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SBU report Sweden and Karolinska: the Swedish change of course

In spring 2021, the Astrid Lindgren Children's Hospital at Karolinska decided to start hormonal treatment of minors with gender dysphoria only within approved research. In 2022 the SBU concluded that the evidence is insufficient to assess the effects, and Socialstyrelsen adjusted its guideline. The Cass Review (2024) later reached similar conclusions about the evidence base.

Karolinska — spring 2021

From 1 April 2021, the Astrid Lindgren Children's Hospital of Karolinska University Hospital in Stockholm no longer started puberty blockers or cross-sex hormones under the age of 16; for 16- to 18-year-olds only within approved research. A guideline of April 2021 (effective 1 May) extended this to all minors. The hospital pointed to a 2019 SBU knowledge overview that found little evidence on long-term consequences, and to the British ruling in the Bell case. See also the criticism of the Dutch Protocol.

SBU 2022 — systematic review

The Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) published a systematic review of hormonal treatment of children and adolescents with gender dysphoria on 22 February 2022 (SBU 342) (source). Conclusions:

• The evidence is insufficient to assess the effects of puberty blockers and hormones on gender dysphoria and psychosocial well-being.
• The long-term effects on, among other things, psychosocial health could not be assessed.
• The SBU itself makes no recommendations; that is the task of Socialstyrelsen.

Socialstyrelsen 2022 — the guideline is adjusted

The Swedish National Board of Health and Welfare (Socialstyrelsen) concluded in February 2022 that the risks of puberty blockers and hormones for under-18s currently outweigh the possible benefits for the group as a whole, and that such treatment should take place within research and outside it only in exceptional cases. The December 2022 guideline calls good psychosocial care essential (source). See also what the Cass Review writes about mental health.

What this means for the "international consensus"

Sweden is not alone in this. The NICE reviews (2020) rated the results for puberty blockers as very low certainty (source); see NICE. Finland (COHERE, 2020) urges extreme caution, and the Norwegian board Ukom recommended in March 2023 that these treatments be defined as "utprøvende behandling" (experimental treatment) (source); see also the Norwegian and Danish guideline. The Cass Review (2024) judged only the Finnish and Swedish guidelines to be recommendable for practice (source).

What this says about the Netherlands

In the Netherlands, the Health Council issued advice on transgender care for young people on 30 June 2026 (source). For the Dutch history, see the Dutch rollout.