Between Suicide and Regret: Media Representations of Gender‐Affirming Care for Transgender and Gender Diverse Youth

ABSTRACT

Prompted by intense public debate and policy shifts, this study examines news media representations of gender‐affirming care for transgender and gender diverse (TGD) youth in Sweden from 2019 to 2023. The analysis draws on Hall's theories of media representation and articulation, with a framework focussing on risk and temporality. Analysing media representations is crucial for understanding how societal discourses on gender dysphoria are shaped. The media articulates a dramatic rise in youth seeking gender‐affirming care, and portrays a new group of patients, primarily young “girls” with neuropsychiatric conditions. This group is frequently articulated as vulnerable, mentally unstable and influenced by social contagion. The media representations draw on a risk discourse, centred on the threat of future regret, the irreversibility of medical interventions and suicidality. Both critics and supporters of gender‐affirming care invoke suicide risk to justify their positions. The study highlights how TGD youths' voices are largely absent from the media representations. It critiques the simplified constructions of gender dysphoria and calls for more nuanced understandings of the rise of a diagnosis, care access and mental health. Finally, the paper illustrates shifting alliances and resistance within a broader conjuncture where professional and cultural tensions shape public discourse on gender‐affirming care.

1. Introduction

In recent years, young transgender and gender diverse (TGD) people's access to gender‐affirming healthcare has been a topic increasingly up for public debate, both in Sweden and in other countries such as the UK and the United States. In 2019, Swedish television aired a documentary titled ‘The Trans Train’, which stirred significant media attention and controversy surrounding gender‐affirming care for TGD youth. The documentary centred on medical interventions such as puberty blockers and hormone therapy for young people with gender dysphoria, with discussions focussing on the appropriateness and evidence basis for providing gender‐affirming care to minors. Follow‐ups to the documentary were aired in 2021 and 2023, together with another critical documentary broadcasted in 2023. The media coverage contributed to, for example, a change of guidelines for care in the biggest children's hospital in Sweden, as seen in the decision from Astrid Lindgren Children's Hospital (2021). The government commissioned the Swedish National Board of Health and Welfare to update the guidelines for gender‐affirming care for minors, which were published in 2022. Now puberty blockers and cross‐sex hormones are only given within research protocols or ‘in exceptional cases’ (Socialstyrelsen 2022). Similar trends towards adopting more restrictive guidelines have also been seen in UK and Finland (Wuest and Last 2024), whereas other countries have guidelines similar to Sweden's previous ones.

Many of the issues raised in our analysis are complex, involving questions of aetiology, suicidality, the causes of increased prevalence and the autonomy of minors. We do not claim that these questions have simple answers. However, it is important to recognise that the scrutiny applied to these medical interventions, and to this care‐seeking group, is not arbitrary. Although gender‐affirming care for TGD youth is problematised and questioned, other medical interventions, such as puberty blockers for cis children, are treated as self‐evident and are not up for debate (Drescher 2023). This disparity warrants critical examination.

Drawing on Hall et al. (2013), we contend that news does not emerge in isolation and is not a straightforward reflection of society. Instead, media play an active role in the social construction of reality by selectively choosing, framing, and amplifying certain issues while marginalising others. As a result, media debates mirror societal discourses on gender dysphoria and healthcare access in relation to it and, in turn, shape public discourses, healthcare practices for youth with gender dysphoria and impacting the lived experiences of TGD youth (see, e.g., Indremo et al. 2022).

Against this background, and by deploying the theoretical concepts of representation and articulation (Hall 1997), the present study aims to analyse media discourses on gender dysphoria among youth and their access to gender‐affirming care between 2019 and 2023 in Sweden, focussing on the following questions:

1. How are youth seeking care for gender dysphoria represented?

2. How is gender dysphoria and access to gender‐affirming care among youth articulated?

1.1. The Role and Importance of Media Discourses

Several previous studies have, in different ways, explored media discourses concerning TGD issues. Studies from Canada, Sweden and the United States have shown how transgender individuals have become increasingly visible in media, but that negative stereotypes and misrepresentation still persist, impacting the perceptions and experiences of transgender youth (McInroy and Craig 2015; Pham et al. 2020; Åkerlund 2018). Hughto et al. (2021) reported that exposure to negative transgender‐related media messages was associated with adverse mental health outcomes among transgender adults living in the United States. Gillig et al. (2018) showed, in a U.S. context, that exposure to positive portrayals of transgender characters on television was associated with more positive attitudes towards transgender individuals and policies among a population sample. Pang et al. (2020) identified that an increase in media coverage in UK and Australia was correlated with higher rates of referral to specialist gender clinics for children and adolescents. However, Indremo et al. (2022) showed that negative media coverage of transgender‐specific health care was associated with decreased referrals to gender identity clinics for TGD children and adolescents in Sweden. Although these studies have explored media discourses on TGD and some specific effects, to the best of our knowledge there are no critical studies focussing on recent media discourses of gender‐affirming care among TGD youth in the Nordic context, and our focus on risk and temporality offers a novel contribution to this field.

1.2. Young Trans People and Gender‐Affirming Healthcare

Gender‐affirming healthcare encompasses a range of medical interventions such as hormone therapy and surgical procedures, as well as mental health support and social transition assistance. These interventions are aimed at alleviating gender dysphoria and improving the overall quality of life for care seekers (Coleman et al. 2022). In Sweden, access to gender‐confirming care requires referral to a specialised multidisciplinary team that conducts comprehensive psychological, psychiatric, medical and social assessments; the duration of this process varies and should be individually adapted. Although adults can access interventions after diagnosis, there are stricter eligibility criteria for minors since 2022, with the new national guidelines limiting hormonal treatment for those under 18 to exceptional cases or within research protocols (Socialstyrelsen 2022).

Over the past 10 years there has been an increase in the number of TGD minors seeking gender‐affirming healthcare, both in Sweden and elsewhere (Frisen et al. 2017; Kaltiala et al. 2020). Studies suggest that gender‐affirming healthcare can reduce the suffering caused by an individual's gender identity not conforming to their assigned sex, and it can improve psychosocial functioning and quality of life (Baker et al. 2021). Puberty blockers and cross‐sex hormones have been shown to have a positive impact on the mental health of young TGD people and better well‐being into adulthood (Arnoldussen et al. 2022; A. E. Green et al. 2022; Mahfouda et al. 2019; van Der Miesen et al. 2020). However, even after gender‐affirming care, there is a continued increased risk of mental ill health (Dhejne et al. 2016). Critics have questioned the long‐term effects and risks associated with medical interventions, particularly among young people whose bodies are still developing (Koener et al. 2025). Studies on gender‐affirming care showing positive outcomes have been questioned, with critics arguing that they are based on small samples and are not prospective and randomised, a kind of studies which at the same time are argued to not be ethical to conduct (SBU 2022).

One central topic in media debates is the issue of regret which may refer not only to changes in gender identity but also to mistreatment, dissatisfaction with treatment or partial re‐/detransition, such as shifting between binary and nonbinary identities. Estimates of regret and detransition range from 1% to around 10%, varying by study and influenced by factors such as definitions, methodology, population and pre‐treatment assessments (Dhejne et al. 2014; SBU 2022). Regret after gender‐affirming surgery is considered to be lower than among many other surgical procedures (Thornton et al. 2024).

2. Conceptual Framework: Risk Discourses and Temporality

The conceptual framework draws on theories about risk and temporality, and these were chosen in an abductive manner, meaning that a first reading of the material guided the choice. Additionally, the analysis draws on media theories of representation.

Risk can be a powerful discourse, as D. Green (2007) states about risk discourses within social work; risk forces its way in and demands priority. D. Green (2007), alongside other scholars (Beck 1992; Lupton 2006), suggests that we have seen a rise of risk. In the past 20–30 years or so, many perceived threats have been framed as risks and, as such, risk is used to assess, manage and mitigate potential harms and threats or future uncertainties.

When risk takes precedence over need, more time and resources will be spent on risk assessment, management and mitigation strategies than on addressing the actual needs of individuals and communities (D. Green 2007). As D. Green (2007) writes, ‘the realisation of potential risk in a/…/future becomes more important than the reality of the present’ so that the ‘future unrealised risk/…/can over‐ride today's need’ (401). This illustrates the intricate connections between risk and temporality. Concerning gender dysphoria, previous research studies have shown how diagnostic criteria, guidelines for care, evaluation practices and legal requirements emphasise temporal aspects, such as childhood cross‐gender behaviour, gender stability over time and present suffering (Alm 2018; Linander 2018).

Temporality is central in relation to risk in terms of age, the timing of medical interventions (e.g., discourses on individuals being too young to know what they want) and in relation to waiting for healthcare (Linander and Alm 2022). In discussions about young people's access to gender‐confirming care, issues about autonomy and maturity are often intimately connected to ideas about age. Threadgold (2020) highlights that youth is, especially within medical discourses, constructed as a transitional phase, situated between childhood and adulthood. Such temporal discourses can involve ideas that youth is marked by uncertainty, that young people may struggle to foresee the consequences of their choices and that the volatile nature of youth can manifest in risk‐taking behaviour.

Besides the concepts of risk and temporality, we also draw on theories from media studies. Representation (Hall 1997) provides a valuable framework for understanding how meaning is constructed and communicated across various contexts. Media representations are not simply reflections of reality but a constitutive process that involves the production of meaning through language. This process occurs within a framework of power relations, where dominant ideas shape and restrict the ways meanings are constructed and interpreted (Hall 1997). Viewing representation through this lens requires attention to the role of media in either reinforcing or challenging these constructions. Consequently, representation becomes a site of contestation, where meanings are continuously negotiated, reflecting and engaging with broader social and political dynamics (Hall 1997).

We draw on Stuart Hall's concept of articulation (Grossberg 1986) to analyse how the constructions of risk and temporality are represented in news articles about gender‐affirming care for TGD youth. In the process of articulations, various signs are positioned and aligned in relation to one another, and by so creating meanings of different concepts. Illustrating this from our empirical material: by articulating some gender dysphoria as ‘contagious’ and as clearly different from ‘genuine’ gender dysphoria, these representations reinforce the understanding that only certain gender dysphoric experiences are legitimate. Employing the concept of articulation allows us to uncover prevailing understandings while also bringing attention to marginalised alternative perspectives. Thus, articulation is helpful in analysing the interconnections between different meanings and the potential social ramifications of such reshaping of meaning.

3. Material and Analysis

Empirically, this paper draws on media material consisting of different types of articles in Swedish news media about young trans people and gender‐affirming care.

The material was identified through a search in the Retriever Research, Media Archive database, with the following search string: ‘(Gender reassignment OR gender dysphoria OR gender affirming) AND care AND young people’ [Sw:‘(Könskorrigering OR könsdysfori OR könsbekräftande) AND vård AND unga’]. The time period was set to 1 January 2019 (The Trans Train was broadcast that spring) to 31 of December 2023—resulting in 1051 articles/pieces. Between 2019 and 2023, the number of published articles varied, with higher volumes in 2019, 2020 and 2023 (360–390 per year) and comparatively fewer in 2021 and 2022 (250–300 per year).

In a first step, we chose to include only articles and other media pieces from established Swedish news media [Sw: redaktionella källor]. This meant excluding, for example, press releases and articles from authorities and we did this as it arguably reflects the general media discourse in Sweden. Due to accessibility, we only included text sources and excluded television or radio. This process resulted in 875 articles. In a second step, we excluded those that did not deal with Sweden, further reducing the material to 572 articles.

After that, the 572 articles were downloaded in their full versions, a total of 1543 pages. These were reviewed for relevance (based on the research questions) and to identify duplicates and incomplete texts, which resulted in exclusion of 228 articles. The final material consists of 344 articles published in Swedish news media. These articles include national daily newspapers, regional and local press as well as smaller online publications spanning the political spectrum from LGBTQ‐oriented magazines to far‐right platforms. It further encompasses a variety of genres, such as news reporting, feature articles, editorials and opinion pieces.

The articles were imported into MaxQDA 24, where parts corresponding to the research questions were initially and inductively coded, with examples of codes being ‘gender‐affirming care potentially dangerous’, ‘lacking scientific evidence’, ‘gender dysphoria from social influence’ and ‘evaluation should take time’. In a second step, illustrative quotes were exported and thematised in Microsoft Word, with attention to ensuring that the codes and quotes within each theme were coherent and conceptually consistent, while the themes were clearly distinct from one another. This process resulted in the findings being categorised into five themes.

The five themes were then read in an iterative manner in relation to our conceptual framework with a focus on risk and temporalities and the concepts of representation and, especially, articulation.

4. Findings and Discussion: Between Suicide and Regret

Our analysis of the five themes in the media material is presented below. The five themes are as follows: ‘They are so many—and it is a new group’; ‘Separating the true gender dysphoric persons from the socially contaminated’; ‘The mentally unstable girls—Saving our vulnerable young “girls”’; ‘The risk of regret—Reconstructing the gatekeeping power of healthcare’ and ‘The risk of suicide’.

4.1. They Are So Many–and It Is a New Group

The first theme highlights representations of the issue that emphasises a significant increase in the number of care‐seekers and describes this group as partly consisting of a new category of patients. The increase of care‐seekers is articulated in at least 80 articles and is formulated in the daily press as follows:

The number of children and young people seeking treatment for gender dysphoria has skyrocketed nationally in recent years.

(Expressen, 3 April 2019)

In another newspaper, it is stated that:

Around the year 2010, a dramatic change took place, and over a ten‐year period, the number of people wanting to change gender in Sweden increased by 2,300 percent.

(Dagen, 12 July 2023)

The increase in the number of young people seeking care for gender dysphoria is articulated with signal words (e.g., the numbers have ‘skyrocketed’) and alarming percentages, such as 2300% in the example above, or a ‘500% increase’, ‘doubling rates per year’, ‘20 times larger group’ or ‘eight times as many’, creating a sense of urgency by representing the increase as a rapid and uncontrollable phenomenon. For example, it is frequently stated that the number of young care seekers has grown ‘dramatically’ (articulated at least 13 times). These articulations evoke a sense of threat, in that the increase is a risky situation. Even though a rapid increase needs serious exploration, sometimes these articulations obscure the fact that these percentage increases started from a very low baseline, making it easier to present small absolute numbers as disproportionately large.

However, in some cases the frequencies are presented as absolute numbers and not percentages: ‘The increase in Swedish children seeking care for gender dysphoria is great. Between 2013 and 2017, the number of cases in Stockholm increased from 24 to 239’ (Göteborgstidningen 2019‐04‐03). The rise in cases in Stockholm from 24 in 2013 to 239 in 2017 would appear drastic in percentage, but here the absolute number of individuals is articulated. Another newspaper also makes the absolute numbers explicit:

The number of referrals coming into the centre each year has exploded. In 2012, 63 people applied to the clinic to start an evaluation for gender dysphoria. In 2022, the number of applicants was 642 people.

(Hallandsposten 25 August 2023)

Here, the increase is articulated as ‘exploding’, thereby establishing a sense of urgency and connecting it to a discourse of risk. Concurrently, the absolute numbers are demonstrated.

Another way of adding to the sense of urgency and risk is by blurring the line between care seekers and care receivers, together with articulations of the signal word ‘dramatically/dramatic’, for example, ‘Gender dysphoria is increasing dramatically among young people’ (Bohusläningen 13 February 2020). Likewise, a journal aimed at medical professionals refers to ‘the dramatic increase of young people with gender dysphoria’ (Läkartidningen 30 October 2019). Although it might be clear to the informed reader that the numbers cited in the articles do not equal the numbers of people receiving hormones etc., many of the articles do not differentiate between young people seeking care for gender dysphoria and those receiving gender‐affirming medical treatments. Sometimes articles focus on the number of people seeking care; less often, they focus on the number of those who receive medical interventions. This, we argue, might contribute to amplifying the discourse of risk.

Furthermore, this growing group of patients is represented as a new group, as the Swedish public service television news site online, SVT news, states ‘But—how many people regret within this new group, no one knows’ (3 April 2019). Similarly, another article in the news magazine Fokus states:

No one questions the suffering that can arise from gender dysphoria. But the diagnosis is uncertain, and for ten years a whole new group of young patients has emerged, which consists of about 70 percent girls (0–17 years), the majority of whom have autism or other psychiatric vulnerabilities. For many, the suffering came before they began to identify as transgender.

(14 September 2023)

In the same manner, a health professional within gender‐affirming care, responded in an interview that he:

… believes that there is a new group that not only has a rapidly onset gender dysphoria but also has a rapid turn to detransition—that is, that they regret it early.

(SVT Nyheter 2 April 2019)

As seen in the quotes above, the media representation of this ‘new group’ are argued to be different from previous patients in the sense that a higher proportion of them are ‘girls’ (i.e., assigned female at birth), they are younger, have mental ill health/neuropsychiatric diagnoses and have a risk of rapid regret/detransition (all issues we will return to). The representation of a ‘new group’ thus functions as a temporal comparison, where ‘new’ not only marks a shift in patient characteristics but also implies a contemporary phenomenon, possibly shaped by recent social or clinical developments. However, the historical contrast is not explicitly delineated; rather, it is only implicitly suggested through the juxtaposition of the absent past, characterised by the presence of mentally stable ‘men’. This articulation connects to a discourse of risk, suggesting that it represent a phenomenon we do not yet understand, and therefore one that may require caution or urgent attention.

4.2. Separating the True Gender Dysphoric Persons From the Socially Contaminated

This second theme concerns how the increase in the number of care seekers is a result of a cultural disease, and how the ‘real gender dysphoric patient’ is articulated as separate from the ‘socially infected patient’. As stated in an editorial in Svenska Dagbladet:

If you ask Mikael Landén, professor of psychiatry and neurochemistry at the Sahlgrenska Academy, it is probably a cultural disease—or psychological contagion, as he calls it: ‘If people in their early teens are encouraged to think about their gender identity and are taught that gender dysphoria is a normal variant, it is not unlikely that some young people will focus their search for identity on gender identity’.

(12 February 2020)

The speculative phrasing, ‘probably’ and ‘not unlikely’, articulated with terms such as ‘cultural disease’ and ‘psychological contagion’, serves to represent gender dysphoria as both an elective condition and one that can be transmitted through social exposure. By referencing a medical expert, the argument is imbued with scientific authority and legitimised within a medical discourse. The articulation of speculative language with the trustworthiness and authority of a medical expert arguably reinforces an understanding of gender dysphoria as something culturally constructed and potentially contagious while simultaneously casting doubt on its legitimacy as an inherent or stable condition.

The increase in the number of care seekers and the new group of care seekers are in several instances also explained as an effect of ‘a cultural disease’ (e.g., in Fokus and Dagen in 2023), ‘a social contagion’ (Fokus), or ‘a culture‐bound psychological contagion’ (e.g., in Göteborgs‐Posten). That gender dysphoria can be contagious is explicitly articulated in at least 14 articles in the material, but in some cases, it is more implied, as in this opinion piece from the association Genid (a parent network critical towards gender dysphoria care):

Concerns about cultural contagion, comorbidity and sudden onset of gender dysphoria in children and young adults need to be highlighted and discussed. We know that humans are social beings. We know that all of us humans are affected by what others say and think, what is presented as truth, by the need to belong and be accepted. Why should this particular context be an exception?

(Göteborgs‐Posten 29 September 2023)

Articulating ‘cultural contagion’, ‘comorbidity’ and ‘sudden onset of gender dysphoria’ with ‘social beings’, ‘humans’ and ‘truth’ as well as ending with the question ‘Why should this particular context be an exception?’ allude to a fear that young people, due to our social nature and peer influence, may be drawn into getting gender dysphoria. It can be argued that this serves to further perpetuate the discourse of risk. The notion of risk is also strengthened by involving the concerns of parents: ‘My biggest concern is that this is, that it comes from outside influences and that this is not grounded in her and that she will eventually discover that’ (SVT Nyheter 2 April 2019).

Articulating sociocultural influence in this context is an effective way of delegitimising the autonomy and agency of young people experiencing gender dysphoria. Certainly, we cannot rule out that people are affected by social norms, cultural narratives and peer environments. However, representing the pursuit of gender‐affirming treatments as a mere response to peer influence or social contagion situates gender dysphoria within a broader risk discourse and mirrors social anxieties about deviance, where change is framed as risky, pathologised and constructed as contagious. This risk discourse obscures a more nuanced understanding of how and why more people come to seek gender‐affirming care, such as more people experiencing or making sense of gender in a particular way, greater willingness to seek care due to changing social climates, and improved accessibility of gender‐affirming healthcare.

Another prominent idea in the material is separation of those that are truly gender dysphoric from those that have gender dysphoria because of social processes:

It cannot be ruled out that gender dysphoria can be ‘contagious’ in the same way as eating disorders and other self‐harming behaviours. Increased information and access to care for transgender people is fundamentally positive. However, we must be aware that there is a risk that in addition to ‘genuine’ transgender people, there may also be young people who find and are attracted by a solution to their problems that is not right in the long run.

(Expressen 2 April 2019)

Another article states ‘This may be the result of a cultural contagion, that is an expression of a cultural disease, and should be distinguished from genuine gender dysphoria’ (Dagen, 12 July 2023). By articulating some gender dysphoria as ‘contagious’ and as different from ‘genuine’ gender dysphoria, these representations reinforce the understanding that only certain gender dysphoric experiences are legitimate. This way of separating the ‘true gender dysphoric persons’ from others has a historical continuity. For example, early Swedish Government Official Reports differentiated between the transvestite, the homosexual, and the true transsexual (Edenheim 2005). Early psychiatric research studies divided transsexualism into primary and secondary, and constructed the primary position, which includes the childhood transgression of gender norms, as more genuine (Kroon 2008). Thus, in a similar manner, the ‘real gender dysphoric patient’ is articulated as separate and different from the ‘socially infected patient’. Those that ‘really’ have gender dysphoria might be legitimised with biologistic arguments within a discourse where they need ‘to become female again’ or are ‘changing back’, correcting the body in line with the biological sex established and fixed early in life, maybe in the brain or in the genes (Long Chu 2024).

The idea that gender dysphoria could be influenced by social factors diminishes the authenticity of certain experiences of gender dysphoria rather than recognising that all identities, including cisgender ones, are shaped in relation to social norms (Linander et al. 2024). In this sense, the articulation of sociocultural contagion not only separates the ‘real’ gender dysphoric patient from the supposedly socially influenced one but also obscures the role that cultural understandings of gender play in shaping all identities, whether trans or cis. However, to acknowledge the socially contingent nature of experiences and identities does not imply voluntarism or reversibility (Butler 2014). To grasp contemporary discourses on gender dysphoria, it is necessary to hold two perspectives at once: that gender identity and gender dysphoria are both historically and socially situated, and at the same time existentially grounded and lived.

However, alternative understandings of the increase in the number of gender dysphoric care seekers also occur in the material. In an article from Expressen, a medical doctor working with gender‐affirming care proposes alternative explanations:

… there are probably several different factors that interact. Issues linked to gender and gender identity have gained increased visibility, they have come a long way when it comes to the destigmatisation of trans people, and there is visibility in social media.

(2 April 2019)

Another way to respond to arguments of an increase is illustrated by this quote from a longer feature story in Svenska Dagbladet:

Among other things, the programmes [e.g., The Trans Train] pursue the thesis that the increased number of open and visible trans people attracts young people with mental illness to begin to identify as trans themselves—a criticism that is sometimes reminiscent of how homosexuality was considered contagious a few decades ago.

(26 July 2020)

This historical parallel can be understood as a rhetorical device and alludes to an assumed social acceptance of homosexuality that should also be extended to young trans people seeking gender‐affirming care.

The prevailing representation in our material is that gender dysphoria has been influenced by social contagion. Nevertheless, alternative articulations that challenge this prevailing perspective are also present within the media discourse.

4.3. The Mentally Unstable Girls–Saving Our Vulnerable Young ‘Girls’

As illustrated above, this new and growing group of care seekers is described as consisting mainly of ‘girls’ (i.e., assigned female at birth) with mental ill health. That the increase in healthcare seekers mainly consists of young girls is articulated in at least 60 articles, with a majority also describing coexistence of mental ill health. In an opinion piece in Svenska Dagbladet, the journalist writes:

Girls, often young, with autism spectrum disorders make up the largest part of the increase in those seeking care for gender dysphoria. Other diagnoses where those with gender dysphoria stand out statistically are depression, anxiety disorders, ADHD and self‐harm.

(13 February 2020)

Different disorders and diagnoses are articulated together with ‘young girls’, creating an understanding of ‘girls’ with mental health diagnoses as especially vulnerable to gender dysphoria. In an editorial published more than 2 years later, the same newspaper as above further emphasises these articulations: ‘A typical patient nowadays is a girl with an autism diagnosis, and many have psychiatric conditions such as eating disorders or ADHD’ (Svenska Dagbladet 12 September 2023). In a similar vein, an article states:

It is important to note that more than half of teenage girls who want to change their gender have other psychiatric diagnoses and may be more susceptible to influence than average.

(Göteborgs‐Posten 2 January 2023)

Thus, the growing number of care seekers are represented as impressionable young ‘girls’ with mental ill health. Although the gender dysphoria diagnosis seems up for debate and questioning, the other mental health diagnoses are articulated as a matter of fact. In a longer article questioning the ‘radical trans activism’, a board member of an umbrella organisation for the Swedish women's movement writes:

Girls make up about 80 percent of children and young people with gender dysphoria. No one knows why, but more and more people believe that there are clear elements of social contagion and cultural disease in the increase. Like [name], the majority of them also have other diagnoses, such as anxiety, ADHD and autism. Many of those with gender dysphoria at a young age become homosexual when they grow up, unless they are led on a path towards medical transition.

(Fokus 8 September 2022)

The understanding of gender dysphoria as a social disease is repeated here, as in other places in the material. Girls are described as particularly vulnerable and at risk of over‐medicalisation and misdiagnosis. Gender dysphoria is articulated together with homosexuality, which arguably ties into ideas about gender dysphoria among youth being a ‘symptom’ of homosexuality rather than ‘true’ gender dysphoria (see also Pullen Sansfaçon et al. 2020), which reinforces a division between true and false gender dysphoria.

Similar apprehensions are also visible in other parts of the material:

She [well‐known Swedish radical feminist] believes that what we are seeing now is something else, and without passing judgment on individual cases, she points to the consequences when society wants to help young girls who feel bad and say that they do not want to be women.

(Dagens Nyheter 24 April 2021)

It is noteworthy that certain radical feminist perspectives appear to articulate notions of mentally unstable 'young girls' incapable of understanding their own best interests. Such articulations might be tied to concerns about a sexist culture that reinforce binary gender norms, but they can also be read as tied to a discourse of ‘saving young vulnerable girls’, which reassembles historical patterns in which individuals identified as women, particularly those constructed as vulnerable (whether due to youth, race, or other factors), have been portrayed as being at risk of breakdown. Additionally, such articulations intersect with dominant ideologies that frame young people as uncertain about their desires and at risk of making the wrong decisions (Threadgold 2020), ideas which are also made explicit in the material: ‘The brain is not fully developed until about 25 years of age’ (Svenska Dagbladet 22 October 2019). Together, the articulations of young age and linking gender dysphoria to psychiatric comorbidity reinforces a discourse of risk in which youth is constructed as ‘too young’. Here, temporality, appropriate age and readiness become central and gender‐affirming care is articulated as premature, risky or inappropriate for youth.

These representations may be seen as protective and out of genuine concern, reflecting an anxiety about young people's vulnerability and the irreversibility of certain medical intervention, and are often voiced by parents or certain parts of the women's movement. At the same time, voices of the care seekers are left unheard. By constructing young care seekers as subjects who need to be saved while simultaneously marginalising their voices, these representations might disempower the very groups they claim to protect by undermining their possibilities for self‐determination.

4.4. The Risk of Regret—Reconstructing the Gatekeeping Power of Healthcare

This part reflects a discourse on the risk of regret, formulated as a potential problem of the future. The risk of regret is articulated repeatedly in the material, in at least 70 articles. This discourse is composed of articulations amplifying fears of potential regret in the future and ‘irreversible’ consequences of treatment (e.g., in SVT Nyheter, Läkartidningen and Svenska Dagbladet), positioning a treatment decision as inherently fraught with risk. This irreversibility is articulated with phrases such as ‘reproductive abilities gone forever’ (Östgöta Correspondenten), ‘people with gender identity disorder are offered irreversible gender‐confirming treatment’ or ‘radical irreversible medical and surgical treatment’ (Läkartidningen). The following example is from a news article in which a parent is interviewed:

The father [of the 18‐year‐old] tells me that they are worried that their child will regret their gender reassignment treatment. ‘The irreversibility, the interventions. […] Our big concern, based on the fact that we know him and know how he works, is that he won't be confident enough in his decision—whatever it will be. To then have done things that cannot be backed away from. That just can't happen,’ he says.

(Expressen 3 April 2019)

This father's words reflect a broader societal anxiety: the risk that certain interventions will render futures permanently foreclosed. Such concerns can be legitimate, as questions of irreversibility inevitably raise ethical and existential stakes. However, it is not clear which interventions are referred to, and such vagueness can potentially mislead readers. Puberty blockers are acknowledged as having at least partly reversible effects, whereas certain effects of cross‐sex hormones and surgery are often presented as less reversible (Coleman et al. 2022). Thus, the articulation of irreversibility becomes not just a medical risk but a symbolic and moral one, reinforcing a heightened sense of temporal urgency, a ‘risk of no return’. In the media material, some proponents of providing gender‐affirming treatment to minors also invoke irreversibility, but with reference to the irreversible outcomes of puberty that would occur without treatment.

The risk of regretting (irreversible procedures) is presented as an idea of care being rushed or given too easily or too quickly:

At the moment, 390 young people are being evaluated for gender change in Stockholm alone. But now worried doctors—and parents of children who have regretted it afterwards—warn that the treatment is given too easily.

(Expressen 2 April 2019)

I get completely cold when I understand how fast it can go and how carelessly you handle this group of actually fragile people.

(SVT Nyheter 3 April 2019)

Media representations emphasise parental anxieties that reinforce the idea of the perceived ease with which medical treatments are accessed and comprise a worry that children might too quickly make decisions that they later regret. The use of value‐laden words and temporal markers such as ‘too easily’, ‘how fast’, or ‘so quickly’ inscribe and reinforce the understanding of access to care as quick, without sufficient time for careful evaluation, possibly leading to future regret. Other articles emphasise a more precautionary principle, as in this example from the parent network Genid:

Our aim is for young people with gender dysphoria to be met with openness and caution, and for the care, like for all other kinds of care, to be evidence‐based. We love our children and want the best for them.

(Göteborgs‐posten 29 September 2023)

In a similar vein, a paediatrician (outside gender dysphoria care) is cited in Dagens Nyheter, stating: ‘Therefore, I think one should take precautions when it comes to quick management of gender dysphoria’ (21 December 2019). Here again, the words ‘quick’ and ‘precautions’ are used to reinforce the representation of access to care. Healthcare providers working within gender dysphoria care also make statements in media emphasising caution and how it characterises their evaluations:

The lack of reliable research and experience is handled by being cautious, she says. Among other things, it is about allowing the evaluation to take time and giving the patient the opportunity to explore and showing different alternatives to medical treatment.

(Bohuslänningen 14 June 2023)

In these articulations, caution becomes a central value, employed both to critique and justify approaches to care. On the one hand, calls for caution argue against early interventions, often equating longer evaluation periods or indefinite postponement of treatment. On the other hand, the idea of caution is also used to defend the provision of care, highlighting the long and explorative evaluations. In both articulations, caution is equated with no treatment, indefinite deferral, a long time until treatment or alternative treatment.

Considering Green's work on risk, this reflects a broader response that ‘has the power to require perfection’ (D. Green 2007, 406). When perfection is demanded, all risks of possible regret must be pre‐emptively avoided. However, such an understanding overlooks the risks of inaction, veiling the psychological and social harm that delaying access to care might have.

In the above quotes, it is also visible how articulations of risk tie into an idea of gender‐affirming care for youth not being based in research or evidence. This interpretation is further strengthened by statements around this care being ‘experimental’ or ‘an experiment’ (e.g., in SVT Nyheter, Helsingborgs Dagblad, Dagens Nyheter, Västerbottens‐kuriren, Svenska Dagbladet). Such terminology articulates a lack of established protocols and reliable data, reinforcing the perception of uncertainty and risk.

In contrast to the temporal representations of a fast evaluation of gender dysphoria and quick access to gender‐affirming care, the media material also contains a competing discourse: ‘It is a problem that so many trans people commit suicide precisely because there is such a long wait’ (Landskrona Posten 6 September 2021), and ‘Young trans people who seek care at the gender identity clinic in Uppsala are affected by a queue time of at least 2 years’ (Dagens Nyheter 25 June 2023). Such statements adhere to a counter discourse which we have previously shown to be experienced as very taxing (Linander and Alm 2022).

In response to the prevailing discourse of ‘too easy and too quick’, some media articles also describe the evaluation as extensive and as a way to reduce the risk of regret. RFSL, the Swedish national LGBTQ organisation, made the following statement in an article:

RFSL:

‘Swedish research shows that the number of people who regret their gender‐affirming treatment is extremely few. Nor can we apply to Sweden experiences of regret from the United States: the evaluation looks different here and is significantly more extensive’. (Svenska Dagbladet Premium 15 March 2019)

Here, RFLS can be seen as arguing that the gatekeeping function of the evaluation teams is successful in preventing the risk of regret and is hence taking a position to defend the gatekeeping role of gender identity evaluations, an issue they had critiqued earlier. We read this as a sign of how the media landscape has changed significantly over the last few years and that what was previously partly an antagonistic relationship between care providers within gender dysphoria care and activists in the trans community can now be seen defending similar positions.

4.5. The Risk of Suicide

Along with regret, suicide is also articulated as a future risk that needs to be considered. The risk of suicide is articulated in at least 40 articles. A recurring representation motivates care for gender dysphoria by referring to the increased risk of suicidality. In a debate article, RFSL writes:

There are also many opinions about gender‐affirming care, and whether young trans people should even have access to care. The statistics on ill health speak for themselves. Transgender people are six times more likely to be treated for suicide attempts than the entire population. That's a frightening number.

(Upsala Nya Tidning 29 June 2022)

The minister for Social Affairs at the time, the Social Democrat Lena Hallengren, shared similar thoughts in the newspaper Expressen:

Let’s be careful to remember that trans people in Sweden today are at a greater risk than others of mental illness and suicide. There is a connection between that and not getting treatment in time, not being able to be, and be respected as, who you are.

(2 April 2019)

Care providers working on care for gender dysphoria voice similar concerns; a child psychiatrist said to SVT News: ‘But there is a not negligible risk of suicide and of very pronounced poor mental well‐being’ (9 October 2019). Interestingly, here we see community representatives, politicians, and care providers voicing similar concerns about the relationship between suicidality and access to care. These shared articulations emphasise that the existing prevalence of suicidality prior to receiving care underscores the urgent need for intervention.

The need for care is further argued for by pointing to research showing improved mental health outcomes and decreased future suicidality following access to gender‐affirming care:

Just this summer, the Public Health Agency of Sweden highlighted in a new research report that completed medical transition is a factor for many trans people that protects against suicidal thoughts and suicide attempts.

(Svenska Dagbladet 20 August 2020)

However, another article references a recent study: ‘[I]t provides support for the fact that if you offer gender‐affirming care in the way it is offered in Sweden, it improves mental health’ (Dagens Nyheter 2019‐10‐24). It is evident that the understanding of suicidality among young people with gender dysphoria is a dominant discourse and that those wanting to restrict access to care for gender dysphoria also want to preclude such arguments, several using reference to research: ‘On the contrary, research has unequivocally shown that the risk of suicide does not decrease after gender reassignment’ (Dagens Nyheter 4 September 2019). Another example:

The risk of suicide is often put forward as a strong argument for treatment, that patients take their own lives if they do not get help with medication and/or surgery. /…/ In the research, there is no support [for the argument] that the number of suicides actually decreases after treatment.

(Svenska Dagbladet Premium 12 November 2019)

Hence, both proponents and critics of providing care use research references to support their claims around suicidality and gender‐affirming care. In other cases, referring to doctors' ‘own experience’ seems sufficient to create validity:

Uppdrag granskning [The Trans Train documentary] has also been in contact with other doctors; none of them have personal experiences of young patients who have taken their lives while waiting for surgery.

(SVT news 9 October 2019)

Although this account does not dismiss the existence of suicidal thoughts, they question the correlation with committed suicides. Thus, research studies’ and/or doctors' statements are articulated together with risk to establish the validity of statements. Some of those objecting to care for gender dysphoria among youth are stating that suicide is actually a problem among those who regret gender‐affirming care, again referencing individual doctors' accounts:

‘I know of cases where people later in life regretted their treatments and took their own lives’, says Jovanna Dahlgren, professor at Sahlgrenska University Hospital.

(Expressen 2 April 2019)

Appeals to medical authority, through expert testimonies and research, and pointing to the risk of suicide is a powerful articulatory manoeuvre employed by both proponents and opponents of gender‐affirming care. This highlights not only the contested nature of the science but also what is at stake when articulating access to care through risk of suicide. The risk discourse surrounding suicidality is both alarming and persuasive, demanding urgent attention (see D. Green 2007). However, the ways in which it is mobilised differ significantly: although advocates for care emphasise the preventative benefits of treatment, critics argue that suicide risks are overstated or shifted to those who experience regret. These contrasting positions illustrate the polarised and simplified media landscape of gender‐affirming care, where evidence and anecdotes are wielded selectively to reinforce already established positions.

5. Concluding Discussion

The material reflects a general representation of a care‐seeking group that has drastically grown over the last 10–15 years. This group is depicted as a new group of gender dysphoric care seekers, largely consisting of ‘girls’ with neuropsychiatric disorders. The care seekers are described as having significant psychiatric problems, including suicidality, and they are portrayed as getting gender‐affirming care too quickly and then being at risk of regretting irreversible interventions. Some of these ideas have been identified in Spanish public debate (e.g., Platero et al. 2023) and in the US media (e.g., Pang et al. 2022), suggesting that they are not unique to Sweden but part of a broader international discourse. Further research is needed to explore how these discourses travel across context or diverge from one another.

In several instances there is a focus on hypothetical futures, for example, the risk of regret or suicide. As Green (2007, 401) argues, the potential risks imagined in the future often take precedence over current conditions, with the effect that attention is directed away from present needs. Hence, the risk discourse might privilege a focus on risk mitigation and precautions rather than addressing the current needs of young individuals. The risk discourse is further reinforced by ideas around young people as not being mature enough to take big decisions, to know what is in their own best interests or to foresee future consequences (see Threadgold 2020).

In the evaluation process of gender dysphoria, the future is often constructed as a linear extension of the past and present (see Linander 2018; Alm 2018). If people with gender dysphoria are evaluated to be dysphoric in ‘the right way’ in the past and present, it is assumed that the risk of regret has decreased, hence preventing the problem of the future (Linander 2018). Based on our analysis, to be assigned girl at birth and to have a neuropsychiatric diagnosis is represented to be gender dysphoric in the wrong way and with greater risks of regret. Looking at a contrasting temporal aspect, regret can be seen as ‘freedom projected into the past’ (Long Chu 2024), a freedom denied to young people with gender dysphoria if they never get the chance to access medical procedures.

Some of the media discourses on youth gender dysphoria care illuminate difficult questions that deserve careful consideration, further research, and ongoing development of clinical practices. However, the responses most often represented in the media material remain overly simplified, reducing complexity to narratives of risk, social influence, and protection, with denial of care presented as the main solution. In doing so, such representations risk foreclosing rather than expanding discussions and understandings, leaving the challenges unresolved.

One example is the articulation of irreversibility of medical procedures which does more than caution against possible risks connected with regret. It creates a present situation in which nonaction becomes the responsible pathway, enabled by articulating risk of regret together with several uncertain claims such as a new emerging group with mental health challenges and the alleged lack of scientific ground. The articulation of irreversibility ties into a binary perspective: complete certainty or regret with irreversible outcomes. It assumes an alternative situation would be possible in which the evaluation of gender dysphoria could predict with 100% certainty which youth are in ‘real’ need of gender‐affirming care.

Another prominent aspect of the media representation is the reliance on expert voices, particularly those of medical professionals, although in several cases, these professionals come from fields other than gender‐affirming care. Invoking such expertise serves to bolster the authority and credibility of particular claims, regardless of the experts' proximity to the specific area of knowledge. Simultaneously, the voices and perspective of the young care seekers are strikingly absent, something that also previous research studies have highlighted (Pullen Sansfaçon et al. 2020). This imbalance raises questions about whose perspectives are granted legitimacy, and consequences of silencing those with lived experience.

Previously, the trans and LGBTQ movements have sometimes questioned expert medical positions, as well as the gate‐keeping power of care professionals within the gender‐affirming care field; however, now there seems to be more consensus between care professionals within this field and the community. This is seen in the emphasis placed by both community representatives and care professionals on the importance of a long and extensive evaluation to decrease the risk of regret. The resistance now instead seems to come more from other care professionals, parents, media representatives (often from conservative media) and radical feminist commentators.

These shifting alliances and positions of resistance underscore how media representations of gender‐affirming care for youth reflect a broader conjuncture where ideological, professional, and cultural tensions converge to shape public discourse (Banet‐Weiser and Higgins 2023). Hall et al. (2013) describes conjunctures as contingent moments of social crisis that emerge from and illuminate the interplay of cultural, political, and ideological forces. We argue that the contemporary moment represents such a conjuncture, in which the media serve as a key arena for the negotiation of trans rights and care. On the one hand, trans identities have gained increased visibility and, in some cases, positive recognition in the media; on the other hand, it coincides with intensified debates and resistance to trans rights and healthcare access. The differing understandings of youth with gender dysphoria and gender‐affirming care reflect competing forces and structural positions that both emerge from and contribute to a broader state of instability. This instability can create conditions for social change, change that may bring rights, and access to care for youth with gender dysphoria, but also heightened scrutiny, resistance, and restricted access to care. The latter may define the current terrain, but conjunctures, as Hall reminds us, are also openings: unstable, contested and potentially transformative moments where resistance can gather force and new solidarities can take shape.

Author Contributions

Ida Linander: conceptualisation (lead), data curation (lead), formal analysis (lead), funding acquisition (lead), methodology (equal), writing – original draft (lead), writing – review and editing (equal). Johanna Lauri: formal analysis, methodology (equal), writing – original draft, writing – review and editing (equal).

Funding

This work was supported by FORTE: Forskningsrådet för hälsa, arbetsliv och välfärd (Grant 2019:00355).

Ethics Statement

Ethical approval was not required for this study as it relied solely on analysis of publicly available media content.

Conflicts of Interest

The authors declare no conflicts of interest.

Permission to Reproduce Material From Other Sources

The authors have nothing to report.

Linander, Ida , and Lauri Johanna. 2026. “Between Suicide and Regret: Media Representations of Gender‐Affirming Care for Transgender and Gender Diverse Youth,” Sociology of Health & Illness: e70141. 10.1111/1467-9566.70141.

Data Availability Statement

The media material generated and analyzed during this study are available from the corresponding author on reasonable request.