For years, liberal Minnesota politicians have viewed Scandinavian countries as the lodestar of progressive thinking. How ironic then, that Democrats here have declared Minnesota a “trans refuge” state, just as Sweden, Finland and other Nordic countries are rejecting America’s medicalized “gender-affirming care” model as risky and non-evidence-based.
Minnesota’s new “trans refuge” law — enacted in April 2023 with great fanfare — is designed to ensure that puberty-blockers, synthetic cross-sex hormone treatments and “gender-affirming” surgery are widely available to young people who want them. The law shields minors who come here for this purpose from legal consequences in their home states.
Democrats insist this law will significantly reduce the risk of suicide, anxiety and depression, and is vital to the well-being of young people with gender distress. Rep. Leigh Finke, the legislation’s sponsor, has labeled the approach, which irreversibly alters young people’s bodies, as “life-saving.” Gov. Tim Walz has accused states that are restricting it of “bigotry and hate.” In Minnesota, he says, “compassion is on the march.”
If this is so, why are Sweden, Finland, Denmark, the United Kingdom and other nations —once on the cutting edge of this medicalized approach — now publicly rejecting it in favor of a holistic focus on psychotherapy and counseling? The “gender-affirming” model, which relies on “off-label” drugs the FDA never approved for this purpose, was widely adopted beginning about 2008 without rigorous clinical trials to establish its effectiveness. Starting in 2019, a variety of troubling factors led some European nations to rethink it. These included an extraordinary, unexplained escalation in the number of gender-distressed young women — a 4,400 percent increase over 10 years in England, for example.
Health authorities in Sweden, Finland and the U.K. have now carried out systematic reviews of all available studies on the effectiveness of the medicalized “gender affirming” model of care. These comprehensive reviews don’t just summarize individual studies’ conclusions, but assess their methodological strengths and weaknesses to determine the reliability of their findings. They represent the gold standard of “evidence-based medicine,” which holds that interventions should be based on the best available research.
The European research reviews flatly contradict the assertion that blockers, hormones and surgery are medically necessary and life-saving for gender-distressed young people. In July 2023, 21 clinicians and researchers from nine countries summarized these findings in a letter to the Wall Street Journal. The “claim that gender transition reduces suicides is contradicted by every systematic review,” they wrote, while evidence that hormones yield mental health benefits is of “low or very low certainty.”
Medicalized treatment for gender dysphoria also creates “significant” risks, including “sterility, lifelong dependence on medication and the anguish of regret,” the clinicians explained. For this reason, in 2022 England’s National Health Service ordered the nation’s only pediatric gender clinic to be closed after an independent review found that the type of treatment provided there “was not safe or viable as a long-term option for the care of young people with gender-related distress.”
European countries are now increasingly reorienting care for gender dysphoria around psychotherapy and counseling, and limiting medicalized treatment to rigorously regulated clinical trials — an approach that would deny puberty blockers and cross-sex hormones to most American teens currently receiving them.
Counseling is vital because it investigates why today’s young patients — primarily adolescent girls with pre-existing mental health diagnoses or on the autism spectrum — are expressing distress about their bodies. “Detransitioners” like Keira Bell in England and Chloe Cole in California, who underwent double mastectomies at ages 20 and 15, respectively, have turned to the courts, saying they never received proper mental health evaluation. Dr. Marcus Evans, a former director of the U.K.’s pediatric gender clinic, resigned because he worried that children were “being fast-tracked onto medical solutions for psychological problems.”
Counseling also reveals that immersion in social media, and the “social contagion” that can follow, plays a central role in many patients’ gender dysphoria. Hearing these girls’ formulaic requests for hormones can be like “listening to them read from a Facebook manual,” in the words of one Danish clinician.
Minnesota Democrats are turning a blind eye to Europe’s about-face on “gender-affirming care.” Instead, they base their support on policy statements and guidelines from the American Academy of Pediatrics (AAP) and other U.S. medical societies, which prefer the medicalized model to non-invasive “watchful waiting.”
But Dr. Gordon Guyatt of Canada’s McMaster University, a founder of evidence-based medicine, has dismissed these societies’ guidelines for managing youth gender dysphoria as “untrustworthy.” For example, an unrebutted, peer-reviewed “fact check” in 2019 found that the AAP’s 2018 statement seriously “misrepresented” the studies cited, which “repeatedly said the very opposite of what AAP attributed to them.”
It seems clear that treatment protocols for, say, cancer patients would never be based on such low-quality evidence. Why is this tolerated for children experiencing gender distress?
The reason is that pediatric gender care in America has become politicized, say the European authors of the Wall Street Journal letter. As a result, they explain, prestigious U.S. medical societies are “exaggerating the benefits and minimizing the risks.”
Ideological capture of this kind has occurred at the U.S. Endocrine Society, according to endocrinologist Roy Eappen of “Do No Harm,” a group that opposes extreme identity politics in medicine. Most endocrinologists “rue” the “elevation of transgender activism over medical expertise and patient needs,” he wrote recently in the Wall Street Journal. But they are “cowed into silence” by activists who equate questioning the gender-affirming model with attacking the troubled young people who express distress.
Once American medical societies “reckon with the reality” that liberal European countries are rejecting the gender affirming model, they have “got a major problem,” says Ian Kingbury, Do No Harm’s research director.
Minnesota’s new trans refuge law poses real danger to at-risk children and their families. At the same time that European nations are embracing holistic care centered on counseling, a new state law banning “conversion therapy” for gender identity will likely bar Minnesota youngsters from receiving such care.
Chillingly, the trans refuge law equates children whose parents resist putting them on invasive puberty blockers and hormones with those who need “protection or services” because of parental abuse or mistreatment. The law opens the way for courts to take emergency jurisdiction over such children, getting involved in and issuing rulings about these matters.
Gov. Walz may regard this as “compassion.” Real compassion and care for these vulnerable young people would be following the science.
Katherine Kersten, a writer and attorney, is a Senior Policy Fellow at Center of the American Experiment. She served as a Metro columnist for the Star Tribune (Minneapolis) from 2005 to 2008 and as an opinion columnist for the paper for 15 years between 1996 and 2013. She was a founding director of the Center and served as its chair from 1996 to 1998.