Sweden As the Canary In the Coalmine of Gender-Affirming Medical Treatment
(In Which I Attempt to See If There Exists the Possibility of a Rational,
Health-Based Discussion of Rapid Onset Gender Dysphoria)
(Whereas Up To This Point the Answer Has Been a Resounding "No")
If we want to peer into the future and see what it holds for the medical
treatment of the current generation of ROGD girls here in America,
we should look to Europe for some clues.
Most everything related to healthcare in the US is complex and expensive, and
a big part of that is that we don't have a centralized healthcare system,
and so data is generally not available. That can make it prohibitive
when trying to look for, and analyze, trends in healthcare.
This is decidedly the case with Gender-Affirming Medical Treatment, as there
is no medical oversight of this treatment, it's not reviewed by an institution
or board (you don't even need a prescription for testosterone), and so there
are no official numbers in the US to accurately show the increase in RODG
in the past few years.
However, this is not the case in Europe. As far as I can tell, Europe is ahead
of the US in this area by quite a few years (by a decade or two), and so
there are some trends that are definitely worth noting.
Several countries have shown a significant increase in the number of adolescent girls
identifying as transgender over the past ~dozen years:
- In England, in 2018, there's
been a 4400% increase in girls being referred for transitioning treatment in the past decade.
- In Sweden, in 2021, they estimate a 1500% increase
since 2000.
- In Finland, beginning in 2012, there was a
sharp increase
in the number of late-presenting cases of gender dysphoric youth, primarily driven by adolescent females
In America, we can only guess.
These European countries leaned in hard on medical interventions for adolescents to
treat gender dysphoria. The treatments were known as the "Dutch Protocol"
and had been the de facto
gold-standard approach to care for children and teenagers with gender dysphoria.
These included the use of puberty blockers, hormones, and eventually,
surgery. This treatment was started for kids as young as twelve.
From what I can tell, they had a 10-year head start on the United States.
What did they learn over those ten years?
Fast forward by about a decade (to "circa now") and let's look at what's happening:
- In Finland, in 2021, thye've
reversed
course
on hormone treatment and surgeries for minors and adolescents.
- In England, in 2022, they've also
reversed course
and shut down their main clinic (Tavistock), following a comprehensive review.
- In France, in 2022, the National Academy of Medicine, called for
“the greatest caution”
in administering puberty blockers or cross-sex hormones to French youth struggling with gender dysphoria.
- In Sweden, in 2023,
they've halted medical treatment
for trans minors.
- In the Netherlands, in 2023,
doubts have now come
about the very treatments that originated in that country.
So these medical interventions (the Dutch Protocol) went on for more than a decade,
but now all of the originating countries have done a
complete about-face and are now recommending against
these treatments for adolescents with gender dysphoria.
Why?
"Western Europe, where governments and medical authorities in at least five
countries that once led the way on gender-affirming treatments for children
and adolescents are now reversing course, arguing that the science undergirding
these treatments is unproven, and their benefits unclear."
"science unproven"
"benefits unclear"
We knew there was a problem at least
a decade ago (2013): "The findings do not fit the commonly accepted image
of a gender dysphoric minor. Treatment guidelines need to consider gender dysphoria in
minors in the context of severe psychopathology and developmental difficulties."
Here's the TLDR on Finland that tells the entire story in one paragraph:
The Finnish gender identity services program is a worldwide leader in pediatric gender medicine.
The 2020 Finnish guidelines represent a strong signal that the pioneers of pediatric medical
transition are concerned about unintended harm to the growing number of gender dysphoric
adolescents presenting for care. The guidelines echo the concerns voiced by the principal
investigator of the Dutch protocol, who warned the medical community in a commentary
published in Pediatrics in 2020 that a “new developmental pathway” of gender dysphoria
has emerged, including patients with "postpuberty adolescent-onset transgender histories"
and “more mental health challenges,” adding, “these youth did not yet participate in the
early evaluation studies. This raises the question whether the positive outcomes of early
medical interventions also apply to adolescents who more recently present in overwhelming
large numbers for transgender care.”
I will go into some detail on why this reversal is taking place later in the this post.
However, there are many fine articles
on this subject.
From that fine article (which is a "must-read"):
Instead, a brand new cohort has emerged, and these young teens, usually female,
often autistic, and almost always very vulnerable, have created a huge and
unexpected demand in gender clinics all over the world.
They often do not present until puberty has already started, and they often
have no history of gender dysphoria. It is not a disorder, but an ‘identity’.
Many have additional psychological issues – as a result of their gender dysphoria, or the cause?”
The harm that the Dutch protocol has unleashed upon the world is becoming increasingly recognized.
Kuitenbrouwer and Vasterman evidently have done their research and have found the massive flaws involved.
If you've decided to stop reading already, please take away these three key
points, which are excerpted from the above article on England:
- American lawmakers need to follow the lead of another country and put the
brakes on “gender affirming” procedures for children.
- It is increasingly clear that we are witnessing a dangerous craze among
children with mental health challenges rather than the liberation
of the sexually oppressed.
- We need all of the responsible adults
working together to recognize and address the underlying
mental health issues children are experiencing.
That's who I'm looking for: some responsible adults, working together, to help ensure
the best possible outcomes for this current generation of adolescent girls.
We really can learn from our friends in Europe. They have valuable wisdom to
share with us, and we should learn from their mistakes.
There's a youtube documentary series from Sweden (links are below) that goes over the
reasons behind the about-face on the Dutch Protocols. One thing I really like about
this documentary is that they really only talk to three groups of people:
- Trans kids
- Medical professionals
- The parents of some trans kids
In other words: they only talk to the people who are making material
decisions, and the direct family members who are affected by
said decisions.
Now, it's hard to sum up a 1-hour documentary succinctly, but I'm going to
do just that. There really is a single, high-level takeaway from Part 1,
and to illustrate this, here's the transcript beginning at 18:00:
Because they've also seen something else that
characterizes this group.
So in the past five years, since 2012, there's been a huge increase. And
again, what we see is that most of them are teenage girls. But then we
see, this group, who are born biologically female, and these are born
biologically male.
And you see that in the the teenage group, of
those born biologically female, over half of them, nearly 60%, have a
complex mental illness. They're carrying significant trauma with PTSD,
post-traumatic stress, they're on the autism spectrum, they have severe
clinical depression, psychotic symptoms.
(emphasis mine)
Now note what's missing from that analysis:
nearly 60% is only "the ones we know about".
Meaning: there are an awful lot of undiagnosed people walking around ... PTSD, ASD,
sexual trauma, physical trauma, mental illness ... literally EVERY single one of
those is under-diagnosed.
Autism (or "neurodiversity", given the depth and breadth of this classification) is incredibly
under-diagnosed.
Many people don't figure out that they have ASD until they're in their 40s or 50s.
So we can read "nearly 60%", but understand that that number is most definitely
higher, and it could be significantly higher.
And what makes this entire gender-affirming medical treatment approach
unscientific is that, now that we have new data on this cohort,
it's time to start at the beginning, do a rigorous analysis,
and then re-base the treatment for those affected. We've learned
something that's overwhelmingly germane here, and to ignore this
data is both unscientific and unethical.
So what we're effectively doing here in the United States is:
- We allow teens to self-diagnose "gender dysphoria".
- We can rightly assume they have better-than-a-coin-toss odds of also having
a complex mental illness (PTSD,
major depression, generalized anxiety disorder, trauma), and/or
are neurodiverse (autism, ASD, etc).
- We then treat them for gender dysphoria, without (a) even a mention
that their diagnosis could be wrong and without (b) even a mention of
conducting an analysis or evaluation for mental illness.
- We are then surprised (apparently) when kids
are no happier in the months and years after their diagnosis
is affirmed. Are they on fewer meds? No. Are they reporting
lower rates of depression? No. Has the discomfort with their
bodies been rectified? No.
And it all makes sense now: it's because we're treating the wrong
thing.
It's because well-meaning parents, schools, and medical professionals
have abdicated their duty to be the adults in the room
and say "Hey, maybe this isn't the right diagnosis".
It's because doctors have become are life-coaches instead of
medical professionals in this one particular area
(and may have their hands tied by the WA State legislature).
It's because schools are caught up in the overwhelming pressure to flex
their LBGTQ+trans support or face cancel culture.
It's because WA State law has prohibited any/all of the requisite
discussions under the banner of "Conversation Therapy", thereby
prohibiting the requisite conversations.
To me, what happens in the US is medically unethical. We allow very young people,
the majority of whom likely have a mental illness or are neurodiverse, to
self-diagnose, and then WA State law has prohibited the pursuit of an accurate
diagnosis: they are more likely than not to be suffering from something other than GD.
We then treat them.
No other medical condition is handled this way.
In effect, we've pathologized adolescence.
And that, my friends, is why we should look to Europe to learn
from their mistakes, and then use that knowledge to advocate
for better health outcomes (both physical and mental) for
our young people.
Here are the four parts. I became so utterly fascinated during part one that
I transcribed most of it, beginning at the 18th minute. The transcript is
below.
The documentary goes over the history of gender-affirming medical treatment
in Sweden and how this has played out over the past few years. Of course
this documentary in very controversial, as apparently [literally]
everything
is when people discuss this subject.
- The New Patient Group & Regretters (Part 1)
- Other Issues, Talk Therapy and Suicidality (Part 2)
- Regret, Reassessment & Policy Reversal (Part 3)
- Puberty Blockers, Complications and Consent (Part 4)
The TLDR on the documentary is as follows:
In May of 2021 Sweden announced a change of their policy regarding the
medical and surgical transition of children. The change came in the wake
of several bombshell documentaries which explored the issue of medicalization
of children experiencing gender dysphoria in Sweden and Europe.
The controversial documentary series examined the evidence base of the
protocols, the ethics of treating children who cannot consent and the
degree of oversight and accountability that clinics held for their patients.
The english speaking world isn't aware of much of what the documentaries
uncovered because of the language barrier, as the films are mostly in
Swedish. English captions have been made available and for the first
time the films are presented here with english voiceover to make them more accessible.
As I watched this documentary I just found there was so much to talk about.
I began to type in various parts and ended up creating a transcript
for the majority of part one.
Suffice it to say: if I emphasized something, I think it's worthy of
emphasis.
(The numbers are MM:SS timestamps for the video)
18:02 They are concerned, because they've also seen something else
that characterizes this group. So in the past 5 years
(since 2012), there's been a huge increase. And again,
what we see is that most of them are teenage girls.
18:18: But then we see, This group is those are born biologically female,
and these are born biologically male. And you see that in the
teenage group, of those born biologically female,
over half of them, nearly 60%, have a complex
mental illness.
18:41: They're carrying significant trauma, with PTSD -
post-traumatic stress. They're on the autism spectrum,
they have severe clinical depression, psychotic symptoms.
19:27: Once you start on testosterone, you become a patient for life.
You have to come to the hospital, take blood tests, it's
a very serious treatment.
19:37: It's the same thing with a deeper voice. It's there and always
will be. That's why it's important to talk to them and ask them
what happens, if you decide two years down the line that this
isn't right, and now you feel that you are a girl, or a
woman. What will it be like for you to live with a deep
voice and facial hair?
20:00: So we try, but these teens aren't in a position to think
clearly about this.
21:49 These are changes you'll have for the rest of your life,
and that's a serious thing. And I think it's important
to take your time.
22:00: That's why i'm so concerned now. So many people are
pushing people to get treatments like testosterone
very quickly. To remove the breasts, very quickly.
And I think that's incredibly scary, considering
how potent these medical treatments are, and
how much it ill affect, if they are wrong. If
they're wrong, that's an awful lot to undo.
22:35 There might be people in this group that we haven't seen
before. and who we aren't sure will benefit from this
treatment. We don't know how they'll be affected in
the long run. There's no research. But we do it,
and we hope and pray, that it will benefit them,
and that they will be happy.
{pointing to the geometric increase in girls who identify
as trans over the past few years}
23:03: Usually, healthcare is based on science and proven experience.
In her opinion piece, she describes it as "experimental
treatment". The experimental aspect of this, is in this
curve here, which you also have in Sweden.<./span>
{pointing to the geometric increase in girls who identify
as trans over the past few years}
It's that there are people here who we aren't sure will
benefit from treatment in the long run.
24:00 In Sweden, more than half of these teens (who are treated
for GD), also have other psychiatric diagnoses, such
as self-harming, autism, and anorexia. And several
describe other traumas, such as sexual abuse.
Are the same evaluation model and treatment from the
past really right for this new group?
24:27: I asked again. What it is that's going to get better?
And how is this going to help your mental state?
And she can't .. she can't say.
{parent, speaking about their child}
24:35: We've seen that she's just been getting worse since
she started this journey, this transition. So
we're really worried that she'll just keep getting
worse, if they keep pursuing this development.
{parent, speaking about their child}
26:53 When a young person starts their journey towards transition,
they are given puberty blockers, hormones that stop puberty.
These powerful drugs are being prescribed to 15-19 year olds.
{great chart}
Doctors say the body returns to normal development
after the treatment, but no one knows what happens
in the long term.
27:15 One research term is seeing a patient's IQ dropping. other
research finds risks of osteoporosis, and that puberty blockers
can affect the brain and heart.
27:34: It's doctors who decides who gets these drugs. The same
drugs - and same doses - used in chemical castration
of adults. Physiologically, we know some of these
things are to be expected. We know that castration has
an effect on the heart. And we know there's a risk with
the bones with castration, and there's also a mental
effect, that's something we see with castration of both
men and women, with the treatments that exist.
And these are the same drugs?
Yes. The same mode of action. So we'd expect to see
this in girls. I would expect that to happen.
28:24: But these are healthy teenage bodies that are
still growing, that are perfectly healthy physically,
and they're being prescribed these strong drugs.
What kind of benefit do they get to make it worth it?
Once again, as I said, I think it's about being able
to show that the individual is happier despite the
risk.
28:51: The question of treatment is in the spotlight in the
UK, after an internal report from the Gender Identity
Development Service leaked. Staff are worried that
diagnoses are made lightly, and that treatment is
fast-tracked.
How many kinds come here, how many referrals?
2017-18: 2,519
29:48: We didn't get in, but a few days later, a member of
the clinic's board stepped down so he could speak
publicly.
"My worry is that we're letting kids down. We're rushing
things through under pressure, in order to make everybody
feel right, we've solved the problem. When in effect we
haven't solved the problem. We've just fitted in with a
quick fix. It's not that I'm saying that people should not
never transition. That's not the point. It's just slow
things down and think things through over time and in
depth. We're saying there's no long-term research studies,
we don't really know about the effects, the long-term
effects of the hormone blockers. What's going on? We
just don't know. But we're acting as if we do.
32:01 But Marcus Evans, an experienced psychoanalyst, thinks it's
wrong to just affirm teens seeking help for gender
dysphoria.
"I wouldn't get myself into an argument, I'd say okay,
that's what you believe, and I understand that it's very
important that I understand how you want to be seen,
but my job is to try and understand who you are, and
what drives this sort of perception, so I don't want to
get into an argument.
"I'm trying to empathize with the individual in terms of
the way they want to be seen, but I've got my own mind
and my own mind is thinking about them, as a person.
33:00: Hormone treatment is life-long, as are the physical
changes they cause. There is also a risk of side effects:
cardiovascular disease and cancer. Testosterone was
designed for men, but in several Swedish countries,
it is prescribed for more girls than boys - aged 15 to 19.
34:00 And because I had that initial feeling, that this isn't
quite right, I started reading up about it. And that strengthened
my initial feeling. And I have my doubts, but what about if this
is right for her, because that's what I keep being told, that this
is right. And all I can do as a parent is support her.
But more and more I was feeling confirmed in my conviction
that this isn't right.
We don't feel the healthcare system is providing anything,
but an offer of hormone treatment and planning for surgery.
To surgically alter our child. And give .. and help our
child change her sex. Which validates that there's something
wrong with her. It confirms her feeling that her body ought to
be different. And that she's "strong" and "brave" to pursue
this. I'm sure the system wants to do the right thing, I just
don't understand that they don't seem to consider that this
is a new patient group and they need to proceed with caution.
We ask how many people regret the decision and they say
"None of them".
{parents being interviewed}
"My greatest worry is that this is .. that she's being
influenced by others. That is't not her own decision,
and that she'll eventually realize that.
37:06 "We must be affirming, and of course you can have
hormones and surgery, and it will only take six
months, because we can see you are unhappy."
It gives me chills when I realize how fast this
can all go, and how carelessly they're treating this
group of patients, who are quite fragile.
I want to tell my child and the healthcare system one
thing: This must not be hurried. We must have the
option of waiting - it should be the main alternative:
waiting until you've reached maturity.
37:54: Wait. Wait a couple of years Live as a man, as the
person you want to be. Express whatever gender you
want, but don't do something you can't change. Don't
do anything irreversible to your body.
38:15: "What the healthcare system told me, basically, was
that on one regrets it. Meaning, someone like me,
born biologically female, who goes through the whole
transition and then goes back. I had never ever heard of
such a thing."
"Regretting - or detransition - is a sensitive subject
in the trans world. "
38:40: We've been in touch with "Mika" for more than six
months. She has been plagued for months about telling
her story. I'm afraid to show my face because
detransitioning is such a terribly sensitive topic.
And because this is a reality that we don't want to
exist, we don't it to be real.
I don't want to show my face, because I'm afraid of
the consequences. Of how people will react when I tell
my version. Which has never been told in Sweden in this
way before. Because many in the trans and queer community
would see it as a threat, that it even exists, that there
are people with different stories.
We want so much for things to be simple. And that the
treatment is easy and that everyone is happy afterwards.
And we're very good at giving that impression, to gain more
acceptance and understanding and so on. And I do see the
point of that. But we have to show all the stories.
Not to hurt anyone, absolutely not, but to give the
best possible treatment and to give people the correct
diagnosis.
40:22: "Mika" got her diagnosis in 2017. She was certain it was
the right choice for her. That she was a boy, born into
the wrong body. I really thought that the biggest obstacle
in my life was that my body didn't reflect who I was.
So if I could resolve that, many other things would become
easier. When I got my 1st dose of testosterone, it was,
it's hard to describe, because all I remember was being
incredibly happy.
"It's finally happening! I'm starting a new chapter of
my life, here and now"
42:10: "I had pretty bad dysphoria. The treatment did take that
away, but it didn't solve the problems in the long run.
I think the 1st two years were really good."
42:24: Both Sametti and "Mika" were born as girls. They say they
suffered from severe gender dysphoria, and when through
major gender reassignment treatments. And still, they
didn't feel better.
Sametti was treated with medicines and surgery for several
years, before she began having doubts.
43:00 [Mika] Suddenly, I found a video of a de-transitioned woman.
A girl who had started, who had been diagnosed and
started treatment at age 16, and then when she was 22 she
realized that this isn't working. And she made a video about
it on youtube. I'd been doubting what I was doing for maybe
six months at the time.
43:30: [Mika] So I only realized afterwards that there are, like,
a lot of people who have detransitioned. There are a lot of
them, mostly women. It's just that no one talks about it.
44:38 British psychotherapist James Caspian has worked with
transgender people at his clinic for many years. But his
proposal to do his master's degree on regretters was
turned down. He is now taking the matter to court. He
says it's taboo to even talk about the existence of
regretters.
45:00 "I think it's not just considered to be a politically
incorrect research topic it's considered to be a politically
incorrect topic to discuss. But it isn't that simple,
because we have to listen to what people are saying.
Until I got into this I didn't really have an opinion
about people who regretted. We thought they were very small
in number and no one ever really talked about them.
But I started to hear that there were more and more of
them and what they were saying to me was that many of them
felt damaged and traumatized.
They felt that when they said that they were revering their
transitions, they became very unpopular, some were vilified,
there have been cases of people who have been very abused,
on the Internet, who've reversed transition, so then they
don't want to speak out. They wanted to speak through my
research.
45:50 [Mika] There's this huge taboo, and it's such a .. I think
it's viewed as like, a really scary threat, against the
classic trans narrative.
"I really want to communicate the seriousness of being
detransitioned. Living as a detransitioned person is
no ... it's not something you want to do. It's not a
nice thing.
46:30 The risk of young people getting an incorrect diagnosis
and an irrevocable treatment has barely been discussed
in Sweden. But a few years ago, the Lundstrom Clinic
noticed that patients were coming back. Now, they offer
trauma care for detransitioners.
46:50: "The group of patients who regret their decision, they
don't make a lot of noise. They are suffering, and they're
not proud of this. They're in crisis, and it's a crisis
of great magnitude. So .. they're not making a lot of noise,
and they blame themselves for ending up where they are.
Not the healthcare system.
48:34 The Lundstrom Clinic saw patients returning, and that
affected the staff who make the diagnoses and treatment
decisions. There's an awful lot we don't know. That's
what creates this, what we call an ethical stress.
That we don't have satisfactory evidence for what we are
doing.
The staff experience "ethical stress", yet the treatments
continue - hormones and surgical procedures. On girls,
breasts are removed. And the number of operations is
increasing. We ask for the ages of the surgical patients.
The hospitals say the youngest are 16, but only with
parental consent.
49:27 All hospitals release data on the number of operations
per age group, except for Karolinska. Perhaps it is
sensitive, for nowhere else in Sweden are individuals as
young as 14 given gender-affirming surgery.
49:46 "If I'm tormented by my breasts, to such a degree that
I can't show myself in public, and I can't hang out
with other young people, if I cant' go to school, if I
can't feel happy in my own body, then it's reasonable,
if all the parents, us medical professionals, and the
young person themselves all see it that way, to help
her, not have to deal with that bust.
Can a 14-year-old really understand the consequences
of such a decision? If it is a very young person, then
we make a particularly careful assessment. But you're
quite right, that there is a dual ethical problem.
The unethicalness of not helping to ease their suffering,
and also there's the unethicalness in that the patient may
change their mind 15 years down the line.
And whose responsibility is it if that happens?
Well, since these decisions are based on consensus, between
the child, the parents, and the professionals, then it's
a shared responsibility.
51:23 Shared responsibility?
They're placing part of the responsibility
on a child with psychiatric problems.
51:32 [[Mika] "Looking back now, I think it's actually
completely sick how this process plays out. Because
it's ... there's so little support for all this.
"At the heart of it, the healthcare system is the one responsible.
They're supposed to provide a correct diagnosis. They're supposed
to be able to say, you're getting this treatment, because we know
it will make you feel better.
The national guidelines for care of young people with
gender dysphoria - written in part by Karolinska's own
doctors - recommends top surgery with gender reassignment,
even though the scientific evidence is insufficient.
The lack of scientific basis - knowledge - is even confirmed
in official healthcare documentation. One research
application to the ethics committee plainly states that
surgery and gender-affirming therapy are carried out today
without quality assurance or follow-up.
52:48: [Mika] "It makes me angry. I think it's incredibly
irresponsible. When I started this process, I was ..
my generation, of mainly young girls, many young
girls, who are just a bit different, who stand out from
the typical female role. We're one giant experiment.
We're guinea pigs. Something that there's no science to
back up.
Where in the medical field do you do that?
Where do you gamble with people's lives like this?
54:03 [Sametti] "Regret was not supposed to happen. Any where
am I now? My problems still exist. I still haven't found
a solution to them. Nothing can be done about my body
anymore. Because the surgeries are, irreversible.
My voice is always going to sound like this. I will
not get my breasts back. I will not get my, this
stuff, back. Nothing can be done.
54:38 Sametti is going to the doctor for help changing her
legal identity back to female. It's the same clinic
that gave her the diagnosis back in the day.
55:12 Transgender treatment is more than just healthcare - it's
politics. The Swedish government is currently preparing a
bill to make it faster and easier to change one's
legal gender. To lower the minimum age to 12. And to
allow bottom surgery on 15 year olds without parental
consent.
55:35 [parents] "We would have expected that adults, doctors,
psychologists, therapists, could tell a 15-year-old that
we think your problem is something else.
That they'd realize that's the case. That they'd be
able to say "We don't think you'll feel better from
hormones or surgery, we think you need this instead."
Now it seems there is no adult who wants to tell our
child that.
56:05 "This is a problem, but I don't share the opinion that
we rush things, or that we disregard the ethical
consequences. If the suffering is so extreme that
treatment must be given from an ethical standpoint,
then we do it. Of course, transgender treatment is
important, and surely right for many. But for the
others .. who is responsible? Most don't dare to talk
about it or go back to their clinics. Sametti dared.
57:00 [Sametti] "I think they have been very professional,
so, I am happy, actually. I'm feeling good now.
"And also, they admitted that they made a mistake,
so I think that is a very big thing. That is a start.
