Why Ron DeSantis’ claim that Sweden ‘shut down’ gender-affirming surgical care is Half True

Florida Gov. Ron DeSantis said parents who seek gender-affirming care for their children subject those children to abuse — so much so that other nations have sought to ban it. 

During the fourth Republican presidential primary debate Dec. 6 in Tuscaloosa, Alabama, DeSantis cited Sweden as an example.

"As a parent, you do not have the right to abuse your kids," DeSantis said. "This is cutting off their genitals, this is mutilating these minors, these are irreversible procedures. And this is something that other countries in Europe like Sweden, once they started doing it, they saw it did incalculable damage. They've shut it down." 

It is hard for transgender minors to get gender-affirming surgical care in Sweden. But much of that stems from a 1970s law that is unrelated to DeSantis’ point.

In 2022, health officials updated guidance for people younger than 18, advising chest surgery only in "exceptional cases." However, the new guidance is a recommendation — and is not comparable to the legal bans in some U.S. states.

Gender-affirming care is an individualized approach to health care that supports transgender and nonbinary people’s gender identity and it can go beyond medical interventions. For the small population of transgender youth, this mainly involves support through social transition, puberty blockers and hormones as children become adolescents. 

The gender-affirming surgery DeSantis cited is rarely performed on minors, said Dr. Marci Bowers, a gynecological surgeon and president of the World Professional Association for Transgender Health. Surgeries on minors happen "only under the most severe conditions of gender dysphoria," she said. Gender dysphoria is the experience of distress that results when people’s sex assigned at birth does not match their gender identity.

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"Top surgeries," or mastectomies, are more common than surgeries that alter genitalia. 

In Europe more broadly, gender-affirming care availability is more often dictated by health policy or guidelines, not legal prohibitions.

U.S. lawmakers have taken a different approach, with states in some cases banning certain procedures. DeSantis signed a law in May that banned all gender-affirming medical care —– including puberty blockers, hormones and surgery. 

A 1975 Swedish law, which ended a decadeslong eugenics and forced sterilization program, says that people younger than 18 cannot have genital surgeries. But the law doesn’t explicitly ban transgender care.

People seeking genital surgery must apply and be approved by the Legal Council at the Swedish Board of Health and Welfare. People younger than 23 seeking this surgery need "special circumstances" to get their applications approved, according to the Swedish Federation for Lesbian, Gay, Bisexual, Transgender, Queer and Intersex Rights, also known as RFSL.

In national guidelines updated in 2022, Swedish health officials cautioned that "the risks of puberty blockers and gender-affirming treatment are likely to outweigh the expected benefits."  The guidelines recommended limiting use of puberty blockers, hormones and mastectomies to "exceptional cases." 

"The guidelines are recommendations, and it's up to the physicians to interpret them and make a judgement in each specific case," said Jêran Rostam, an expert in trangender issues at RFSL.

The guidelines don’t "ban"  top surgeries, but do signal shrinking access to the procedure. 

Speaking about gender-affirming surgical care for minors, DeSantis said Sweden "shut it down."

A 1970s law on sterilization requires people in Sweden to be 18 or older to qualify for genital surgeries. The law does not explicitly ban transgender care. Citing potential risks, Swedish health officials in 2022 advised that mastectomies for minors be reserved for "exceptional cases." But it is not a legal prohibition.

The statement is partially accurate but leaves out important information. We rate it Half True.

Editor’s Note: Google Translate was used throughout the research of this story to translate websites and documents into English. We corroborated our understanding of translated documents with expert sources.