Evaluations › Karolinska · Last reviewed 2026-05-16
Karolinska University Hospital (May 2021)
Summary
On 1 May 2021 Karolinska University Hospital — the largest paediatric gender clinic in Sweden — published internal policy guidelines stating that GnRHa and cross-sex hormones would no longer be prescribed to minors outside approved research protocols. The decision was motivated by uncertainty about long-term effects on bone density, cardiovascular health and neurocognitive development.
1. Content of the policy document
The Karolinska document stated:
- For patients under 16: no more routine GnRHa prescriptions.
- For patients aged 16–17: treatment only in research settings with explicit consent and extensive monitoring.
- Patients already in treatment were not abruptly tapered off.
- The policy explicitly referred to uncertainty in the evidence base and the NICE report of 2020.
2. International resonance
The Karolinska policy was the first clinical policy decision by a major European centre that explicitly diverged from WPATH SOC-7. It was followed by similar policy adjustments in Finland (COHERE), the UK (NHS) and Norway (Ukom).
See also
- Clinical context: Sweden — overview
- Next step: SBU systematic review 2022
- Criticised three-phase model: The three phases of the Dutch Protocol
- Research framework: Age criteria
- People register — Socialstyrelsen and Karolinska figures.
- International comparison — policy in table form.
- Timeline 2021 — position in chronology.
- FAQ · Glossary · For clinicians.