What Are The Top 5 Countries That Have Hormones?

Why Did These Countries Change Their Policies?

The shift in these five countries did not happen overnight. It came after several European health authorities looked at the same research and reached similar conclusions. The key problem they identified was that the studies used to support hormone treatments for minors were not strong enough.

Most of the existing research was “low quality” by scientific standards. Many studies followed patients for only a year or two. They often did not have proper control groups, meaning researchers could not compare what happened to kids who got treatment versus those who did not. According to the National Institute for Health and Care Excellence (NICE) in the UK, the evidence for puberty blockers showed no reliable improvement in mental health outcomes. This review was a major turning point.

Finland was the first to act in 2020. Their Council for Choices in Health Care concluded that hormone therapies should be used only in very specific, research-based settings. Sweden followed in 2022. The Swedish National Board of Health and Welfare stated that the risks of puberty blockers and hormones for adolescents under 18 currently outweigh the benefits. Norway and Denmark issued similar clinical guidelines shortly after, restricting treatments to clinical trials or exceptional cases.

What Does the Research on These Restrictions Show?

It is important to understand what the research does and does not say. The studies that these countries relied on do not prove that hormones are always harmful. What they show is that the evidence for benefit is weak, and the evidence for potential harm is growing.

A 2020 systematic review published in the Journal of the Endocrine Society looked at outcomes for gender-affirming hormone therapy in adolescents. It found that while some mental health measures improved, the studies were small and short-term. Another review from the University of York in 2024 found no good evidence that puberty blockers improve body image or long-term mental health.

On the other side, bone density loss is a documented risk. Puberty blockers stop the bone growth that normally happens during adolescence. Research from the Endocrine Society has shown that bone mineral density may not fully recover after stopping these drugs. There is also the question of fertility. Hormone treatments can permanently affect a young person’s ability to have biological children. These are not minor side effects. They are life-altering decisions.

The countries that restricted treatments looked at this balance and decided the uncertainty was too high. They did not ban care outright. They moved it from standard practice to a more cautious, research-focused approach.

How Do These Five Countries Compare to the United States?

The United States is a different story entirely. There is no national policy. Instead, there is a patchwork of state laws. Some states like California and New York have passed “shield laws” that protect access to hormone treatments for minors. Other states like Florida, Texas, and Alabama have banned them entirely.

This creates a confusing situation for families. A 14-year-old in one state can get a prescription for testosterone or estrogen. A 14-year-old in a neighboring state cannot. The American medical establishment, including the American Academy of Pediatrics and the Endocrine Society, still supports gender-affirming care for adolescents. They argue that withholding treatment causes harm.

However, a growing number of U.S. doctors and researchers are questioning this position. They point to the European reviews and ask why American guidelines have not been updated. The main difference is that European countries rely on national health boards to set standards. In the U.S., care is often guided by professional organizations that have been slower to change their recommendations.

What Are the Top 5 Countries That Have Hormones as Standard Care?

While the list above covers countries that have restricted hormones, it is also worth knowing which countries still offer them as standard care. The Netherlands, Canada, Australia, New Zealand, and parts of the United States are among the most permissive.

The “Dutch Protocol” from the Netherlands has been the model for gender-affirming care since the 1990s. It involves puberty blockers starting around age 12, followed by hormones at age 16. This protocol is still widely used. Canada’s guidelines are similar, though some provinces are starting to review their policies. Australia and New Zealand have also followed the Dutch model for years.

The difference between these countries and the five on the restricted list is not about whether they care about transgender youth. It is about how they interpret the same evidence. The Dutch researchers who created the protocol argue that their long-term follow-up data shows positive outcomes. Critics point out that the Dutch studies had high dropout rates and did not track patients who later regretted their treatment.

This is a genuine scientific disagreement. It is not settled. The evidence is not as clean as either side wants it to be.

What Should Parents Know About These International Differences?

If you are a parent trying to make sense of this, the international differences matter for one main reason: they show that the science is not settled. When five developed countries with strong healthcare systems all independently decide to restrict care, it is not because they are anti-science. It is because they read the same studies and came to a different conclusion.

Some things are clear from the research:

• Puberty blockers have been used for decades for early puberty in children, but their use for gender dysphoria is newer and less studied.
• Cross-sex hormones cause irreversible physical changes. Voice deepening, breast growth, and facial hair changes do not reverse if the person stops the medication.
• Mental health outcomes are mixed. Some studies show improvement, but others show no change or even worsening in certain groups.
• Regret rates are reported as low in most studies, but these studies often do not track patients who stopped treatment and did not return to the clinic.

The best advice from the evidence is to take a slow approach. The European countries that restricted care did not ban it. They made it harder to get, requiring more evaluation and more certainty before starting treatment. That is a reasonable position given the current state of the science.

What Are the Common Misconceptions About These Policies?

There are several misconceptions that come up often in discussions about these countries.

First, some people claim these countries “banned” hormone therapy for all transgender people. That is not true. The restrictions apply specifically to minors. Adults in these countries can still access hormone therapy through standard medical channels.

Second, some claim the restrictions were driven by politics rather than science. In the UK, the Cass Review was commissioned by the National Health Service and led by Dr. Hilary Cass, a respected pediatrician. Her team reviewed over 100 studies. The review was not a political document. It was a systematic look at the evidence. The same is true for the Swedish and Finnish reviews.

Third, some argue that these countries have low regret rates, so the restrictions are unnecessary. But regret is only one measure of harm. There is also the question of whether the treatment actually improved the person’s life in a meaningful way. If a young person goes through puberty suppression and then stops, they have missed out on normal pubertal development without clear benefit. That is a harm even if they do not “regret” their decision in a clinical sense.

The goal of this information is not to tell you what to think. It is to show you what the evidence actually says and how different countries have interpreted it. The five countries that have restricted hormones did so because they looked at the same data and saw too much uncertainty. That is a valid medical judgment, not a political one.