Child and adolescent psychiatrist Sven Roman explains Sweden's historic turn towards caution on gender medicine BERNARD LANE SEP 19 READ IN APP Sweden moved in the opposite direction to the US Photo by Susan Q Yin on Unsplash Young people with immature brains cannot grasp the consequences of irreversible gender medicalisation, a prominent Swedish child and adolescent psychiatrist has warned. “It is my opinion that the irreversible measure of sterilisation should not be carried out until the age of 25, and it is therefore appropriate to have the same age limit for gender-reassignment treatment for gender dysphoria,” the psychiatrist, Dr Sven Roman said. “[In the adolescent brain, the] frontal lobe matures last, at 25-30 years of age. This is where overall thinking and judgment are located. A teenager can therefore not understand the consequences of an irreversible sex-change treatment.” Dr Roman, who trained in medicine at the prestigious Karolinska Institute, said he believed that social contagion in the age of smartphones and social media “largely explained” Sweden’s “astonishing” surge in atypical cases of gender dysphoria chiefly diagnosed among adolescent females.¹ He made the remarks in an expert report for the American Supreme Court test case, US v Skrmetti, which involves a constitutional challenge to Tennessee’s law prohibiting gender medicalisation of minors. Hearings may begin later this year. Dr Roman said he had taken part in about 600-700 neuropsychiatric investigations and evaluations and in the course of his work, had met about 30 children with diagnosed or self-identified gender dysphoria. His opinion on the issue was also shaped by his study of the international scientific literature. While the evidence for puberty blockers and cross-sex hormones was “non-existent or extremely weak”, there did exist evidence-based treatments for co-morbidities common among these young people, such as depression, anxiety, autism and ADHD, he said.² And he said non-invasive treatment of those co-morbid conditions was known to “resolve gender dysphoria in many such cases.” “It is my experience and the opinion of many psychiatrists in Sweden that psychosocial treatment of gender dysphoria for children and young adults should always be tried first [before any talk of medical intervention],” Dr Roman said. After concerned experts kick-started public debate in Sweden in 2019, a systematic review of the evidence for paediatric gender medicine was undertaken, leading Sweden’s National Board of Health and Welfare to issue new, more cautious treatment guidelines in 2022, representing “essentially a ban on puberty blockers, cross-sex hormones, and surgeries in children,” Dr Roman said. He said the new policy, comparable to the position adopted by England’s National Health Service after the 2020-24 Cass review, left open the possibility of medicalised gender transition in exceptional cases³ and in research. Gender Clinic News is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.