Evaluations › SBU · Last reviewed 2026-05-16
SBU (Sweden, 2022)
SBU. Hormone therapy at gender dysphoria in adolescents — a systematic review and assessment of medical, health-economic, social and ethical aspects. Report 327. Stockholm: Swedish Agency for Health Technology Assessment; 2022. Position in chronology: timeline 2022-02.
Summary
The Swedish Agency for Health Technology Assessment (SBU) carried out a systematic review of hormone treatment in adolescents with gender dysphoria. After screening 9,934 records, 24 studies met the inclusion criteria. SBU classified all primary outcomes as "very low certainty" per GRADE, citing study design, risk of bias, attrition and the absence of control groups.
1. Methodology
- PRISMA systematic review, registration no. PROSPERO CRD42021266806.
- Inclusion criteria: studies in adolescents with gender dysphoria, GnRHa or CSH, with psychological or somatic outcome measures.
- GRADE classification for certainty of evidence.
2. Conclusions
- Certainty of evidence for effects of GnRHa on mental wellbeing: "very low".
- Certainty for effects of CSH on dysphoria: "very low".
- Unknown or poorly documented long-term effects on bone, cardiovascular and fertility.
- Recommendation: treatment in a research setting with informed consent and long-term registration.
See also
- International comparison — Sweden in table form alongside other countries.
- People register — authors and evaluators.
- Policy consequences in Sweden: Sweden — Karolinska and Socialstyrelsen.
- Earlier clinical policy change: Karolinska 2021.
- Studies SBU assessed: Follow-up studies overview, de Vries 2014.
- Parallel systematic review (UK): Cass Review 2024.
- Comparable national policy change (Finland): COHERE 2020.
- Aftercare structure SBU criticises: Follow-up in the Dutch Protocol.
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