Ah, Sweden and Finland! If there are countries that are often held up as models in Quebec, it is these. And when it comes to gender transition for teens, what happens there can fuel the conversation happening here on this issue.
However, in recent years, the two Nordic nations have backed down on the delicate issue of medical interventions for teenagers who want to change their gender. These are now much more difficult to obtain for minors.
England made a similar shift.
Several readers have pointed out these realities to me following my recent columns on trans people. I explained what is happening in Quebec medical clinics, in addition to giving a voice to a non-binary trans person.1.
Dear readers, you are right. It is true that what is currently taking place in these countries sheds interesting, even essential, light on the debate that has been raging here since the Conservative Party of Canada adopted a motion aimed at banning medical interventions in minors who want to change of gender.
Hence this new column.
The case of Sweden is particularly interesting because it was the first country in the world to officially recognize trans people, in 1972. It is difficult to argue that we are in transphobic territory.
However, in December 2022, new guidelines significantly tightened the criteria for obtaining medical interventions for gender transitions in minors. This includes the famous hormone blockers, these drugs that delay puberty. They are given to us to “save time” and reduce the anxiety of teenagers who see their bodies changing with distress.
Socialstyrelsen, in some ways the Swedish equivalent of our National Institute of Excellence in Health and Social Services (INESSS), has ruled that these interventions for minors should only be offered in a research context, or to adolescents who meet very strict criteria.
Among these criteria: the existence of an inequality between the assigned gender and the felt gender (which we call “gender dysphoria”) present from childhood, “clear distress” and the “absence of factors that complicate the diagnosis “.
These recommendations do not have the force of law, but serve as a guide for doctors who work with adolescents.
Quebec doctors are far from giving hormone blockers to the first teenager who asks for them. A long investigation, particularly psychological, is carried out beforehand. But several health specialists confirm to me that the Swedish criteria are stricter than those used here.
Why has Sweden changed course on this? The reasons are set out in a document of which there is an English version2.
There, we have seen an increase in requests for gender change, particularly among 13-17 year olds. Another intriguing fact: individuals assigned girls at birth are now much more likely than those assigned boys to want to change their gender. This is true elsewhere, notably in Quebec.
Sweden says it wants to understand the causes of these phenomena before carrying out medical interventions on minors.
As I wrote in my previous column, medical interventions aimed at changing a person’s gender are not trivial. They have both physical and psychological side effects.
Concerns that these blockers could slow bone mineralization, for example, have been raised.
Overall, Swedish authorities conclude that “the risks associated with puberty blockers and gender-affirming treatments are likely to outweigh the expected benefits.”
They nevertheless recognize that “puberty-suppressing treatment can, in certain cases, be considered very beneficial” for certain minors.
As far as I can judge from here, the Swedish shift seems to me to be the result of real independent analysis and not pressure from right-wing groups.
And with us?
It’s easy to look at what’s happening in Sweden and a handful of other countries and conclude that the practices here are dangerous and irresponsible.
The reality is much more complex.
Quebec professionals do not base their practices on wind, but on guidelines published by the World Association of Transgender Health Professionals. These guides are not precisely drawn up on the corner of a table.
The latest version, published last year, is signed by 139 researchers and health professionals from 16 countries3. After reviewing hundreds of studies, these scientists conclude that treatments such as hormone blockers should be offered to adolescents according to criteria that are less strict than those of the Swedish, Finnish or British authorities.
What is going on ? Clearly, we are faced with two different interpretations of a still emerging scientific literature on the risks and benefits of medical interventions in adolescents.
Everyone (in good faith) agrees that these interventions can significantly help some young people. Everyone also agrees that they carry risks. What differs is the assessment of the balance between the two and the question of who to reserve the treatments for.
In Sweden, for example, it has been decided to only medically treat adolescents who have demonstrated gender dysphoria since childhood. But this criterion is hotly contested in Quebec.
“There may be young people who have known it since they were very young, but who have never said it – either because they did not have the words to say it, or because they were made rebuff, or because they had the freedom to adopt atypical behaviors and it was not a problem for them before adolescence”, illustrates Annie Pullen Sansfaçon, holder of the Research Chair on transgender children and their families.
Between the risks of intervening and the risks of not doing so, we are therefore faced with a complex scientific debate which remains to be resolved. The only thing that should guide us in this is the well-being of young people. No desire to be right.