In recent years, something has changed in the care of gender dysphoria. The proportion of young people living with the feeling of being born in the wrong body has increased dramatically. Many of them have in common that they simultaneously have several different psychiatric diagnoses.

However, as Assignment Review has previously stated, research is lacking on the new and growing group of patients. And more and more people are raising alarms about the risks involved.

"Very high psychiatric illness"

Psychiatrist Angela Sämfjord thinks that transplant care is important. She believes that transgender people who are assisted by gender-affirming treatment need to have smooth access to care.

But in her work on building up gender-corrective care for young people in the Västra Götaland region, she also met a patient group with great co-morbidity.

- It is a clearly overweight assigned girl sex, up to 85 percent in certain age groups. It is very high psychiatric illness, 90 percent have a psychiatric diagnosis. 45 percent have self-harm behavior. 20 percent have an autism diagnosis, but another 35 percent had so many symptoms that we wanted to refer them for investigation, she says.

"Not prepared to take that risk as a doctor"

Angela Sämfjord believes that health care is expected to provide a clear indication for sex-corrective treatment, despite the complexity of cohabitation.

- I was not prepared as a doctor to take the risk of doing harm to these patients.

The consequence was that she resigned from her job. It eventually became a matter of conscience, she says.

- We also need care that captures the individuals who are not helped by the gender-affirming treatment and we need to ensure that they do not receive it, says Angela Sämfjord.

“An unfortunate wording”

Karolinska in Stockholm is clear that anyone who seeks care from the KID team, which receives the majority of children and young people under 18 with gender dysphoria, is not given treatment. The website states that only one in three of those who started investigations last year met the diagnostic criteria. But when Assignment Review asks questions about the task, it turns out that it does not mean saying no to the majority of patients.

What happened to these other 70 percent who started the investigation?

- They had to be 18 years before we finished the investigation and therefore referred to the adult unit Anova, says Louise Frisén, chief physician at the KID team.

So it wasn't that the 70 percent did not meet the diagnostic criteria, but that they were moved over?

- Yes. Most people come when they are 17, 17 and a half.

But why don't you write it then? When I read this sentence, I read it as if you only made a diagnosis in a third of the cases and that the others have made a professional assessment that they do not have gender dysphoria.

- I also think it is an unfortunate wording.

Assignment review report "Tran Train: Part 2" will be sent on Wednesday 9 October. You can watch it from 12pm on SVT Play or 8pm on SVT1.