Gender-Transition Treatment Doesn’t Seem to Improve Eating Disorders in Youths, Finnish Study Finds

A new study based on nationalized Finnish health data found that gender-transition treatment was not associated with a tempered need for eating-disorder treatment.

Source: Grok

Undergoing gender transition treatment did not appear to be associated with a long-term resolution of eating disorders among a population of Finnish youth, according to a new study.

The study calls into question previous scholarship that has suggested that prescribing cross-sex hormones to youths experiencing gender dysphoria will help treat eating disorders, such as anorexia or bulimia, among them.

The paper, which was published recently by the European Journal of Developmental Psychology, is one of a slew out of Finnish research team that over the past decade have collectively called into question the presumption that gender-transition interventions are widely beneficial to youths attending gender clinics.

One of the coauthors of the eating disorder paper, Dr. Riittakerttu Kaltiala, a psychiatrist at Tampere University in Finland, was tasked with founding one of the nation’s two youth gender clinics in 2011. After she observed that the patient population’s outcomes were not in keeping with the promising results from the foundational pediatric-gender-medicine studies out of the Netherlands, she began systematically documenting these outcomes. She has consequently become a controversial figure and is a bête noire of many transgender activists.

'Rubbish'—Finland's Top Pediatric Gender Psychiatrist Derides Exposé Claiming Her Clinic Provided Shoddy, Cruel Care

In April, Dr. Kaltiala and her colleagues published a study with a similar methodology to the eating disorder paper in which they found that a proxy measure for severe psychiatric problems—specialist psychiatric care—did not improve after youths underwent what in Finland is known as gender reassignment. The paper prompted an outcry from many academic supporters of pediatric gender medicine. The journal that published the paper recently published a slew of letters critiquing its methodology. These critiques prompted the paper’s authors to respond with their own rebuttals. (I hope to write in more detail about these exchanges in a forthcoming Substack.)

Indicators of Major Psychiatric Problems Didn't Improve After Youth Gender-Transition Treatment In Finland—They Rose

The new paper is sure to ruffle feathers by suggesting that gender dysphoria and eating disorders may have a common biopsychosocial root in young people, in particular for the adolescent natal girls among whom both conditions are particularly prevalent. The study authors depicted what they suggested is a glaring contraction between how two similar mental health conditions are treated. Both conditions concern an individual’s disproportionate focus on and unhappiness about their body. And yet the treatment for eating disorders is to help the patient minimize such discordance internally and come to accept their body; whereas the treatment for gender dysphoria is essentially the opposite, to lean into the concerns and to change the body to resolve the discordance.

Numerous studies, the paper’s authors noted, have found disproportionate rates of eating disorders among youth with gender dysphoria. But while research has suggested that gender-transition interventions may help resolve eating disorders, the authors noted that it almost entirely based on case reports and is of “very low quality,” and thus not reliable.

The new study was based on Finnish health-registry data regarding 2,080 youths who were 13 to 22 years old when they first presented at one of Finland’s two youth gender clinics between 1996 and 2019. The investigators analyzed data on the youth through June 2022. They assembled a control group by matching four natal males and four natal females with each youth attending the gender clinics, matched for birthplace and birth year, including 16,619 youth total.

The gender-dysphoric youth were an average age of 18.5 years at their first gender clinic visit. Fifty-nine percent of them were natal girls.

Among all the gender dysphoric youth, 5.0 percent ever received specialist-level psychiatric treatment for an eating disorder—a 3.2-fold greater proportion than the 1.6 percent of the controls who did so.

Among the gender dysphoric youth, 2.5 percent were diagnosed with an eating disorder before first visiting the gender clinic and 2.4 percent were diagnosed after. A total of 2.8 percent received eating disorder treatment two or more years after that first gender-clinic visit. Those diagnosis rates were all about three to four times greater than those seen in the control group.

Gener reassignment was much more common among those without any history of an eating disorder. Of the gender dysphoric youth, 18 percent of those who were ever diagnosed with an eating disorder underwent gender reassignment, compared with 39 percent of those never diagnosed with an eating disorder. Of those gender dysphoric youth who were diagnosed with an eating disorder prior to attending a gender clinic, 15 percent went on to undergo gender reassignment, compared with 39 percent of those who were not previously diagnosed with an eating disorder.

At first glance, being diagnosed with an eating disorder after attending the gender clinic seemed to be associated with not receiving gender reassignment. Compared with the control group, the rate of those who were diagnosed with an eating disorder for the first time after attending the gender clinic was 4.9-fold higher among those who did not undergo gender reassignment and 2.1-fold higher among those who did receive gender reassignment. But when the study authors controlled for birth year, the year of the first visit to the gender clinic and legal sex, they found that regardless of whether they received gender reassignment, the gender dysphoric youth had a similarly higher rate—of about 3- to 4-fold higher than in the controls—of a subsequent eating disorder diagnosis.

The most crucial question was whether there was a difference in the elevated rate of needing eating disorder treatment two years or more after first attending the gender clinic. As with the recent paper these academics put out about mental-health treatment, the paper’s authors chose the two-year mark because they presumed that the youth who received gender reassignment were significantly into that process by then. Other academics criticized this research team’s paper on mental-health treatment for what they have deemed an imprecise measure that does not account for variations in treatment start times.

The eating disorder paper’s authors found that before they adjusted the data, those who did not undergo gender reassignment had the greater increased rate—5.5-fold higher than the controls, compared with 2.5-fold higher among those who did undergo gender reassignment—of needing eating disorder treatment two-plus years after first attending the gender clinic. This would suggest that there might have been a tempering effect on eating disorders of receiving gender reassignment.

However, then the study authors controlled for birth sex, birth year and the year of the first visit to the gender clinic. This reduced the difference in those two rates to 4.2-fold higher than the controls for those who didn’t receive gender reassignment and 3.3-fold higher for those who did. And then, after the investigators controlled for having received treatment for an eating disorder prior to attending the gender clinic, these rates became essentially identical: a respective 3.6-fold and 3.4-fold higher than the controls.

The greatest predictor, the study authors found, of receiving eating disorder treatment two-plus years after attending the gender clinic was having received such treatment beforehand.

The study authors concluded: “Literature has often suggested that [an eating disorder diagnosis, or ED] emerges as an attempt to control a body suffering distress due to [gender dysphoria, or GD]. In this case, resolution of ED after medical GR might be expected. In light of the present data, this is not the case.” They continued: “When ED prior to gender identity assessments was [accounted] for, the risk of requiring specialist-level treatment for ED two years or more after contacting the [gender clinic] was similar among the individuals with GD regardless of obtained medical GR interventions.”

The authors proceeded to make quite a number of bold claims in their efforts to theorize why gender reassignment might not have helped resolve eating disorders among the youth. Gender dysphoria, they wrote, may “provide an explanation for self-hatred and body dissatisfaction that predisposes” youth to eating disorders. They went on to state that online communities that foster “positive support and belonging” among youth with gender dysphoria “may strengthen symptom behaviors and halt identity exploration, resulting in rigid foreclosed identity commitment.” Then the authors compared such communities to “pro-anorexia or pro-bulimia online content,” saying: “Online communities may act similarly regarding development of feelings of gender dysphoria and pursuit of” gender reassignment.

In their brief section noting the study’s limitations, the authors did not broach ascertainment bias. It is possible that because youth undergoing gender reassignment were in more routine care, this would raise their likelihood of then receiving specialist-level eating disorder treatment, just by virtue of being so dialed into the care system. This could have effectively masked the benefit of gender reassignment.

It is also possible that the study simply wasn’t powered enough to detect actual differences in the rates of eating disorders treatment relative to the control group. Only 103 of the gender-dysphoric youth ever had an eating disorder. Just 19 of them underwent gender reassignment. And only 8 of those who underwent eating disorder treatment prior to attending the gender clinic did so.

This research group has also been criticized in the past for over-controlling their data, in particular in a 2024 study that found that there was no statistically significant, independent association between gender reassignment in Finnish youth attending gender clinics and the suicide death rate among them. Critics might argue, as they did with the suicide study, that controlling for a baseline factor that’s tangled up with the exposure washes out an important signal.

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I am an independent journalist, specializing in science and health care coverage. I contribute to The New York Times, The Guardian, NBC News, The Free Press and The New York Sun. I have also written for the Washington Post, The Atlantic and The Nation, among many others. Follow me on X: @benryanwriter. Visit my website: benryan.net