Some European countries are changing how they approach gender care in children and young adolescents experiencing gender incongruence/dysphoria. There is a move away from medicalized care to placing more emphasis on providing psychosocial support for this younger age group.
England’s Cass Review Said Evidence Is Weak
On April 10, 2024, the final report of the Cass Review was published following 4 years of meta-analyses of the available literature. The review, carried out by pediatrician Dr Hilary Cass, was prompted by a soaring rise in demand for gender identity treatments, such as puberty blockers, among children and teens in the UK. It found “remarkably weak evidence” to support gender treatments for children. “For most young people,” the review said, “a medical pathway will not be the best way forward to manage gender-related distress.”
In March, England’s National Health Service said it will no longer prescribe puberty blockers to children at gender identity clinics owing to a lack of evidence to support their safety or effectiveness. Instead, they will only be available as part of clinical research trials.
On April 18, Scotland’s only gender clinic announced that it had also paused prescribing puberty blockers to persons younger than 18 years, and new patients who are minors will no longer receive other hormone treatments.
Some Changing Practices in Europe
The Netherlands
In the Netherlands, where the Dutch Protocol originated, practice guidelines have not yet been revised. However, on February 15, 2024, the Dutch Parliament ordered that an investigation be conducted into the physical and mental health outcomes of children prescribed puberty blockers.
Norway
Norway’s Healthcare Investigation Board (Ukom) recommended in 2023 that the Ministry of Health and Care task the Directorate of Health to revise the national professional guideline for gender incongruence in a way that is based on a systematic summary of knowledge. The Ukom report recommended that puberty blockers and hormonal and surgical gender confirmation treatment for children and young people should be defined as experimental treatment. Explicit new guidance from the country has not yet been issued.
France
France’s National Academy of Medicine recommended in 2022 that the “greatest reserve” is required regarding the use of puberty blockers and/or transitioning hormones in children and adolescents. However, their prescription continues to be possible with parental authorization at any age.
Sweden
Sweden’s National Board of Health and Welfare said in 2022 that the risks of puberty blockers and gender-affirming hormone treatments for persons younger than 18 years currently outweigh the potential benefits for the group as a whole. It added that treatment with hormones should continue to be given, but only within a research framework to further understand its impact on gender dysphoria, mental health, and quality of life in this age group. Hormones can also be given to this age group in exceptional cases, the board said.
Finland
Finland’s Council for Choices in Health Care revised its guidelines in 2020 to prioritize psychosocial support over medical intervention but confirmed that initiation of hormonal interventions may be considered in a person before the age of 18 “if it can be ascertained that their identity as the other sex is of a permanent nature and causes severe dysphoria.”
More Data From Europe
One of the studies that informed the Cass Review conducted a survey of European gender services for children and adolescents between September 2022 and April 2023.
It found that Greece, Luxembourg, and Ireland do not have gender services for children and adolescents.
Source: Medscape Registration
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