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.
It is most unfortunate that our government and most social-media platforms continue to stifle these important discussions — just as they did, with catastrophic results, during the Covid pandemic. What is really needed now is not the suppression of opinions but open and robust debate in the medical community and among the public as to how we might best treat children for what might be an essentially psychological condition. The Swedes have outlined the proper scientific approach to this most delicate and controversial question.