We’ve all heard the basic pitch for gender affirming care at this point. In public arguments and in private doctors offices it often boils down to “Would you rather have a live son or a dead daughter?” The underlying claim being made is that gender transitions are so important to maintaining mental health that we should encourage them and never engage in any “gatekeeping” even if the patients are 14-year-old and much too young to buy a beer.
A study of young people in Finland which was published earlier this month found that the evidence gender affirming care resolves mental health issues is lacking. In fact, the study found the opposite.
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 authors wrote in their conclusion: “When prior psychiatric morbidity was controlled for, the gender-referred adolescents had a 5-to 6-fold increased need for specialist-level psychiatric treatment two years or more after the index date compared to the male controls, and 3-to 4-fold greater risk compared to the female controls, regardless of the desired direction of change and [gender-transition-treatment] status.”
They continued: “This does not support the suggested improvement in mental health after medical [gender-transition treatment] initiated during developmental years, and in light of the present findings, severe psychiatric disorders do not appear primarily attributable to [gender dysphoria]. Psychiatric disorders require their due treatment regardless of a young person’s gender identity.”
In short, swapping genders does not appear to resolve psychiatric issues.
As you can imagine, the study has been attacked by proponents of gender affirming care, with some claiming that the psychiatric care used as a proxy for mental health issues in the study is misleading.
Ben Ryan contacted the authors of the study and Dr. Riittakerttu Kaltiala offered responses to his questions about it. As you might expect, she does not find the complaints of the critics to be very significant.
Is it fair to say that just by virtue of having contact with GIS [gender identity services—ie: the gender clinic] and undergoing GR [gender reassignment], the youth in the study cohort would be more likely to be referred to a specialist psychiatrist than someone in the general population, even if they had similar psychiatric comorbidity?
No. Specialist level psychiatric treatment is provided in case of severe mental disorders, and the need is assessed with national equity criteria that exist to maintain equal access across the country. Referrals to specialist level psychiatric services by different referring agents (such as primary care, GIS, occupational health, student health, private practitioners) are assessed similarly regardless of where they come from.
Some of the critics of this study have suggested that this supposed increased likelihood of receiving referrals due to attending a gender clinic would explain all of the increased contact with specialist psychiatry in the study cohort. Would it be fair to say that that is an exaggeration?
That is not a valid argument, see above. Referrals to specialist level psychiatric care are assessed similarly regardless of from where they come, and treatment is provided in case of severe mental disorders…
We have looked at being in psychiatric treatment 2 years or more after the gender identity assessment. Even if the contact was initiated because of what was observed in the gender identity assessment, 2 years later any relatively temporary problem would have passed. Gender identity assessment is no direct route to specialist level psychiatric care even if some mild mental health issues were detected. Mild and moderate problems are treated in primary care. Specialist level psychiatry serves people with severe disorders, regardless of who refers them there.
Obviously the people who are committed to the idea that transitioning kids is the best and perhaps the only solution for gender dysphoria are not going to be convinced easily. Still it’s a relief that at least some experts in the field are not willing to assume they already know the answer to these questions.
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