The “Dutch protocol” for treating gender dysphoric minors has been discontinued over concerns of medical harm and uncertain benefits

News update originally published by the Society for Evidence-Based Gender Medicine

 

The Karolinska Hospital in Sweden recently issued a new policy statement regarding treatment of gender dysphoric minors at its pediatric gender services division. This policy, which took effect in April 2021, ended the practice of prescribing puberty blockers and cross-sex hormones for minors under age 16. Hormonal intervention for youth ages 16-18 is still allowed, but can only occur in research settings approved by Sweden’s ethics review board, following a thorough informed consent that discloses the significant risks and uncertainties of hormonal interventions, and considers the minor’s maturity level and ability to provide true informed consent.

This is a watershed moment. Sweden is the first country whose renowned hospital has explicitly stopped following the Dutch protocol, which allows for administration of puberty blockers at age 12 (and increasingly, as young as 8-9, at the early stage of puberty known as Tanner 2), and cross-sex hormones at the age of 16. It also is the first country to officially deviate from WPATH guidance. WPATH has long positioned itself as the world authority in transgender health. However, in recent months, several countries’ health authorities have conducted their own reviews of the evidence and found the evidence insufficient to justify early medical interventions promoted by WPATH’s guidelines.

Sweden’s new policy is consistent with Finland’s recently revised guidelines, which were changed to prioritize psychological interventions and support rather than medical interventions, particularly for youth with no childhood history of gender dysphoria (presently the most common presentation). Significant changes are also underway in the UK, following the High Court ruling that deemed hormonal interventions for minors experimental, and cautioned that minors are rarely able to provide truly informed consent for interventions with such profound life-long consequences. The NHS (National Health Service) has recently suspended the initiation of hormonal interventions to minors under 16. The ruling is currently under appeal, with a hearing scheduled for June 2021.

In the US, the debate about the treatment for gender dysphoric minors has become politicized, with some states introducing laws banning the use of various hormonal interventions in minors, while other states perusing legislation to ban psychological treatment modalities for gender dysphoria. As international awareness of the low quality of evidence of the benefits and the potential harm of medical interventions in gender-dysphoric minors grows, the focus is expected to shift to the non-invasive options for ameliorating distress, such as the provision of ethical psychological treatments and support.

The original announcement of the new policy obtained by SEGM, as well as the unofficial translation, are below: