The 2019 documentary Tranståget och tonårsflickorna (The Trans Train and the Teenage Girls) directed by Carolina Jemsby and Karin Mattisson has sparked significant debate on the ethics and science behind medical treatments for children with gender dysphoria, particularly in Sweden. This film, and its follow-up documentaries, have cast a spotlight on the growing number of young people, especially teenage girls, seeking gender-affirming care, and the potential long-term consequences of this treatment. The documentary series explored whether the medical protocols used for minors were sufficiently grounded in scientific evidence, and whether the experiences of those who regret their transitions were being adequately considered.
The issue became even more controversial in May 2021 when Sweden announced a shift in its approach to the medical and surgical transition of children. This policy change followed revelations from investigative documentaries that called into question the safety and effectiveness of the Dutch Protocol, a model that had been adopted by Swedish clinics for treating gender dysphoria in minors. The Dutch Protocol, which had been in use in Sweden since 2014, involves starting children on puberty blockers, followed by cross-sex hormones and eventually surgery. Originally designed with strict inclusion criteria, it became evident that this protocol was being applied to a broader, and potentially inappropriate, range of children and adolescents, resulting in unintended consequences. The growing number of detransitioners - people who regret their gender-affirming treatments - raised concerns about the potential harms of this medicalization.
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These documentaries raised questions about the medical treatment of gender dysphoria, revealing that many young people, particularly teenage girls, were increasingly seeking gender transition treatments, sometimes without clear evidence that they would benefit from such interventions. The core issue centers around the Dutch Protocol’s application, which had not been adapted to the changing demographics of patients seeking treatment. While the protocol was designed for a specific group of patients - mainly young people with early-onset gender dysphoria - its implementation in Sweden had led to a rapid increase in the number of patients, particularly adolescent girls, who were given treatments like puberty blockers and hormones. This shift raised critical questions about the protocols' appropriateness for a wider range of patients and whether adequate psychological evaluations were being conducted to assess the root causes of the distress these patients were experiencing. As the number of detransitioners grew, it became clear that medical and surgical transitions were not always successful in alleviating their underlying issues, leading to a national reckoning over gender-affirming care for minors.
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One of the most important aspects of this controversy is the role of investigative journalism, particularly the Swedish television series Mission: Investigate (Uppdrag granskning). Over several episodes, the program examined the impact of gender-affirming care on minors, speaking to people who had undergone treatment and later regretted their decision to transition. Their voices and experiences provided critical insight into the potential harms of transitioning minors without fully considering their psychological and emotional well-being. These revelations eventually led the Swedish national health system to reassess the Dutch Protocol, resulting in the 2021 policy change that halted the use of puberty blockers and cross-sex hormones in minors, at least until further studies and reviews could be conducted. The documentaries sparked widespread public debate in Sweden and beyond, especially concerning the medical risks of gender-affirming care for minors. While a Swedish study from the 1970s to 2010 found that only a small percentage of those who transitioned regretted their decision, more recent trends show a sharp rise in the number of people - especially young women - who express regret or detransition after undergoing gender-affirming care. This shift has contributed to the controversy, as many question whether the medical treatments are being overprescribed and whether more comprehensive psychological evaluations are needed before such significant decisions are made.
The issue became even more explosive with the release of the third documentary in the series, Transbarnen (The Trans Children), in late 2021. The film highlights the story of a young child, Leo, who was placed on puberty blockers at a very young age and kept on them for over four years without sufficient medical follow-up. As a result, Leo developed osteopenia (a weakening of the bones), severe spinal damage, and chronic pain, and there was no improvement in Leo’s psychological condition during this period. This case, along with others highlighted in the documentary, raised serious concerns about the lack of proper oversight and accountability in the medical treatment of gender-dysphoric children. Additionally, the documentary revealed cases of medical harm that had been downplayed or concealed, raising alarm over the adequacy of care for children undergoing such treatments.
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Amnesty International, in its response to the program Tranståget och tonårsflickorna, released a statement that underscores the complexity and the ethical concerns surrounding gender-affirming care for minors. Amnesty acknowledged the importance of giving a platform to those who regret their gender-affirming treatments, noting that these stories are tragic and should not be silenced. At the same time, Amnesty emphasized the need to consider the experiences of young trans individuals and ensure that their rights are protected, particularly in a country like Sweden, where access to gender-affirming care is generally considered a given. The organization also criticized the Mission: Investigate documentary for failing to include voices from the transgender community, especially young trans people and trans organizations. Amnesty pointed out that the film presented a skewed view of gender-affirming care, giving the impression that treatments such as hormone therapy and surgery are administered without sufficient scientific basis or oversight.
According to Amnesty, the documentary painted a misleading picture by suggesting that these treatments are provided hastily, without proper investigation into other possible causes of the patients' suffering. Amnesty contended that, in reality, the investigations for gender-affirming care in Sweden are rigorous and thorough, involving interprofessional teams and standardized processes based on scientific research. Moreover, Amnesty highlighted the broader societal context in which these debates are taking place.
While Tranståget och tonårsflickorna raised important questions about the medicalization of gender dysphoria in minors, Amnesty emphasized that the primary issue was not the provision of care to trans youth, but rather the deep-rooted discrimination and lack of understanding that transgender people face in Swedish society. Transgender individuals, particularly young people, often face a disproportionate amount of stigma, mental health challenges, and discrimination. Amnesty argued that the solution to the problems raised by the documentary is not to limit access to care, but rather to improve the care system and develop better support mechanisms for trans individuals. The statement further stressed that gender-affirming care, when properly administered, has been shown to reduce suffering and suicidal tendencies among trans youth. Research suggests that the vast majority of trans people who undergo such treatments experience significant improvements in their quality of life and mental health. Amnesty concluded that the solution to the issues raised by the documentary is not to restrict access to gender-affirming care, but rather to ensure that the system is improved, making it more accessible and responsive to the needs of trans people, particularly young people.
In conclusion, the controversies surrounding Tranståget och tonårsflickorna and the subsequent policy changes in Sweden have sparked a heated debate on the ethics, science, and consequences of gender-affirming care for minors. The involvement of organizations like Amnesty International, which advocate for the rights of trans individuals, has been crucial in providing a broader perspective on the issue. While there are valid concerns about the safety and efficacy of certain medical treatments, it is clear that the solution lies in improving the care process, ensuring thorough psychological evaluations, and protecting the rights and well-being of trans youth rather than denying them the care they need. The ongoing debate will likely continue as more research is conducted and as society grapples with the challenges of providing compassionate, informed, and ethical care for young people experiencing gender dysphoria.
Image credits: YouTube
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