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Feb 23 10 tweets 2 min read
Yesterday, Sweden released its long-awaited guidelines for the care of gender-dysphoric youth. These guidelines represent a major departure from the WPATH "Standards of Care," and are a vital step towards safeguarding vulnerable youth from medical harm./1…
SEGM will be undertaking an analysis of Sweden's new guidelines, which we will share at a later date. Below is a summary of our initial take-aways and observations. /2
Sweden’s new guidelines emphasize that gender-dysphoric youth will continue to receive care. However, health care for gender dysphoria is no longer reduced to “hormones and surgeries.” The recommendations now call out a key role for psychiatric and psychosocial services. /3
The guidelines assert that based on current evidence, the risks of hormonal interventions outweigh the possible benefits. Thus, these interventions (often referred to as "gender-affirming care") will not be available outside of research settings, except as "last-resort." /4
Sweden is realigning with the classic “Dutch Protocol” model, where only early childhood-onset gender dysphoria cases will be considered for hormones and surgeries. Those with post-puberty onset of trans identity will not be candidates for hormones/surgeries as minors. /5
The guidelines highlight the unexplained rapid rise in trans identification in youth, especially teenage girls. They also note the worrying rise of detransitioners & regretters, which contradicts prior estimates of "low regret." They cite Littman 2021. /6…
The guidelines also note the lack of knowledge about how to treat "non-binary" youth (the predominant presentation today). They assert that access to medical interventions should be based on the presence of gender dysphoria, rather than the presense of a transgender identity. /7
Sweden is centralizing its gender care for minors to a few centers for highly specialized care. Individual clinics and private providers will not be allowed to provide "gender-affirming" services. /8
The guidelines express concern that little advance in quality knowledge has occurred since "gender-affirming" interventions were first recommended in Sweden in 2015, and that generally, little is known about how to best care for gender-dysphoric youth. /9
In summary, Sweden has changed direction because of a lack of evidence to support medical interventions for gender-dysphoric minors. A new emphasis has been placed on psychiatric care and psychosocial support. Hormonal interventions for minors will be highly restricted. /10

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More from @SEGMtweets

Feb 1
Gender medicine does not have a monopoly on bad science. But if poor research were an Olympic event, it would arguably be a favorite to win the gold. SEGM researchers analyze a recent systematic review of puberty blockers, highlighting key problems./1…
Since individual studies can be unreliable, clinicians prefer to rely on systematic reviews (SR) of evidence. SRs scrutinize all the studies about a topic using rigorous and reproducible methods, separating the “signal” from the “noise.” However, a misleading SR can cause harm./2
A SR by Rew et al. of puberty blockers concluded, "the evidence to date supports the finding of few serious adverse outcomes and several potential positive outcomes." This contradicts the UK NICE SR, which found "little change with GnRH analogues from baseline to followup." /3
Read 10 tweets
Jan 22
The topic of suicide in trans-identifying youth is frequently in the headlines. Yet, until recently, the focus has been on their self-harming thoughts & behaviors, rather than completed suicides. A new study fills this key knowledge gap./1…
Using data from the world’s largest gender clinic (UK GIDS), the rate of completed suicides in the UK was found to be 0.03%, or an annualized rate of 13 per 100,000. No difference between those waitlisted vs treated was detected, likely due to low numbers of suicides (n=4)./2
Gender-dysphoric youth who self-harm must be supported, including - if indicated - with evidence-based suicide prevention protocols. To date, however, no studies have shown that transition reduces the risk of suicide long-term. /3……
Read 6 tweets
Jan 18
SEGM has provided feedback on the draft WPATH SOC8 guideline, which is available on our website. We welcome WPATH's recognition of the profound shift in the incidence of gender dysphoria/gender incongruence and its presentation among youth. /1…
We also welcome WPATH's acknowledgement of the risk of inappropriate medical transition for youth, and the increased focus on psychotherapy assessments, since gender incongruence in youth can arise from multiple causes and may have multiple paths to resolution. /2
At the same time, we are disappointed by the significant methodological limitations of the draft SOC8 guideline. They are most evident in the guideline reporting, but these gaps also raise questions about the quality fo the methodological process used to produce this guideline./3
Read 10 tweets
Dec 29, 2021
What happens when a young person's desire to medically transition is granted, with minimal attention paid to the factors contributing to the development of gender dysphoria? A new publication explores this through a case study of a young detransitioner./1…
The patient identified as transgender at age 14 and was immediately "affirmed" by the school psychologist.
Medical transition was initiated at age 18 after a 30-minute visit with a physician’s assistant. The transition produced initial euphoria that quickly subsided. /2
The patient subsequently developed anxiety, anger and intensely self-destructive moods and behaviors, leading to hospitalizations for suicidal ideation. She suspected that testosterone contributed to her deteriorating mental health, detransitioned, and re-identified as female. /3
Read 7 tweets
Dec 9, 2021
The Journal for Infant, Child, and Adolescent Psychotherapy has published a paper by Dr. David Schwartz. Dr. Schwartz, a psychologist, argues that psychotherapy, rather than hormones and surgery, should be first-line treatment for gender dysphoric youth./1…
Drawing on his extensive experience with gender dysphoric youth and their parents, Dr. Schwartz observes that “gender dysphoria in pre-adolescent children is a condition that ameliorates by itself in most cases if you are just patient" and many grow up to be gay or lesbian. /2
Dr. Schwartz advises clinicians to question the etiology of the rapid rise of gender dysphoria in youth; to be weary of the risks of medical transition; and to help youth overcome preoccupation with the idea that their lives depend on obtaining surgery and hormones. /3
Read 5 tweets
Nov 8, 2021
The Royal Australian and New Zealand College of Psychiatrists (RANZCP) released a position statement in which it no longer presents "gender-affirming" hormonal and surgical interventions as the preferred treatment for gender dysphoria in youth. /1…
The position cites “polarised views and mixed evidence regarding treatment options for people presenting with gender identity concerns, especially children and young people,” stating that “professional opinion is divided" whether affirmation vs other treatments are appropriate./2
The statement recognizes that gender dysphoria can arise from multiple causes, and highlights the important role psychiatrists have in performing a comprehensive assessment. Psychotherapy is presented as a valid alternative to gender-affirmation with hormones and surgery./3
Read 4 tweets

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