A large study of health data on Finnish youths who sought care from gender clinics has found evidence that its authors suggest challenges the prevailing claim that gender-transition interventions are tied to improvements in mental health. The study found that the use of specialist psychiatric care—a general, if imperfect, indication of serious mental health problems—increased dramatically among those adolescents and young adults who underwent gender-transition interventions.
Among such youths, the proportion who had appointments with specialist psychiatrists prior to attending the gender clinic, compared with the proportion who had such appointments during later years, surged: among natal males, from 10 percent to 61 percent; and among natal females, from 22 percent to 55 percent.
The study, published Saturday in Acta Paediatrica, included data on nearly 2,100 Finnish people who first sought care from a gender clinic before age 23 between 1996 and 2019. Thirty-eight percent underwent gender-transition interventions.
Youths who first presented to gender clinics in 2010 or later had much worse mental health than those who presented previously, the researchers found.
The study authors suggested that their findings gave credence to the theory, anathema among proponents of gender-transition interventions for minors, that for some adolescents, gender dysphoria may be an outgrowth of deeper psychological problems and that their adoption of a transgender identity may amount to a maladaptive coping mechanism.
The investigators concluded that, among some youth presenting at gender clinics, gender dysphoria “may be secondary to other mental health challenges.” They continued: “The notable increase in those contacting [gender clinics] and the increased psychiatric morbidity among them since the 2010s may also suggest that, for some, mental health challenges may manifest as concerns related to gender identity.”
After controlling for differences in the prior use of specialist psychiatric treatment, the study authors found that regardless of whether they underwent gender-transition treatment, youth who went to gender clinics had much higher use of specialist psychiatric treatment during follow-up compared with age-matched controls from the general population—about three times higher than females and five times higher than males.
Given the study’s robust and comprehensive data set, long follow-up time and use of age-matched controls, it addressed key limitations seen in various other studies that have found such interventions are linked to improvements in mental health outcomes. Most studies of youth who undergo gender-transition interventions are small, have short follow-up times, no control groups, and suffer from substantial loss to follow-up.
A weakness of the study is the blunt measure provided by the use of specialist psychiatric care, which could represent a broad range of mental health conditions, and the lack of more specific and nuanced measures of mental-health-related outcomes.
Finnish scholarship cuts against the grain
The Finnish study’s four coauthors have published some of the strongest scholarship challenging the assertion that providing them to adolescents improves their mental health and is life-saving. All of these Finnish investigators were also coauthors of a paper published in 2024 that found that there was no independent, statistically significant association between taking cross-sex hormones and the rate of suicide deaths among youths attending gender clinics.
One of the coauthors, Dr. Riittakerttu Kaltiala, a psychiatrist at Tampere University in Finland, was tasked with founding one of the nation’s two pediatric gender clinics in 2011. Over the years, she became increasingly concerned that her patients were not improving on gender-transition interventions. So she began to systematically document what she observed. In 2023, she wrote an article for The Free Press entitled: “Gender-Affirming Care Is Dangerous. I Know Because I Helped Pioneer It.”
Dr. Kaltiala, who I met when she presented her suicide research at the 2023 conference of the Society for Evidenced Based Gender Medicine, or SEGM, and who I have interviewed a few times, is frequently pilloried by transgender activists as a supposed bigot driven by animus toward transgender people. I have never detected any veracity to this claim.
Dr. Kaltiala has argued that researchers need to focus on more objective measures of mental-health outcomes, rather than the surveys that studies of youth gender medicine typically rely upon. Examples of objective outcomes include whether the young person is employed or in school, has a romantic partner, or routinely ventures outside of the home. Such a proposition on the researcher’s part has enraged certain transgender advocates, who have accused her of moving the goalposts. But Dr. Kaltiala has countered that she has often observed that young people who have undergone these medical interventions are often functioning poorly in life and fail to hit major life milestones.
Systematic literature reviews—the gold standard of scientific evidence—have all found that the research backing the use of puberty blockers and cross-sex hormones to treat gender dysphoria in youths is weak and unreliable. It was due in part to Dr. Kaltiala’s influence that Finland conducted its own systematic literature review of pediatric gender medicine. Given the review’s findings, the nation has sharply restricted youths’ access to gender-transition interventions.
Dr. Kaltiala and her colleagues found in their new study that among youth who presented at gender clinics, those who did not ultimately undergo gender-transition interventions had a much higher rate of previously attending specialist psychiatric appointments. The study authors theorized that part of the reason for this difference could be that severe mental illness is a contraindication for such interventions in Finland. So those who showed up at the clinic already severely mentally ill would have been less likely to be approved for gender-transition drugs.
The finer details of the study
The study is buttressed by the robust health data that Finland keeps on all citizens, from birth to death. The authors’ task was simplified by the fact that gender-identity assessments for potential gender-transition interventions are centralized at two university hospitals.
The study examined health data on youths who first presented at these clinics between 1996 and 2019 and who did so before they hit age 23. The follow-up period began after that first appointment and continued until either June 2022 or the death of the patient.
