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SBU report Sweden and Karolinska: the first country to break with affirmation

In 2021, Sweden was the first Western country to break with the affirmative approach for minors. The Karolinska Clinic scrapped hormones and blockers outside of a research setting. The SBU report confirmed this in 2022. Sweden preceded the Cass Review by three years — and reached the same damning conclusion. Four Scandinavian countries plus the UK have since independently rolled back the affirmative model for children.

Karolinska — May 2021: the first breakup

The Karolinska University Clinic in Stockholm—at the time a leading European gender clinic—discontinued the use of puberty blockers and cross-sex hormones for minors outside of approved research. The reason was clinical and methodological: the Dutch Protocol could not be replicated and the evidence was insufficient for routine clinical use. A clinic that had been working according to WPATH guidelines for years thus pulled the plug on the model itself. That was not a political decision; it was their own data that could no longer be denied.

SBU 2022 — systematic review

The Statens beredning för medicinsk och social utvärdering (SBU) examined all available studies according to GRADE methodology. Conclusions:

• Evidence for blockers and hormones in gender dysphoria in children is insufficient.
• Potential harm is a major concern — not suitable for routine child psychiatric care.
• Treatment must be within the research protocol and subject to strict ethical review.

Socialist Party 2022 — policy is being reviewed

The Swedish health authority (Socialstyrelsen) subsequently redesigned the guideline: psychosocial support is primary care, and hormonal and surgical interventions for young people are the exception. A complete reversal from the old policy. Comorbidity — autism, depression, eating disorders — must be treated first, as the Cass Review later confirmed.

What this means for the "international consensus"

The largest WPATH-affiliated European gender clinic has abandoned the model. With that, the "international consensus for gender-affirmative care" — if it ever existed — is fiction. NICE reached the same conclusion regarding the evidence as early as 2020; COHERE , Ukom , and the Danish guideline followed. Four Scandinavian countries plus the UK, independently of each other, based on transparent evidence-based research. The claim that this is "anti-trans" is propaganda; it is simply medicine correcting itself.

What this says about the Netherlands

The WPATH-affiliated Dutch gender care providers — VUmc, UMCG — have so far delivered nothing with this level of transparency. No independent evidence review by a Dutch authority, no replication of their own Dutch Protocol, no public long-term data. Sweden had a 30-year head start as a European center and has abandoned the model. The Netherlands is clinging to a protocol whose empirical basis has been internationally falsified.