Finland is Incredibly Bad at Treating Transgender Young People
A new study out of Finland casts doubt on the efficacy of the country’s lengthy assessments, harsh, invasive questioning, and delayed medical treatments.
Opinion, by Evan Urquhart
In the trans community, Finland is well known for taking among the strictest, most punishing approaches to the treatment of trans young people. Of countries who offer treatment for youth with gender dysphoria, Finland’s reputation is in the bottom tier. I reported on this in 2024, when I found young trans Finns were subjected to years of assessment visits, with no counseling or other treatment being offered to them all that time. The assessment visits consisted of harsh, invasive, sometimes accusatory questioning, often conducted by staff who the young patients found hostile and unkind. The assessment process was, in many cases, literally unending: Of patients I spoke with, only one received treatment at 17 years of age. All the others reached their 18th birthday without receiving any treatment for their gender dysphoria from the youth gender clinic.
A recently released study of youth transgender healthcare out of Finland suggests that this approach, the same one preferred by skeptics of trans care, leads to high psychological distress and worse outcomes than care in countries with less stringent protocols. But you’d never know it from reading the study itself.
The study authors make no effort to describe how Finland treats patients with gender dysphoria, or highlight the differences between their model and mainstream practices in the field. Instead, they present their findings as relevant to outcomes of medical gender reassignment writ large. The study omits any details that might allow readers to understand the differences between Finland’s approach and those of other countries, including the age at which patients began medical transition steps, how many (if any) received puberty blocking medications versus hormone therapy, or how long it took between their first contact with a gender clinic and their first hormone prescription.
The study heavily implies that 2 years after initiating contact with a gender clinic most patients will have begun treatment, but my prior reporting casts heavy doubt on this, as many patients I spoke with spent more than 2 years in the assessment process. The study claims they included all patients in Finland who initiated treatment by 22 years of age because “identity development in young individuals extends beyond the age of legal maturity.” My reporting suggests another possible reason: Almost no youth under 18 have ever received treatment for gender dysphoria in Finland. By looking at young adults through the age of 22, the study may be attempting to conceal this.
A critique of the new study’s methods by Erin Read can be found on her site, Erin in the Morning. It brings up many methodological flaws that would tend to undermine the study’s conclusion, if the study itself is taken at face value. However, there is no reason to take this study at face value as one that can be generalized to patients who seek gender-affirming treatments outside of Finland. There are few other clinics in the world which assign masturbation to young teens as “homework,” blame a child’s parents for their trans identity, keep them coming to regular appointments year after year with no counseling or therapy, and generally make seeking treatment as arduous and unpleasant as possible for vulnerable patients. That such a process might lead to poor outcomes is not something that should worry proponents of gender-affirming care, which takes the opposite approach, treating patients with dignity and humanity throughout an assessment process that is collaborative, respectful, and humane and offers counseling and psychosocial support to all patients, regardless of whether medical interventions are sought.
Something similar to the Finnish approach has been adopted in the UK, and advocates are pressuring the US to adopt similarly harsh treatment modalities. What the new study suggests is that the way Finland treats young trans people may increase psychiatric distress and increase their need for psychiatric services. Among the study’s most shocking findings, young transfemminine patients came into the gender clinic with a lower rate of prior psychiatric contacts (9.8 percent) than cisgender controls of either gender. After having at least two years of contact with Finland’s gender clinic the rate had skyrocketed to an eye popping 60.7 percent.
The findings from Finland are far from the norm in the research on gender transition. A recent Australian study found that, for patients who sought gender affirming care, psychiatric contacts initially went up as they entered the system, then fell as they continued their transition. For those on testosterone, psychiatric treatment had fallen below the baseline at the start of the study after one year. For those on estrogen, the process took longer, but after five years those patients had also dropped below their initial baseline of utilization of psychiatric supports.
Specifics about the different methods used by the Finnish researchers and the Australians might explain these differences, but we should not discount the possibility that the Finnish model is harmful to patients. As a causal story, it makes a lot of sense that children separated from their parents and asked about their masturbatory habits and sexual fantasies by uncaring adult strangers might struggle more than children who are treated kindly and given access to counseling that meets them where they are.
Allowing Finnish researchers to present their findings without pointing out the many ways that Finnish clinics diverge from best practices is a mistake, because the Finnish practices are exactly what trans care skeptics advocate. If outcomes for trans patients degrade as the care worsens, this could become fuel for ever greater restrictions on care, leading to ever worsening outcomes. It’s even possible that this could be used to argue that medical transitions are inherently harmful when, in reality, the harm could be caused by a treatment modality that treats patients with suspicion and hostility and attempts to deny care by any means possible.
Most doctors publish their successes, but Finnish researchers, led by the notoriously anti-trans Dr. Riittakerttu Kaltiala, are eager to publicize the poor results of their approach, all while blaming an affirming model of care that has never been available for youth in that country. We must not allow Finland’s failures in treating youth gender dysphoria tarnish the reputation of skilled, compassionate providers who decry their harsh methods.
Evan Urquhart is the founder of Assigned Media.