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Denmark Adopts More Cautious Approach to Treat Gender Dysphoria in Children

August 23, 2023

Denmark has “initiated a more cautious approach to [gender transition] hormone therapy [for minors] until more evidence is available for its beneficial effect,” according to a recent article in the journal of the Danish Medical Association, Ugeskrift for Laeger. The Danish-language article identified increasing reports of detransitioners, psychiatric comorbidities, and an “underexplained” prevalence of teen girls seeking to transition as reasons for caution.

Denmark joins other European countries who first embraced these treatments but then pulled back when the harmful effects became apparent. The authors acknowledged that “reports of reversal” — people discontinuing hormone treatments — “have led to several countries, including Sweden and Finland, recommending a cautious approach. … A similar development in Denmark has led to hormone treatment being offered to far fewer people than before.”

Denmark’s nationalized health care system only recorded four intakes for minors seeking puberty blockers or cross-sex hormones in 2014 — none of which were approved. But since Denmark began approving such treatments in 2016, the number has exploded, climbing to 352 minors in 2022 (an 8,700% increase), not a small number in a country with a population similar to that of Wisconsin.

At first, the rate at which these minors were approved for treatment also exploded, from 14% in 2016 to 65% in 2018. From that peak, the approval rate has declined to 6% in 2022, with only 22 minors placed on gender transition hormones. Not only did this represent a lower percentage rate of approvals, but the raw number of approvals is a half to a third as many of any year since 2016 — even as the number of minors seeking them continues to rise.

One reason why Danish health practitioners have cut back on prescribing gender transition hormones for minors is the lack of an explanation for the lopsided demographics. “In contrast to the sex ratio in previous cohorts, the increase among young people is mainly made up of birth-assigned girls,” said the article. “Birth-assigned girls aged 11-18 make up 70%” of the minors who entered the system in 2022. “The background for the change is underexplained,” they admit, but they acknowledge “the importance of social influence” and changing gender norms. Abigail Shrier’s 2020 book, “Irreversible Damage: The Transgender Craze Seducing Our Daughters,” argues the explosion in teen girls renouncing their sex is due to “social contagion.”

Another reason for Denmark’s back-pedaling is the “prevalence of psychiatric diagnoses” among the youth seeking gender reassignment hormones in some countries — up to 75% in Finland. “The most frequent psychiatric diagnoses are depression, anxiety, suicidal thoughts/self-harm, autism, and ADHD,” reported the article, and some diagnoses increase the risks of gender transition hormones. “Contraindications to hormone therapy are abuse, suicidal ideation/self-harm, severe psychological distress and worrisome somatic conditions (e.g. cancer, thromboembolic disease).”

Danish practitioners are also concerned about the possibility of young people detransitioning after undergoing irreversible hormonal treatments. The article reports rising numbers of youth “where the sexual discomfort started after puberty” — those with whom it is more likely to be a phase. Under the new Danish medical practice, “in case of unstable psychosocial conditions or short duration of sexual discomfort, the referral [of a minor for gender transition hormone treatment] is rejected.”

Denmark’s return to caution is advised by the dearth of solid evidence regarding the effects of gender transition treatments, especially as the demographics of those seeking gender transitions undergo dramatic, unexplained change. “In particular, knowledge is lacking about the increasing proportion of young people with the onset of sexual discomfort after puberty … and about the presumably increasing proportion with mental disorders,” said the article.

Danish youth seeking gender transition hormones can find themselves in three separate categories. For those under the age of 10 who have not begun puberty, there is a “Pending Process,” where health care professionals offer “advisory conversations” and information about hormones, but not the hormones themselves. For patients over 10 “who do not meet criteria for current treatment,” there is the “Reflection Process,” which consists of “conversations about gender, identity, and sexuality.”

For teens “with gender discomfort since childhood and stable psychosocial situation,” there is a “Standard Investigation,” which involves at least “five investigative interviews,” “discussion of treatment options,” a “psychiatric examination,” and a “hormone information interview, puberty assessment, and somatic screening.” Health care professionals also assess youth with “a broad diagnostic interview and cognitive testing,” review school and municipal records for psychopathology and functional level, and other specific measures if needed.

Denmark joins other nations in northern and western Europe — Finland, France, Norway, Sweden, and the U.K. — that have reversed an “affirming” policy for youth seeking gender transition hormones for a more cautious approach. These progressive-leaning countries were early adopters of gender transition procedures for children on ideological grounds, but after years of data and experience, they have judged it prudent to reverse course.

For their part, some American providers lack the safeguards of the Danish system. In February, a whistleblower prompted a state investigation when she revealed that the Washington University Transgender Center at St. Louis Children’s Hospital was prescribing cross-sex hormones without addressing underlying mental health issues and failing to keep records or track patients adequately. No less than The New York Times corroborated core elements of her story in a piece published Wednesday.

The closest America’s medical gatekeepers have come to recognizing the harms is that earlier this month the American Academy of Pediatricians (AAP) commissioned a “systematic review of the evidence,” which some members have clamored for since 2019. At the same time, however, the AAP reaffirmed their 2018 statement endorsing a “gender-affirmative care model,” in which health care providers “destigmatize gender variance, promote the child’s self-worth, facilitate access to care, educate families, and advocate for safer community spaces where children are free to develop and explore their gender.”

Joshua Arnold is a senior writer at The Washington Stand.