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Danish policy on youth gender care: more cautious than before

Denmark has had a national service for under-18s with gender dysphoria since 2016. In a review article in the Danish medical journal Ugeskrift for Læger (July 2023), the authors write that hormone treatment is now offered to far fewer young people than before and that Denmark, like Sweden and Finland, has taken a more cautious approach (source).

What changed

Referrals rose from 97 in 2016 to 352 in 2022; in 2022, 70 percent were young people aged 11 to 18 registered female at birth. According to the article, the Danish service involves:

• Before hormone treatment begins, a thorough assessment and psychiatric evaluation. Decisions on hormones are discussed in a multidisciplinary team of paediatric endocrinologists, child and adolescent psychiatrists and psychologists.
• The duration of the gender dysphoria and the psychosocial situation weigh heavily. A referral is rejected if it is unlikely that medical or surgical treatment can be offered, for example with an unstable psychosocial situation or a short duration of dysphoria.
• The standard pathway (at least five assessment sessions, psychiatric evaluation, hormone information) is intended for young people over 10 with gender dysphoria since childhood and a stable psychosocial situation.
• Puberty blockers can be given from Tanner stage II or III, hormones from age 15 to 16. Surgery is generally not offered before age 18.
• According to the article, a mental disorder is not a barrier to treatment, but the assessment weighs whether the dysphoria could be an aspect of that disorder, for example in autism, and whether the young person can grasp what the treatment entails.

The youth service is concentrated at the Sexologisk Klinik and the Department of Growth and Reproduction at Rigshospitalet and the child and adolescent psychiatry unit at Bispebjerg Hospital, all in Copenhagen. From age 18, care continues at one of three adult centres in Aalborg, Odense and Copenhagen.

Co-occurring mental health problems

The authors name depression, anxiety, suicidal thoughts or self-harm, autism and ADHD as the most common psychiatric diagnoses among referred young people. This picture is based on research from several countries; the share of young people with a psychiatric diagnosis ranged from 75 percent in Finland to 33 percent in the Netherlands, and why has not been investigated. It matches what the Cass Review on co-occurring problems describes.

What the Danish doctors also write

The article is not a call to stop. The authors write that early gender-affirming treatment showed good physical and psychological results in a number of studies, but that knowledge is lacking on long-term effects, on regret and on the changed group of referred young people. They write that newer studies suggest the beneficial effects are not found in young people with psychiatric disorders. They do conclude that several countries, Denmark included, have started a more cautious approach to hormone treatment until more evidence is available.

Denmark in the Cass Review

The final report of the Cass Review mentions Denmark in its comparison of guidelines: Belgium, Finland, Denmark and Norway require long-lasting gender dysphoria or incongruence for puberty blockers, and Denmark and Finland describe a different pathway for young people with psychosocial concerns or a short history of distress (paras 14.15 and 19.2 of the report; source). The report also discusses a Danish register study of 3,812 transgender people (Glintborg et al., 2023; para 15.31).

The Netherlands

In the Netherlands, the Ministry of Health asked the Health Council for advice following two motions in the House of Representatives. In its advice of 30 June 2026, the Council calls the strength of evidence for the effects of hormone treatment low to very low, but describes Dutch care as carefully organised and sees no reason to organise it differently (source). See also the Dutch rollout.