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Updated recommendations regarding hormone therapy for gender dysphoria in adolescents

Published: 2022-02-22 at 10:00


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The National Board of Health and Welfare is today releasing new recommendations for hormone treatment for adolescents under 18 with gender dysphoria. Due to scientific uncertainties and new knowledge, the National Board of Health and Welfare now recommends restraint when it comes to hormone treatment. At the same time, it is important that children and young people with gender dysphoria are taken seriously, treated well and given adequate care.


Gender dysphoria is psychological suffering or a reduced ability to function in daily life caused by a gender identity that does not match the registered gender. The National Board of Health and Welfare updates knowledge on the management of gender dysphoria in young people and today presents new recommendations for anti-puberty treatment and confirmatory hormone therapy of the kind among young people.


The National Board of Health and Welfare has previously presented statistics showing that the pool of young people seeking treatment for gender dysphoria has increased significantly. Between 2008 and 2018, the number of newly diagnosed cases of gender dysphoria increased. The increase was particularly large among people aged 13 to 17 and whose declared sex was female at birth.


- The change is greater in young people than in older people, and greater in the group whose registered sex is female than male at birth. Several factors have been put forward as explanations, but it has not been possible to identify the underlying causes. The changes therefore represent an uncertainty that we had to take into account when deciding what care to recommend for minors,” says Thomas Lindén, head of service at the National Board of Health and Welfare.

Lack of firm conclusions on the efficacy and safety of treatments


At the request of the National Board of Health and Welfare, the SBU carried out a literature review of all relevant studies on the efficacy and safety of hormone treatments. The report, published today, shows that it is not yet possible to draw firm conclusions about the effectiveness and safety of treatments based on scientific evidence.


- The conclusion is that very little knowledge has been added on the effects and safety of treatments since 2015", says Thomas Lindén.


- During the development of the knowledge material for the care of children and adolescents with gender dysphoria in 2015, the importance of systematic monitoring and evaluation of the measures proposed in the context of clinical work was emphasized in the best possible way. We now see that this has not yet been done, which contributes to the need to modify the recommendations.


The SBU has also compiled studies on changes in perception of gender identity or discontinuation of treatment. It is not possible to determine how often it is that people undergoing gender affirming treatment subsequently change their perception of their gender identity, discontinue treatment, or regret it in some way. At the same time, detransition is documented to occur, and there may also be a hidden risk.


- For the group that regrets or discontinues the treatment, there may be a risk that the treatment has led to a deterioration in health or quality of life", explains Thomas Lindén.

The risks outweigh the benefits right now


Based on these findings, the National Board of Health and Welfare concludes that the risks of anti-puberty and sexual reassurance hormone therapy for those under 18 currently outweigh the potential benefits for the group. in its entirety.


- The assessment is that hormone treatment should continue to be provided as part of research. We need to know more about the impact of treatments on gender dysphoria and on the mental health and quality of life of minors, in the short and long term,” says Thomas Lindén.


- Pending the establishment of a research study, we believe that treatments can be administered in exceptional cases. Here we offer a set of criteria that healthcare providers can use as the basis for individual clinical assessments.


At the same time, it is important that young people with gender dysphoria continue to receive care and treatment within the health system. This includes both hormonal treatments when deemed justified and, for example, psychosocial interventions, child psychiatry treatments and suicide prevention measures when necessary.


- Health services must continue to ensure that children and young people with gender dysphoria are taken seriously, well cared for and receive adequate treatment. In the future, this care will become highly specialized national care, which will increase the possibilities for research and the development of knowledge in this area of care, while further improving patient safety and quality,” says Thomas Lindén.


Facts and figures

The National Board of Health and Welfare is in the process of updating the knowledge material for children and young people with gender dysphoria/gender incongruence.

The works are carried out in stages and are commissioned by the government. The chapters on support and investigation have already been published.

This update is done to reflect new knowledge and changes in care since the knowledge material was published in 2015, and to provide recommendations for good care based on current conditions.

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