A recent Finnish study found that psychiatric problems tend to worsen rather than improve after the hormonal and surgical interventions offered by gender clinics. In simple terms, gender surgeries and permanent medical treatments for gender dysphoria may not be as helpful as we have been led to believe.
The study’s authors, including renowned adolescent psychiatrist Prof. Riittakerttu Kaltiala, concluded that severe psychiatric disorders are common in this population, do not seem to be caused mainly by gender dysphoria itself, and do not lessen after medical transition. They argue that psychiatric conditions should be prioritised for treatment regardless of gender identity and highlight that, in some cases, medical transition might be linked to worsening mental health.
The large, nationwide register-based cohort study published in Acta Paediatrica (2026) by Sami-Matti Ruuska and colleagues, including Prof. Riittakerttu Kaltiala, analysed data on 2,083 individuals in Finland from records of the country’s two centralised gender identity services, collected between 1996 and 2019, before the age of 23. These “gender-referred” adolescents and young adults were compared with 16,643 matched population controls (4 males + 4 females per case, matched on birth year and city). Follow-up began at the initial gender clinic appointment and continued until death or June 2022 (median 4.93 years, maximum 25 years).
The study used Finland’s comprehensive national health registers to track specialist-level psychiatric treatment (hospital/outpatient care, excluding the gender assessment itself) both before referral and more than 2 years afterwards (to allow time for assessment and possible treatment). Of the study cohort, 38.2% (796 individuals) went on to receive medical gender reassignment (GR: masculinising or feminising hormones ± surgery).
The study’s findings were:
- Gender-referred adolescents showed far higher psychiatric morbidity than matched controls both before their first gender-clinic appointment (45.7% vs 15.0%) and ≥2 years afterwards (61.7% vs 14.6%).
- Psychiatric treatment needs noticeably increased in the gender-referred group during follow-up, while they stayed stable in the general population controls.
- The increase was especially striking among those who actually underwent medical gender reassignment:
- Feminising GR (biological males seeking female phenotype): psychiatric treatment need rose from 9.8% before referral to 60.7% ≥2 years after.
- Masculinising GR (biological females seeking male phenotype): rose from 21.6% before to 54.5% after.
In the later cohort (2011–2019, coinciding with the sharp international rise in referrals), nearly half (47.9%) already required specialist psychiatric care before their first gender-clinic visit, double the rate seen in the 1996–2010 cohort, while the control group showed no comparable rise.
After adjusting statistically for prior psychiatric history, birth year, and index year, all gender-referred groups—whether they received GR or not—had similarly increased risks of ongoing specialist psychiatric care. The risk was approximately three times higher than in female controls and five times higher than in male controls. Note: Medical gender reassignment did not reduce this risk.
The authors concluded that “Severe psychiatric morbidity is common among gender-referred adolescents and seems more frequent in those referred following the recent rise in referrals. Psychiatric issues do not diminish after medical gender reassignment. They also highlight that in some cases, medical GR “seems to be connected to worsening mental health,” particularly the depressive effects of oestrogens.
The study showed that psychiatric disorders are not mainly caused by gender dysphoria itself. Instead, these conditions “require their due treatment regardless of a young person’s gender identity”. The study’s authors stressed the importance of thoroughly assessing and properly treating mental disorders in individuals seeking GR before and after irreversible medical procedures, making sure their psychiatric needs are fully addressed.
It is important to note that the study is observational. This means the study itself does not prove that gender reassignment causes worsening of psychiatric issues in an individual, as the reasons for a patient’s use of psychiatric services could not be analysed. However, the research remains significant due to its nationwide coverage (minimal loss to follow-up), long follow-up period, large sample size, and a proper control group. In other words, factors that could have obscured any correlation or causation aspects of the findings were mitigated.
The Finnish study also references the UK Cass Review, underlining its main themes: high and ongoing psychiatric morbidity in gender-referred youth (which often worsens after medical transition), greater severity in newer cohorts, and the importance of prioritising treatment for underlying mental health issues regardless of gender identity.
It needs to be noted that both studies emphasise that medical gender reassignment does not seem to address the psychiatric needs of an individual struggling with gender dysphoria and that evidence for claimed “lifesaving” benefits is weak.
*Written by Family First staff writers*