While Spain pushes ahead with laws making it easier for teenagers to change gender, other European countries that previously championed transgender rights are quietly backtracking.
The U-turns come amid a sharp rise in people reporting gender dysphoria - where people feel that the gender assigned to them at birth is not the one they identify with.
Sweden, known as a pioneer in LGBTQ rights, started restricting gender-affirming hormone therapy for minors - allowing it only in very rare cases - a year ago.
In December last year, it also limited mastectomies for teenage girls wanting to transition to a research setting, citing the need for "caution".
'The risks outweigh the benefits'
Back in 2015, the Swedish health authority had stated that puberty blockers and cross-sex hormones were “safe”. These treatments are designed to help people with gender dysphoria transition from their biological sex to the gender they personally identify with.
Sweden’s National Board of Health and Welfare explains that the reason behind the rollback is that little is known about the effects of these treatments over the long term and "the risks outweigh the benefits currently".
However, experts say those treatments were designed for exceptional cases in the first place.
"We had a protocol in place which was designed for very rare and extreme cases and suddenly the demand exploded so we continued to use that protocol,” said Mikael Landen, a psychiatrist specialising in gender dysphoria who contributed to the scientific study on which Sweden’s health authority based its decision.
“Maybe we shouldn’t have done that. But I wouldn’t be the one criticising the clinicians for doing that because it was difficult, they wanted to help these patients," he told AFP.
Sweden, like many other western countries, has in recent years seen a sharp rise in diagnoses of gender dysphoria.
According to the Swedish health authority, the trend is particularly visible among 13- to 17-year-olds assigned female at birth, with an increase of 1,500 per cent between 2008 and 2018.
Experts say the reasons for this increase remain largely a "mystery".
"Tolerance has been high in Sweden for at least the last 25 years, so you can't say it has changed," Landen said when asked if it was simply a result of a more accepting society.
‘Serious side effects’
In 2019, there were at least 13 minors who suffered from "serious side effects,” according to Swedish reports.
One of them had developed osteoporosis - a health condition that weakens bones - after taking puberty blockers. Others have suffered from liver damage, significant weight gain and depressive symptoms.
This was revealed by investigative journalist Carolina Jemsby, who directed the documentary ‘The Trans Train’.
She believes the current debate shows the issue of gender-affirming care for trans teens is "more complex than the healthcare system and society had hoped".
"One aspect of this dilemma is that it has become a political issue," she told AFP.
"It does a disservice to this group who need scientifically proven medical care to help them and give them a better life, and a better ability to live who they are".
A Swedish paediatric endocrinologist, Ricard Nergårdh, recently told the country’s public broadcaster that the procedure teenagers with gender dysphoria go through was “chemical castration”.
‘Hormones save a lot of people’
The change is all the more notable as Sweden was the first country in the world to authorise legal gender transition in 1972, paving the way for sex reassignment surgery to be covered by its universal healthcare system.
As the government revisits its policies, some in the transgender community are concerned.
"These people might need more care and invasive procedures in the future, because the decision could not be made earlier, even though the medical need was there," said Elias Fjellander, youth representative of RFSL, the Swedish Federation for Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Rights.
"What we're really seeing is that in some cases, the hospitals do not have resources, that teams giving gender-affirming care do not have the resources to follow up in the way that is needed".
Antonia Lindholm, a Swedish transgender woman, is worried for those who no longer have access to hormone treatments.
“Hormones save a lot of people, and yes I do feel upset that if I were to come out and be 13 right now, I wouldn’t have a chance”.
Several European countries are stepping back from gender-affirming care.
Finland, which recently passed a new law allowing trans people to change their legal gender with a simple declaration, restricted hormone therapy for minors in 2020.
France followed suit by calling for "the utmost reserve" on hormone treatments for young people.
Broadly speaking, transgender rights have been a hot-button issue across many countries. Hungary passed a law in 2020 banning trans or intersex people from legally changing their gender,
Just last month, the UK government blocked the Scottish government's Gender Recognition Reform Bill, which made it easier for people to self-identify as transgender without the need for a medical diagnosis. The reform championed by Nicola Sturgeon caused a major political row and played a role in her shock resignation as first minister on Wednesday.
One country, however, is bucking the trend: Spain has just passed a controversial law allowing anyone over 16 to freely change gender on their ID card.
Until now, adults in Spain could only request the change with a medical document attesting to gender dysphoria and proving they had undergone hormonal treatment for two years. Minors needed judicial authorisation.
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