The Karolinska Hospital in Sweden has ended the practice of prescribing puberty blockers and cross-sex hormones for minors under age 16 who think they belong to the opposite sex.

Hormonal intervention for young people ages 16-18 is still allowed, but can only occur in research settings approved by Sweden’s ethics review board, following a thorough informed consent that discloses the significant risks and uncertainties of the drugs, and considers the minor’s maturity level and ability to provide true informed consent.

Sweden is the first country whose leading hospital has explicitly stopped following the Dutch protocol, which allows for administration of puberty blockers at age 12 (and increasingly, as young as 8-9), and cross-sex hormones at the age of 16. It also is the first country to officially deviate from WPATH guidance—the group which has long positioned itself as the world authority in transgender health.

The Swedish hospital’s new policy is consistent with Finland’s recently revised guidelines, which were changed to prioritise psychological interventions and support rather than medical interventions, particularly for youth with no childhood history of gender dysphoria (presently the most common presentation). Significant changes are also underway in the UK, following the High Court ruling that deemed hormonal interventions for minors experimental, and cautioned that minors are rarely able to provide truly informed consent for interventions with such profound life-long consequences.