Overview

Between 2019 and 2022 the Swedish public broadcaster SVT ran a series of investigations into youth gender care on its flagship programme Uppdrag granskning ("Mission: Investigate"). The first two, Tranståget och tonårsflickorna ("The Trans Train and the Teenage Girls", April 2019) and Tranståget: del 2 (October 2019), looked at the fast rise in teenage girls seeking transition and at young people who regretted it. The third major report, Transbarnen ("The Trans Children", November 2021), said that at least 13 minors treated in Stockholm's youth gender services had suffered serious side effects or care injuries. Doctors at Karolinska University Hospital knew about these cases, but the hospital had not mentioned them in public (SVT 2021).

The best-known case was "Leo", who started puberty blockers at 11 and was found more than four years later to have bone loss and changes in two vertebrae. In March 2022 Karolinska filed a lex Maria report about his care with the national Health and Social Care Inspectorate (IVO). A lex Maria report is a mandatory self-report of a serious care injury, or the risk of one. In the report the hospital concluded that he and other children had been exposed to a risk of serious care injury (SVT 2022).

Status as of October 2026: In May 2021 Karolinska had already stopped starting hormonal treatment for minors outside approved research. In February 2022 the National Board of Health and Welfare (Socialstyrelsen) followed: it now judges that at group level the risks of puberty blockers and cross-sex hormones probably outweigh the benefits, and recommends them only in "exceptional cases" or in research. That guidance was finalised in December 2022 and was still in force in October 2026. No public record of IVO's final decision on the Karolinska self-report could be found for this page. The case is one of several covered in the hub on gender medicine scandals and whistleblowers.

Background

Sweden was an early adopter of medical transition. Under the 2015 national guidance from Socialstyrelsen, puberty blockers for adolescents with gender dysphoria were described as safe. Youth assessments were done by a small number of regional teams. In Stockholm, the psychiatric assessment team (KID, part of child and adolescent psychiatry, BUP) was separate from the endocrinology service at Astrid Lindgren Children's Hospital, which belongs to Karolinska and gave the hormones. SVT later argued that this split was central to what went wrong (SVT 2021).

The patients were also changing. In February 2020 Socialstyrelsen reported that new diagnoses of gender dysphoria among 13–17-year-olds registered female at birth had risen by nearly 1,500% between 2008 and 2018. Diagnoses among males aged 18–24 had risen by 400% (Socialstyrelsen 2020). The board found that many people with the diagnosis also had psychiatric diagnoses such as autism, depression and anxiety. An investigator for the board told Svenska Dagbladet: "we can see that there is a clear increase, but what it is based on, what drives it, we don't know" (SvD 2020). For the international picture, see the demographic shift in trans identification.

At the government's request, the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) published a scoping review in December 2019. It found no scientific literature explaining the rise in young people seeking care, no relevant randomised controlled trials, and few studies of long-term outcomes (SBU 2019).

What was reported

"The Trans Train and the Teenage Girls" (April 2019)

Reporters Carolina Jemsby and Karin Mattisson presented the programme as a story about "young women whose lives were ruined after they asked healthcare for help" (SVT Play). It featured young women who regretted transition, parents who felt their children had been moved quickly towards medical treatment, and clinicians in Sweden and Norway. According to the published script, one clinician said that among teenage girls referred, "up to 60 percent" had complex mental health problems (SVT UG-referens).

"The Trans Train: Part 2" (October 2019) and follow-ups

The second programme asked whether, in SVT's words, lives were being lost while young people waited for irreversible surgery. This was the main argument for a proposed law that would have let some 15-year-olds have certain surgery without parental consent. The programme followed "Johanna", 19, who had come out as "Casper" two years earlier. At 17 she was too old for the children's clinic and too young for the adult clinic, and spent a year waiting for assessment. During that wait her identification changed (SVT UG-referens del 2). A shorter follow-up the next day featured one of Sweden's best-known trans people, who said they were not sure they would have had treatment if deciding today (TheTVDB listing). A third Tranståget report aired in May 2020.

"The Trans Children" (November 2021)

Transbarnen aired on 24 November 2021, with an English version, Mission: Investigate: Trans children (SVT Play). SVT's main claims were:

• Leo's case. Doctors at Astrid Lindgren Children's Hospital started Leo on puberty blockers at 11. According to SVT, his bone density was not checked for 4.5 years. International guidance generally treats about two years as the defensible maximum. When he was finally X-rayed, the bone was "more porous than it should be" and two vertebrae had changed. He was diagnosed with osteoporosis, had stopped growing and had constant back pain. Treatment then continued for three more months, and no incident report was filed (SVT 2021).
• Twelve further cases. SVT said it had seen documentation on 13 minors in total who had suffered serious side effects or care injuries. The list included suspected liver effects, falling bone density that forced an early stop to treatment, compulsory psychiatric admission for suicide risk about a month after starting blockers, and a patient who regretted transition and had permanent voice changes from testosterone (SVT 2021; Läkartidningen 2021).
• Non-disclosure. In May 2021 Karolinska justified stopping new treatment partly by "potential side effects". SVT reported that concrete cases already existed in the hospital's own service, and that the policy did not mention them (SVT 2021).
• A doctor reported for warning the family. In a letter, a doctor had urged hospital management to act on Leo's case and file an incident report. No report was filed. Instead, the KID team filed an internal incident report against that doctor for telling Leo's family about the risks of treatment (SVT 2021).
• Treatment length. Figures compiled by SVT showed that 87 children had been on blockers for more than three years (SVT UG-referens).

In the programme, paediatric endocrinologist Ricard Nergårdh said that blocker treatment "is chemical castration" and can affect mental state in unintended ways. He stressed that families must be well informed (SVT UG-referens). Transbarnen won the Swedish investigative journalism award Guldspaden for 2021 (FGJ).

Responses from the institutions and clinicians

Karolinska and Region Stockholm (November 2021). Svante Norgren, head of Astrid Lindgren Children's Hospital, told SVT: "Injuries that have been caused by treatment with us, we of course have a responsibility for." He said he could not discuss an individual case during the interview. Asked how he could be unaware of 13 injured children, he said: "We are two different units. The children's hospital handles the paediatric medicine part; the assessment and the psychiatric follow-up lie with the KID team." Göran Rydén, head of child and adolescent psychiatry in Stockholm, said the cases were being reviewed again. An incident report on Leo was filed only after SVT's interviews, about 1.5 years after the injury was found, and Karolinska opened its own review (SVT 2021; SVT 2021b).

Karolinska's lex Maria report (March 2022). After its internal review, the hospital reported itself to IVO over Leo's care. As summarised by SVT, the report found that:

• Leo and other children had been exposed to a risk of "serious care injury", and there was a continuing risk of incorrect treatment.
• There had been no routines for monitoring bone density.
• The family "had not received sufficient and clear information about known side effects of the treatment".
• Care had been split between two providers.
• In the hospital's words, "it is clear that the diagnosis of gender dysphoria is not static".

SVT also reported that a doctor involved in the review thought Leo should not have started treatment at all, given his unaddressed psychiatric problems, suicide attempts and his own early hesitation (SVT 2022). In February 2023 Stockholm's child and adolescent psychiatry service filed a separate lex Maria report. It concerned a teenager whose autism and ADD (attention deficit disorder) assessments had been put on hold after blockers were approved. Läkartidningen noted that this teenager also appeared in another lex Maria case about severe osteoporosis from hormone treatment (Läkartidningen 2023).

Clinicians defending treatment. Louise Frisén, a child psychiatrist on Karolinska's youth team, argued in Svenska Dagbladet that blockers had long been used for early puberty without the "irreversible, very severe side effects" critics described. She also argued that "there is a risk in not treating", because unwanted pubertal changes are themselves permanent (SvD, Frisén). Critics who replied argued that the Dutch protocol (the Dutch model of blockers, then hormones, then surgery for adolescents) was designed for a different, earlier patient group (SvD replik).

Clinicians critical of treatment. Psychiatry professor Mikael Landén co-authored the SBU review. He said in 2023: "Our conclusion was that there is no evidence that this helps against gender dysphoria or that it reduces depressive symptoms or anxiety." He added that some patients should be helped with transition and that many are helped, but that clinicians should be "extremely careful" about who receives blockers (SVT 2023).

Trans organisations. RFSL, Sweden's main LGBTQ rights federation, called the first programme "grossly slanted and thesis-driven" ("grovt vinklat och tesdrivet") and gave SVT its "Rosa Tisteln" shame award at Stockholm Pride 2019 (QX 2019). RFSL chair Sandra Ehne said there were "no stories from people who are satisfied with the care they receive". Reporter Carolina Jemsby answered: "Our investigation is not about trans people, it is about the healthcare" (SVT 2019). On the May 2020 follow-up, RFSL said it was "very unfortunate" that some people were disappointed with their treatment. It added that "nobody should be ashamed", but that the programme "completely ignored" trans people whose care had helped them (RFSL 2020). The trans association FPES warned in 2022 that the new guidance risked forcing young people with long-standing, documented dysphoria through "an enforced puberty" and could increase self-medication (FPES 2022).

Investigations, legal and regulatory outcomes

What the national guidance says

Socialstyrelsen's December 2022 English summary states that "at group level (i.e. for the group of adolescents with gender dysphoria, as a whole)" the board "currently assesses that the risks of puberty blockers and gender-affirming treatment are likely to outweigh the expected benefits" (Socialstyrelsen 2023). It makes weak negative recommendations: blockers, cross-sex hormones and mastectomy "can be administered in exceptional cases", ideally in research. It names three factors that moved the balance: the unexplained rise in diagnoses "particularly in the 13 to 17 age group and especially among people whose registered sex at birth is female"; documented medical detransition among young adults; and expert experience that is "less uniform than it was in 2015". It also tells services to screen systematically for autism and ADHD early in assessment, and to offer "unconditional exploration of gender identity".

At the February 2022 launch, Socialstyrelsen's Thomas Lindén said: "We cannot rule out negative effects of it and we don't know if it does any good; it is always associated with discomfort and risk" (Omni 2022). SBU found that blockers delay bone maturation and density gain, and that the evidence could not settle effects on dysphoria itself. It also criticised studies for reporting only group averages, which can hide individual outcomes far from the mean (SBU 2022). The peer-reviewed version screened 9,934 abstracts and found 24 relevant studies, none of them randomised (Karolinska Institutet 2023).

Significance and wider impact

Sweden is often cited, alongside Finland and England, as a country that moved away from routine medical transition of minors after reviewing the evidence (Block 2023). The Swedish case has three features that set it apart:

1. A hospital acted before the regulator. Karolinska's 2021 policy came before national guidance, and Socialstyrelsen was openly critical of it at the time. Nine months later the board made what SVT called a complete "U-turn" (SVT 2022b). Karolinska's policy cited the English High Court ruling in Bell v Tavistock, brought by detransitioner Keira Bell, and the need for caution. See also the Tavistock GIDS case (England's former national youth gender clinic).
2. Harm was documented in the institution's own records. Elsewhere the debate was mostly about weak evidence. Transbarnen produced specific incident reports, and the hospital's lex Maria report confirmed failures of monitoring and information. These are the kinds of iatrogenic harm and informed consent failures discussed elsewhere on this wiki. For what is known about bone and other risks, see puberty blockers.
3. Diagnoses and treatment fell. Dagens Nyheter reported, from Socialstyrelsen data, that patients under 15 receiving care for gender dysphoria fell by 37% between 2021 and 2023. There were 22 new diagnoses among 0–14-year-olds in the first ten months of 2024, against 67 in the same period of 2021 (as reported by Bulletin, a right-leaning outlet citing Dagens Nyheter). Clinicians quoted gave different explanations: Landén pointed to negative publicity about regret and side effects, while Angela Sämfjord pointed to growing acceptance. Socialstyrelsen's own page lists possible drivers of the earlier rise: better access, greater awareness, less stigma and "social influence factors" (Socialstyrelsen). See social contagion and peer influence.

Sweden's change in medical policy happened alongside a separate legal reform of gender recognition. That is covered in sex and gender in law across Europe. For other countries' reviews, see evidence reviews.

Criticisms of how the case has been framed

• The broadcasts themselves. The April 2019 programme was formally censured for breaching the privacy of a young trans person who did not take part. That person told Sveriges Radio that the ruling felt like vindication (Sveriges Radio 2020). RFSL and other critics argued that the "trans train" framing presented a trend rather than individuals, and left out satisfied patients. A 2023 Lund University bachelor's thesis made a similar argument about stereotyping (Lund University). Defenders, including SVT, said the subject was the healthcare system, not trans people.
• "Sweden banned blockers" is inaccurate. The guidance allows exceptional cases. SVT found that 41 new patients started blockers in 2022, and trans groups reported that the lack of approved research studies meant some clinics refused everyone under 18 (Ottar). Both sides have overstated what changed.
• Causation. Some advocacy sources, such as Genspect, credit the documentaries with the change in policy and the fall in diagnoses (Genspect, gender-critical advocacy). The official documents base the change on the SBU evidence review, the unexplained rise and detransition. The journalism plainly sped up the timetable, since Socialstyrelsen delayed its guidance after Transbarnen. But the evidence review was commissioned in 2019, before the injury revelations.
• The 13 cases. The figure comes from SVT's review of documents. Neither Karolinska nor IVO has published a matching count. The hospital's lex Maria report concerned Leo and referred to "other children" without public numbers. Some foreign outlets restated the claim as "13 of 440 children were injured", a ratio SVT did not publish in that form.
• Later documentaries. SVT's 2023 series Transkriget, fronted by journalist Aleksa Lundberg, was reported to Granskningsnämnden by RFSU, the sexual health organisation (RFSU 2023). It was called "a conspiratorial wreck" in Aftonbladet's culture section (Aftonbladet) and defended as "a generally factual account" in a Göteborgs-Posten editorial (Göteborgs-Posten). No ruling on that complaint was found.

What detransitioners say

On r/detrans the Swedish case often comes up as proof that blockers are not a harmless "pause". Leo's case is retold most often:

There's a kid in Sweden, Leo, who has osteopenia due to blockers. … It happened because they put him on blockers for five years and never checked his bone health. He was lost in the files of these incompetent providers. There shouldn't be a single case of this degree of negligence, but there are multiple. —Takeshold, detrans and female

Some commenters describe the same kinds of harm, and the same gap in information, that SVT documented:

Yeah I have a very low bone density now and have very bad bone and joint pain. It hurts to walk and the pain keeps me up most nights. … I was only on puberty blockers for 1.5 years but the effects haven’t improved at all since going off bone and joint wise. —AttorneyRich8118, detrans female

I wanted puberty blockers when I was younger because I heard they were harmless and would help people struggling with their self-image like me. I was never told about any sort of biological damage they could cause. —willow_wind, questioning own transgender status

A Stockholm detransitioner describes a long assessment that was slow because of limited resources, without much exploration, and where another team's concerns were set aside in favour of trying transition first:

The only reason the process took so long was the lack of resources, appointments were far between and they were in the nature of just checking in that I hadn’t changed my mind. … he and his team actually thought there might be other issues to explore, but they decided to put that on hold until I had tried transitioning —christa-paffgen, detrans male

Not every Swedish experience is negative. Another commenter says the Swedish clinic followed up after they stopped hormones:

I decided to contact them when I stopped taking HRT, and they made sure to have conversations with me about my experiences, what they could have done differently and what they could do to aid me. —acupofmorningcoffee, detrans

Swedish detransitioners have also commented on who appears in these documentaries. One noted that Tranståget "interviewed two detrans women and didn't even feature detrans men" (Werevulvi, detrans female). For accounts of being attacked for speaking out, see backlash against detransitioners and transition regret.

Trans perspectives

Trans commenters, and organisations such as RFSL and the Swedish trans association FPES, mostly describe the Swedish changes as a loss of access to care. In their accounts, assessment queues have grown to years, adolescents who might once have qualified are refused, and some young people turn to private clinics abroad or self-medication. One Swedish trans man described the adult pathway like this:

Wait 2-5+ years to be called to a first visit at the gender clinic —armadillotangerine, trans man (FTM)

Others hold that blockers prevent permanent unwanted changes and are safe. One trans man who took blockers at 15 described bone density loss as the main concern providers raised, but believed it recovers once hormones start (arrowskingdom, trans man (FTM)). SBU's review found that density rose again on cross-sex hormones. It could not determine whether it returns to population levels in the long term (SBU 2022). Leo's case shows what can happen when that monitoring does not take place. Karolinska itself acknowledged that it had no routines for checking bone density.

If you are affected by these issues, the support directory lists gender-exploratory therapists and detransition support groups. Detransition video accounts are in the video archive, and published research is in the study archive.

Related pages

• Gender medicine scandals and whistleblowers
• Evidence reviews
• Puberty blockers
• Tavistock GIDS
• Keira Bell v Tavistock
• Sex and gender in law: Europe
• Demographic shift in trans identification
• Iatrogenic harm

References

• SVT Uppdrag granskning (2019). Tranståget och tonårsflickorna – script and sources. source, SVT Play.
• SVT Uppdrag granskning (2019). Tranståget: del 2 – script and sources. source.
• SVT (2019). RFSL kritiskt till Uppdrag gransknings program. source.
• SVT Uppdrag granskning (2021). Uppdrag granskning avslöjar: Flera barn har fått skador i transvården. source.
• SVT Uppdrag granskning (2021). Läkare informerade mamma om risker med hormonbehandling – anmäldes. source.
• SVT Uppdrag granskning (2021). Vart femte barn som fått stopphormoner har behandlats för länge. source.
• SVT Uppdrag granskning (2021). UG-referens: Transbarnen. source; English version SVT Play.
• SVT (2021). Karolinska stoppar hormonbehandling av barn med könsdysfori. source.
• SVT Uppdrag granskning (2022). Leo skadades i transvården – nu har sjukhuset anmält sig självt. source.
• SVT Uppdrag granskning (2022). Socialstyrelsen tvärvänder om transvården av unga. source.
• SVT (2023). Trots varningarna – stopphormoner har getts till över 40 barn. source.
• Läkartidningen (2021). SVT: Barn i transvården har fått skador av hormonbehandling. source.
• Läkartidningen (2023). Sena psykiatriska diagnoser vid könsdysfori lex Maria-anmäls. source.
• Föreningen Grävande Journalister (2021). Transbarnen – Guldspaden 2021. source.
• Journalisten (2020). UG-program identifierade transperson (Granskningsnämnden ruling). source; Sveriges Radio (2020) source.
• SBU (2019). Gender dysphoria in children and adolescents: an inventory of the literature (report 307). source.
• SBU (2022). Hormonbehandling vid könsdysfori – barn och unga (report 342); summary article. source.
• Ludvigsson JF et al. (2023). Systematic review on hormonal treatment in youths with gender dysphoria, Acta Paediatrica; Karolinska Institutet news release. source.
• Socialstyrelsen (2020). Vanligt med flera psykiatriska diagnoser hos personer med könsdysfori. source.
• Socialstyrelsen (2022). Uppdaterade rekommendationer för hormonbehandling vid könsdysfori hos unga. source.
• Socialstyrelsen (2022). Vård av barn och ungdomar med könsdysfori – Nationellt kunskapsstöd (2022-12-8302). source; English summary (2023-1-8330) source; topic pages source, source.
• Svenska Dagbladet (2020). Kraftig ökning av könsdysfori hos flickor. source.
• Frisén L. Det finns en risk i att inte behandla, Svenska Dagbladet. source; reply source.
• Omni (2022). Socialstyrelsen vänder om stopphormon till unga. source.
• SEGM (2021). Sweden's Karolinska Ends All Use of Puberty Blockers and Cross-Sex Hormones for Minors Outside of Clinical Studies (advocacy organisation; hosts translated policy). source.
• Block J (2023). Gender dysphoria in young people is rising—and so is professional disagreement. BMJ. study page.
• RFSL (2020). All trans people needing care should get it – RFSL comments on Uppdrag granskning (advocacy organisation). source; QX (2019) source.
• FPES (2022). Nya riktlinjer för hormonbehandling av unga (trans association). source.
• Ottar (RFSU magazine). »Npf ska inte hindra någon att få hjälp för könsdysfori«. source.
• RFSU (2023). 3 sanningar RFSU saknar i SVT:s "Transkriget" (advocacy organisation). source.
• Pahnke E. "Transkriget" är ett konspiratoriskt haveri, Aftonbladet Kultur (opinion). source; Katzeff Silberstein B, Göteborgs-Posten (editorial) source.
• Lund University (2023). Skadlig omtanke – bachelor's thesis, Lund University. source.
• Bulletin (2024). Färre barn får vård för könsdysfori efter ändrade riktlinjer (right-leaning outlet citing Dagens Nyheter). source.
• Genspect. Sweden: How it Started, How it's Going (gender-critical advocacy). source.
• TheTVDB. Uppdrag granskning – Tranståget: När Solveig ångrade sig (episode listing). source.