Adolescents struggling with gender dysphoria who sought gender transition medical treatment were found to have worse mental health symptoms in the long term compared to their peers, contradicting the belief that so-called “gender-affirming care” significantly improves outcomes.
Youth patients with gender dysphoria who were referred to gender medicine clinics in Finland were upward of three times as likely to need psychiatric treatment following their referral compared to patients without a history of gender transition counseling or interventions.
A new study published this week in the journal Acta Paediatrica analyzed 1996-2019 data on mental health services for children and young adults in Finland’s education system, tracking patients with gender dysphoria, referred to Gender Identity Services, for transition treatment. Researchers were able to collect this long-term data for each patient due to the country’s socialized medicine system and comprehensive mental health screening in schools.
The authors found that adolescents suffering from gender dysphoria “showed significantly higher psychiatric morbidity” before being referred to gender clinics than their peers, which continued even after being referred to gender transition clinics. They argue that their findings indicate gender dysphoria “may be secondary to other mental health challenges.”
“This underscores the need to thoroughly assess and appropriately treat mental disorders among those seeking [gender reassignment] before and after undergoing irreversible medical treatments,” the authors wrote. “Psychiatric needs must be adequately met.”
The findings of the report challenge guidelines promoted by some U.S. professional medical groups that children with gender dysphoria do not need significant mental health counseling before receiving life-altering interventions, such as puberty blockers, cross-sex hormones, mastectomies, or genital reconstructions.
Adolescent patients in the U.S. who have undergone medical gender transition and their families often say that their medical professionals told them such interventions would be necessary to prevent suicide or other adverse mental health outcomes.
But the data to support such clinical practices has come under increasing scrutiny from the medical community and public policy experts.
Both the U.S. and the United Kingdom have published comprehensive systematic reviews of the scientific literature used to support gender medicine guidelines, concluding that the methodology and data support transition procedures.
The Finnish study is unique because of the size and scope of the dataset. Even among high-quality studies, collecting more than 25 years of data on a nationally representative sample of about 2,100 patients referred for gender identity services provided a unique opportunity to capture long-term findings that few other studies offer.
The authors found that adolescents referred to gender clinics had significantly higher rates of requiring further psychiatric treatment than the control groups, both before and two years after referral.
Nearly 46% of adolescents with gender dysphoria had obtained psychiatric treatment before being referred to a gender clinic. Two years later, that rate increased to nearly 62%.
The need for further psychiatric treatment increased significantly during follow-up for patients who underwent medicalized gender transition, rising from roughly 10% to 61% for male-to-female transitioners and from 22% to 55% for female-to-male transitioners.
After adjusting for prior treatment, girls with gender dysphoria were three times as likely to need additional psychiatric treatment in the future compared to their peers, regardless of whether they underwent medical sex reassignment. Boys with gender dysphoria, with or without medicalization, were five times as likely to need future psychiatric care compared to their peers.
Dr. Kurt Miceli, a psychiatrist and the Chief Medical Officer for the medical ethics organization Do No Harm, told the Washington Examiner that he believes the study challenges the argument that gender transition medicine is the necessary first-line treatment.
“In reality, what we’re seeing is that there’s an even greater need for individuals who have undergone these medical interventions for psychiatric services,” Miceli said. “That really should help alarm us and make sure that we were providing those psychiatric services initially.”
Miceli and Do No Harm advocate against gender transition medical treatments for minors, instead supporting a holistic approach that first and foremost treats underlying mental health concerns for gender dysphoric youth.
Miceli says the data from the Finnish study is consistent with data from other studies and systematic reviews that indicate children with gender dysphoria suffer from a range of comorbidities, including mental health concerns like anxiety and depression.
“As a psychiatrist, it certainly screams of the need to really make sure that we are providing good quality psychiatric care,” Miceli said.
