number of people being diagnosed, especially 13–17 years old and with registered sex female at birth, less uniform experience-based knowledge among participating experts than in 2015, and the documented prevalence of detransition.

This recommendation makes clear that, despite the caterwauling of gender-ideology warriors, there is no general scientific agreement — much less certainty — on how to best care for children with gender dysphoria, nor is there currently the depth of knowledge or the kind of systematically collected evidence required to assume that certainty. The recent spike in cases warrants an investigation as it may indicate a social contagion, akin to how youth suicide can sometimes proliferate….

Hormonbehandling vid önsdysfori – barn och unga

En systematisk översikt och utvärdering av medicinska aspekter

Swedish National Board of Health and Welfare (NBHW) – 22 February 2022

LITERATURE SEARCH

EXCLUDED – HIGH RISK OF BIAS

INCLUDED STUDIES

Summary of Key Recommendations from the Swedish National Board of Health and Welfare (Socialstyrelsen/NBHW)

27 February 2022 – SEGM

Background
In February 2022, the Swedish National Board of Health and Welfare (NBHW) issued an update to its health care service guidelines for children and youth <18 with gender dysphoria / gender incongruence. This update contains 14 distinct “recommendations,” with justification for each, referencing a recently completed systematic review of evidence. Three of the recommendations provide guidance for social support for gender dysphoric youth and their families; nine focus on the assessment of gender dysphoria/gender incongruence; and two target hormonal interventions: puberty blockers and cross-sex hormones. Additional updates are anticipated later in 2022.

Key Changes in the Updated Guidelines

Following a comprehensive review of evidence, the NBHW concluded that the evidence base for hormonal interventions for gender-dysphoric youth is of low quality, and that hormonal treatments may carry risks. NBHW also concluded that the evidence for pediatric transition comes from studies where the population was markedly different from the cases presenting for care today. In addition, NBHW noted increasing reports of detransition and transition-related regret among youth who transitioned in recent years.

NBHW emphasized the need to treat gender dysphoric youth with dignity and respect, while providing high quality, evidence-based medical care that prioritizes long-term health. NBHW also emphasized that identity formation in youth is an evolving process, and that the experience of natural puberty is a vital step in the development of the overall identity, as well as gender identity.

In light of above limitations in the evidence base, the ongoing identity formation in youth, and in view of the fact that gender transition has pervasive and lifelong consequences, the NBHW has concluded that, at present, the risks of hormonal interventions for gender dysphoric youth outweigh the potential benefits.

As a result of this determination, the eligibility for pediatric gender transition with puberty blockers and cross-sex hormones in Sweden will be sharply curtailed. Only a minority of gender dysphoric youth—those with the “classic” childhood onset of cross-sex identification and distress, which persist and cause clear suffering in adolescence—will be considered as potentially eligible for hormonal interventions, pending additional, extensive multidisciplinary evaluation.

For all others, including the now-prevalent cohort of youth whose transgender identities emerged for the first time during or after puberty, psychiatric care and gender-exploratory psychotherapy will be offered instead. Exceptions will be made on a case-by-case basis, and the number of clinics providing pediatric gender transition will be reduced to a few highly specialized centralized care centers.

Summary of Key Points (NBHW February 2022 Update)

Following a rigorous analysis of evidence base, there has been a marked change in treatment recommendations. The guidance has changed from a previously strong recommendation to treat youth with hormones, to new caution to avoid hormones except for “exceptional cases.” A more cautious approach that prioritizes non-invasive interventions is now recommended, due to recognition of the importance of allowing ongoing maturation and identity formation of youth…