A New Finnish Study on Mental Health Outcomes Among Adolescents Referred for Gender Identity Assessment
Summary
A newly released Finnish study of 2,083 adolescents who contacted specialised gender identity services found high levels of psychiatric distress which was not reduced and sometimes increased following medical gender reassignment.
The study, conducted by researchers from Tampere University Hospital and Helsinki University Hospital, was based on anonymised national health records and looked at 2,083 under 23-year-olds who contacted the two Finnish gender clinics in the period 1996-2019. They were compared with a control group of 16,643. The mean age of those seeking assessment was 18.5 years and the mean follow up period was 5.49 years. 481 males sought feminisation; 1,602 females sought masculinisation. Of the gender-referred group, 38.2% went on to undergo medical gender reassignment.
Key Findings
All gender-referred adolescents had an elevated risk of severe and long-lasting psychiatric symptoms before referral. Depression and anxiety were particularly common. Before referral, 45.7% of gender-referred adolescents had needed specialist psychiatric treatment compared to 15.0% of controls. Two or more years after referral this rose to 61.7% compared to 14.6% of controls.
Psychiatric needs did not reduce following gender reassignment and sometimes increased.
Psychiatric distress was particularly marked among adolescents seeking assessment after 2010 when there was a ten-fold increase in gender referrals.
There is limited evidence showing improved mental health, quality of life or functioning following medical gender reassignment.
Psychiatric distress was particularly marked among females seeking to transition to male.
The intensity of psychiatric need was markedly greater than in the general population. More than a quarter of gender-referred adolescents had over 100 lifetime contacts with specialist psychiatric services, compared to just 4.3% of controls.
Observations
The researchers sought to address the shortcomings of previous studies by employing a large, nationally representative data set rather than relying on volunteers with associated large drop out rates; having direct comparison with a large, matched population control group and observing mental health outcomes over a long follow up period, up to 25 years.
The study noted that oestrogen may be linked with depressive symptoms associated with feminising gender reassignment and while masculinising hormones may temporarily improve mood due to testosterone related bodily changes, long term expectations may not be met and psychiatric treatment needs markedly increased among females who pursued masculinising gender reassignment.
The authors noted that there is limited understanding of the course of mental health distress following gender reassignment, the mental health differences between males and females seeking reassignment and negative impacts of gender transition. There is a need for thorough psychiatric assessment and treatment both before and throughout gender reassignment.
The study is careful to note that it does not establish causation. It cannot determine whether medical treatment itself contributed to the increases in psychiatric service use seen in follow-up. When prior psychiatric history was taken into account, the elevated risk of requiring specialist psychiatric treatment was broadly similar regardless of whether young people had undergone medical gender reassignment, suggesting that pre-existing psychiatric morbidity rather than treatment itself may be the primary driver of outcomes. This finding underlines the authors' conclusion that thorough psychiatric assessment before any medical intervention is essential.
Our Perspective
This study matters to us in Australia because we are watching the same pattern unfold here that Finland documented over two decades, and we are not acting on what the evidence is telling us.
Our gender clinics have followed the same referral growth trajectory as Finland's, with dramatic increases in young people presenting for assessment, the large majority of them natal females, many carrying significant psychiatric histories before they ever reach a gender clinic door. LGB Alliance Australia has raised consistent concerns that vulnerable young people, including those living with depression, anxiety, autism, trauma and other complex presentations, may be reaching a medical pathway before their underlying mental health needs have been properly identified and treated. This study vindicates those concerns. Nearly half of those referred after 2010 were already requiring specialist psychiatric treatment before their first gender clinic appointment. That is not a minor clinical footnote. It is a serious indictment of a system that has moved too fast and asked too few questions.
The tenfold increase in referrals since 2010 has not brought a healthier population through the door. It has brought a more unwell one. If growing social acceptance were the primary driver of increased referrals, one might expect the arriving population to be less distressed. The opposite has been observed, and Australia should not assume our clinical picture is any different.
We are also concerned about who these young people are. Research from other contexts has consistently found that a significant proportion of children who experience gender dysphoria, if supported through puberty without medical intervention, go on to be comfortable in their bodies and to identify as gay or lesbian. The population in this study, predominantly natal females seeking masculinisation, is precisely the demographic that warrants the most careful, unhurried clinical attention. These may be our community's young people, diverted onto an irreversible medical pathway before they have had the chance to understand themselves. They deserve better.
This Finnish study adds to a substantial international body of evidence, including the UK's Cass Review and systematic reviews from Sweden, Denmark and Norway, that raises fundamental questions about the evidence base for medicalising gender-distressed young people. Australia has not yet commissioned the kind of rigorous, independent review this evidence demands. The NHMRC review currently underway must be genuinely independent, genuinely evidence-led, and willing to follow the data wherever it goes, including to conclusions that are uncomfortable for those who have built clinical careers and institutional identities around the affirmation model.
The psychiatric wellbeing of every young person who walks through the door of an Australian gender clinic must be the central concern, including those who may grow up to be gay or lesbian, and who deserve the chance to find that out.
Further Reading
The following resources represent critical and evidence-sceptical perspectives on youth gender medicine. They are included as substantive contributions to the current clinical and policy debate rather than as a comprehensive survey of the literature.
Gender Clinic News - Bernard Lane (Substack)
Detailed, evidence-focused reporting on gender medicine developments in Australia and internationally, including coverage of clinical dissent and the shifting regulatory landscape. https://www.genderclinicnews.com.
An article on this study https://www.genderclinicnews.com/p/transition-blues
Society for Evidence Based Gender Medicine (SEGM)
Publishes rigorous summaries and analyses of the peer-reviewed literature on youth gender medicine
LGB Alliance UK - The Medicalisation of LGB Youth
A detailed backgrounder on the medicalisation of gender non-conforming and same-sex attracted young people, drawing on clinical evidence and the findings of the Cass Review.
https://lgballiance.org.uk/the-medicalisation-of-lgb-youth/
Hazard Ratio - Benjamin Ryan (Substack)
Independent health and science journalist covering paediatric gender medicine in depth, including investigative reporting on WPATH, the first detransitioner lawsuit, and the international evidence base. https://benryan.substack.com
Full Study Reference Ruuska, S.-M., Tuisku, K., Holttinen, T., and Kaltiala, R. "Psychiatric Morbidity Among Adolescents and Young Adults Who Contacted Specialised Gender Identity Services in Finland in 1996–2019: A Register Study." Acta Paediatrica (2026): 1–9. https://doi.org/10.1111/apa.70533