April 13, 2023

SWEDEN: Sweden, The First Country To introduce Legal Gender Reassignment Puts Brakes On Treatments For Trans Minors. Also Watch Documentary 'Sweden's U-Turn On Trans Kids'.

Thoughts on Things and Stuff published January 16, 2023: Sweden's U-Turn on Trans Kids: The Trans Train (Part 1): The New Patient Group and Regretters.
Thoughts on Things and Stuff published January 17, 2023: Sweden's U-Turn on Trans Kids: The Trans Train (Part 2): Other Issues, Talk Therapy and Suicidality.
Thoughts on Things and Stuff published January 18, 2023: Sweden's U-Turn on Trans Kids: The Trans Train (Part 3): Regret, Reassessment and Policy Reversal.
Thoughts on Things and Stuff published January 19, 2023: Sweden's U-Turn on Trans Kids: The Trans Train (Part 4): Puberty Blockers, Complications and Consent. 
Thoughts on Things and Stuff published January 27, 2023: Surgical Transition: Underlying Issues, Ethics & Regret (Dutch Documentary - English Narration)

Transgender people are becoming more widely seen and accepted. There are many positive and celebratory stories about medical and surgical transition in the media. What is less commonly seen are the stories of individuals who transition and then realize that it was not the right choice for them after major and irreversible changes have been made to their body.

In many cases, these regretters originally presented with multiple complex underlying psychological issues - however the affirmation-only model of treating these individuals leads to their gender issues becoming the priority, rather than first addressing such co-morbid conditions as depression, PTSD, anxiety or body dysmorphic disorder among other considerations.

Stories of regret and detransition should provide important information to doctors and institutions about the ethics of these interventions and the criteria for recommending patients to surgery without first addressing underlying issues. This type of reflection and revision of clinical criteria, protocols and policies does not appear to be happening, however, possibly due to strong pressures made by activist forces both inside and outside of the medical profession.

In 2018 a Dutch documentary aired which looked into one such story of regret and examined the medical institutions and clinical culture which led to the tragic outcome for this individual. Also examined are the influences of social media and the phenomena of regretters who disappear from the view of clinics and the public due to the irreversible harm they experienced as well as ethical considerations in selecting patients for surgery and even the ethics of allowing euthanasia for patients harmed by this therapeutic pathway.

The documentary is presented here with english voiceover based on the original captions.
  
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France24 News
written by AFP staff
Wednesday February 8, 2023

Stockholm – Sweden, the first country to introduce legal gender reassignment, has begun restricting gender reassignment hormone treatments for minors, as it, like many Western countries, grapples with the highly-sensitive issue.

With the number of diagnoses soaring, the medical community faces the dilemma of weighing precaution against the risks associated with not offering treatment to those suffering from "gender dysphoria".

Sweden decided in February 2022 to halt hormone therapy for minors except in very rare cases, and in December, the National Board of Health and Welfare said mastectomies for teenage girls wanting to transition should be limited to a research setting.

"The uncertain state of knowledge calls for caution," Board department head Thomas Linden said in a statement in December.

So-called puberty blockers have been used in young teens contemplating gender transition to delay the onset of unwanted physical changes.

Like many other countries, Sweden has seen a sharp rise in cases of gender dysphoria, a condition where a person may experience distress as a result of a mismatch between their biological sex and the gender they identify as.

According to the Board of Health and Welfare, approximately 8,900 people were diagnosed with gender dysphoria in Sweden between 1998 and 2021, in a country of around 10 million.

In 2021 alone, about 820 new cases were registered.

The trend is particularly visible among 13- to 17-year-olds born female, with an increase of 1,500 percent since 2008.

"It used to be a male phenomenon and now there is a strong female over-representation," psychiatrist Mikael Landen, chief physician at Sahlgrenska University Hospital in Gothenburg, told AFP.

Landen, who contributed to the scientific study on which the Board of Health based its decision, said the reasons for this increase remain largely a "mystery".

"Tolerance has been high in Sweden for at least the last 25 years, so you can't say it has changed," he said when asked if it was simply a result of a more accepting society.

Western debate

The profile of those diagnosed is often complex, according to Linden, as gender dysphoria often occurs in those also suffering from other diagnoses, such as attention deficit and eating disorders or autism.

In May 2021 -- before the Swedish authorities' decision to restrict gender reassignment hormone treatments -- the prestigious Karolinska Hospital in Stockholm chose to restrict such hormone treatments to research projects only.

Other countries are weighing the same questions.

Neighbouring Finland took a similar decision in 2020, while France has called for "the utmost reserve" on hormone treatments for young people.

The UK meanwhile saw a high-profile court case in 2020.

Keira Bell, who regretted her transition from female to male, filed a complaint against the public body responsible for gender dysphoria treatments, claiming she had been too young at age 16 to consent to the treatments.

She ultimately lost her case.

Sweden's recent rollback is all the more notable as it was first in the world to authorise legal gender transition in 1972, paving the way for sex reassignment surgery to be covered by its universal healthcare system.

Rights groups have expressed concern.

Elias Fjellander, president of the youth branch of RFSL, the country's main organisation championing LGBTQ rights, says Sweden's decision risks leading to increased suffering.

"These people might need more care and invasive procedures in the future, because the decision could not be made earlier, even though the medical need was there," he said.

Twenty-year-old Antonia Lindholm, a trans woman who began her transition as a teenager, agreed.

"I think hormones save a lot of people," she told AFP.

"If I were 13 today, I wouldn't have a chance" of getting this treatment, Lindholm added.

Regret

But others who have had hormone treatment support the Swedish position.

Mikael Kruse, 36, changed his gender in his late 20s but had a change of heart and finally "detransitioned".

"I think it's good to take a break to understand what's going on," he told AFP.

For seven years, the Swede lived as a woman, but that never resolved his discomfort.

A new diagnosis revealed he had Asperger's Syndrome as well as Attention Deficit Disorder, and the suffering he thought was related to his gender was due to different factors.

"All the pieces of the puzzle fell into place," Kruse said.

For Carolina Jemsby, co-director of the Swedish documentary The Trans Train which brought the care of adolescents into the limelight in 2019, the current debate shows it is "more complex than the healthcare system and society had hoped".

"One aspect of this dilemma is that it has become a political issue," she told AFP.

"It does a disservice to this group who need scientifically proven medical care to help them and give them a better life, and a better ability to live who they are."

In 1972 Sweden introduced an act to allow people to legally change their gender thus becoming, according to the government, "the first country in the world to introduce a formal option in law to be assigned with a new legal gender".

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Euro News
written by Roselyne Min with AFP
Friday February 17, 2023

While Spain pushes ahead with laws making it easier for teenagers to change gender, other European countries that previously championed transgender rights are quietly backtracking.

The U-turns come amid a sharp rise in people reporting gender dysphoria - where people feel that the gender assigned to them at birth is not the one they identify with.

Sweden, known as a pioneer in LGBTQ rights, started restricting gender-affirming hormone therapy for minors - allowing it only in very rare cases - a year ago.

In December last year, it also limited mastectomies for teenage girls wanting to transition to a research setting, citing the need for "caution".

'The risks outweigh the benefits'

Back in 2015, the Swedish health authority had stated that puberty blockers and cross-sex hormones were “safe”. These treatments are designed to help people with gender dysphoria transition from their biological sex to the gender they personally identify with.

Sweden’s National Board of Health and Welfare explains that the reason behind the rollback is that little is known about the effects of these treatments over the long term and "the risks outweigh the benefits currently".

However, experts say those treatments were designed for exceptional cases in the first place.

"We had a protocol in place which was designed for very rare and extreme cases and suddenly the demand exploded so we continued to use that protocol,” said Mikael Landen, a psychiatrist specialising in gender dysphoria who contributed to the scientific study on which Sweden’s health authority based its decision.

“Maybe we shouldn’t have done that. But I wouldn’t be the one criticising the clinicians for doing that because it was difficult, they wanted to help these patients," he told AFP.

Sweden, like many other western countries, has in recent years seen a sharp rise in diagnoses of gender dysphoria.

According to the Swedish health authority, the trend is particularly visible among 13- to 17-year-olds assigned female at birth, with an increase of 1,500 per cent between 2008 and 2018.

Experts say the reasons for this increase remain largely a "mystery".
Oh really? A mystery? The children are being confused by their teachers at school, cartoons, super hero movies, and even children's books. Gender confusion is being pushed on vulnerable children. This is child abuse. (emphasis mine)
"Tolerance has been high in Sweden for at least the last 25 years, so you can't say it has changed," Landen said when asked if it was simply a result of a more accepting society.

‘Serious side effects’

In 2019, there were at least 13 minors who suffered from "serious side effects,” according to Swedish reports.

One of them had developed osteoporosis - a health condition that weakens bones - after taking puberty blockers. Others have suffered from liver damage, significant weight gain and depressive symptoms.

This was revealed by investigative journalist Carolina Jemsby, who directed the documentary ‘The Trans Train’.

She believes the current debate shows the issue of gender-affirming care for trans teens is "more complex than the healthcare system and society had hoped".

"One aspect of this dilemma is that it has become a political issue," she told AFP.

"It does a disservice to this group who need scientifically proven medical care to help them and give them a better life, and a better ability to live who they are".

A Swedish paediatric endocrinologist, Ricard Nergรฅrdh, recently told the country’s public broadcaster that the procedure teenagers with gender dysphoria go through was “chemical castration”.

‘Hormones save a lot of people’

The change is all the more notable as Sweden was the first country in the world to authorise legal gender transition in 1972, paving the way for sex reassignment surgery to be covered by its universal healthcare system.

As the government revisits its policies, some in the transgender community are concerned.

"These people might need more care and invasive procedures in the future, because the decision could not be made earlier, even though the medical need was there," said Elias Fjellander, youth representative of RFSL, the Swedish Federation for Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Rights.

"What we're really seeing is that in some cases, the hospitals do not have resources, that teams giving gender-affirming care do not have the resources to follow up in the way that is needed".

Antonia Lindholm, a Swedish transgender woman, is worried for those who no longer have access to hormone treatments.

“Hormones save a lot of people, and yes I do feel upset that if I were to come out and be 13 right now, I wouldn’t have a chance”.

Hot-button issue

Several European countries are stepping back from gender-affirming care.

Finland, which recently passed a new law allowing trans people to change their legal gender with a simple declaration, restricted hormone therapy for minors in 2020.

France followed suit by calling for "the utmost reserve" on hormone treatments for young people.

Broadly speaking, transgender rights have been a hot-button issue across many countries. Hungary passed a law in 2020 banning trans or intersex people from legally changing their gender,

Just last month, the UK government blocked the Scottish government's Gender Recognition Reform Bill, which made it easier for people to self-identify as transgender without the need for a medical diagnosis. The reform championed by Nicola Sturgeon caused a major political row and played a role in her shock resignation as first minister on Wednesday.

One country, however, is bucking the trend: Spain has just passed a controversial law allowing anyone over 16 to freely change gender on their ID card.

Until now, adults in Spain could only request the change with a medical document attesting to gender dysphoria and proving they had undergone hormonal treatment for two years. Minors needed judicial authorisation.

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