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Scandinavia stopped

The countries that were leading the way have changed course. The Netherlands has not yet done so.

Sweden, Finland, and Denmark were long considered progressive role models in the field of gender care. All three have since drastically tightened their policies on medical interventions for minors with gender dysphoria—based on their own scientific evaluations. The Netherlands, which developed the original treatment protocol, is falling behind.

Sweden

The Karolinska Institute—one of the world’s leading medical institutions—stopped prescribing puberty blockers and cross-sex hormones to minors outside of research settings in 2021. The Swedish National Board of Health followed suit in 2022 with a national policy: the risks “likely outweigh the expected benefits.”

Finland

Finland revised its guidelines as early as 2020. The new approach prioritizes psychological counseling over medical intervention, particularly for adolescents whose gender dysphoria developed after puberty. Medical treatment remains reserved for cases of long-standing, stable gender dysphoria.

Denmark

In Denmark, referrals to the gender clinic tripled between 2016 and 2022. At the same time, the proportion of patients receiving hormone treatment dropped from 67% to 10%. The clinic tightened its selection criteria following its own evaluation of the outcomes.

The shift in Scandinavia is not the work of conservative politicians but of medical institutions that evaluated their own data. The fact that the Netherlands—birthplace of the Dutch Protocol, which was emulated worldwide—barely engages in this debate is telling.

Related topics:

The Cass Review, Children and gender, Detransition

What the international reevaluation reveals

The “Scandinavia Halt” is not separate from the broader medical reevaluation. The Cass Review (2024) in the United Kingdom led to a de facto halt on puberty blockers within NHS England. Starting in 2022, SBU and Karolinska in Sweden withdrew their support for medical transition in minors outside of a study context. Finland (COHERE, 2020) and Norway (UKOM, 2023) followed suit. NICE (2020) classified the evidence base for puberty blockers and cross-sex hormones as “very low certainty.”

The Netherlands is lagging behind. The Dutch Protocol—once touted as an international model—is being abandoned elsewhere. The data on which it is based do not come from randomized trials, but from observational studies with cohorts that are not generalizable to the current referral population.

How the discussion is being stifled

Across Scandinavia, the gender-affirming model is defended through moral pressure and scientific claims that do not hold up to scrutiny. Anyone who refers to the Cass Review or the Scandinavian shift is not met with a rebuttal but labeled as transphobic. The WPATH Files (2024) revealed that even within WPATH, there was uncertainty regarding informed consent for minors.

Parents who come forward with concerns are dismissed as troublemakers. Clinicians who advocate for caution face internal complaints and public campaigns. The result: only one side of the story remains audible.

International Reconsideration

In recent years, various national health authorities have distanced themselves from the gender-affirming model for minors. The common denominator: evidence of lasting benefits is lacking, while the risks are real.

  • Cass Review (2024). Review commissioned by NHS England, conducted by Hilary Cass. Conclusion: the evidence base for puberty blockers and cross-sex hormones in minors is weak. NHS England ceased the routine prescribing of puberty blockers outside of clinical trials.

  • SBU — Sweden (2022). The Swedish Agency for Health Technology Assessment (SBU) and Karolinska University Hospital discontinued the use of puberty blockers and hormones for minors outside of clinical trials. Reason: lack of evidence for effectiveness and safety.

  • NICE — United Kingdom (2020). Two NICE evidence reviews (puberty blockers and cross-sex hormones) classified the evidence base as very low certainty. None of the studies identified met modern methodological standards.

  • COHERE — Finland (2020). The Finnish Council for Choices in Health Care revised the protocol: psychotherapy as first-line treatment, medical transition for minors only in exceptional cases and within a research setting.

  • UKOM — Norway (2023). The Norwegian UKOM classified transgender care for minors as experimental; existing protocols do not meet the requirements for evidence-based care.

  • WPATH Files (2024). Internal discussions among WPATH clinicians acknowledge that informed consent for minors is problematic and that serious side effects (bone density, fertility, cognitive development) are not adequately explained.