Finnish Study: Psychiatric Problems Skyrocket After Gender Reassignment Treatments – 10% to 61%

The results of a newly published long-term register study in Finland found that gender reassignment, including hormonal and surgical treatments, increased psychiatric morbidity substantially after medical gender reassignment. This is one of the most robust long-term nationwide register studies from a single country and comes as the Supreme Court recently ruled that Colorado’s ban on so-called “conversion therapy” is possibly a violation of First Amendment rights because of viewpoint discrimination. A federal judge recently blocked a declaration made by HHS Secretary Robert F. Kennedy Jr. that “sex-rejecting” or “gender-affirming” procedures are unsafe and ineffective for children.

 As the battle rages on across the country between states and the federal government to determine whether hormone and surgical gender reversal treatments should be made available to minors, this latest study concludes, “Psychiatric needs do not subside after medical gender reassignment.” The study followed over 2,000 gender-referred adolescents and young adults.

 The trial group, who were approved to receive feminized hormones and/or surgery, started with only 9.8% needing specialist psychiatric care. Following the gender reassignment treatments, 60.7% of the group required specialist psychiatric care, which is a 6-fold increase.

 Gender-affirming treatments are often promoted as life-saving care for individuals with high levels of suicidality. While this Finnish study does not directly measure suicidality or suicide, the significant increase in psychiatric morbidity following medical gender reassignment suggests that these interventions may not deliver the promised mental health benefits or reduce overall risk as commonly claimed.

The follow-up occurred at least 2 years after a Gender Identity Service (GIS) or gender clinic was contacted. The median follow-up time was 4.9 years.

 In the group approved for masculinized treatments, 21.6% needed specialist psychiatric care before the gender reassignment treatment, and 54.5% required specialized psychiatric care during the follow-up – a 2.5-fold increase.

 “The considerable severe psychiatric morbidity prior to contacting the GIS, and its increase over time, suggest that for some of these adolescents, GD may be secondary to other mental health challenges,” the authors wrote. “This underscores the need to thoroughly assess and appropriately treat mental disorders among those seeking GR before and after undergoing irreversible medical treatments. Psychiatric needs must be adequately met.”

 The study had a control group from the general population, but also had a group of individuals experiencing gender dysphoria who did not proceed with gender reassignment. Both females and males experiencing GD who did not proceed with GR in the study started with a higher percentage needing specialist psychiatric care before the index date. That is 53.1% of biological males before the index date and 59.7% afterward, and 65% of biological females before the index date and 67.2% afterward.

 “The overrepresentation of prior psychiatric treatment in those who did not proceed to treatment probably reflects the fact that severe psychiatric morbidity may be a contraindication for medical GR,” the authors wrote.

 The authors also noted a significant change in the data set when comparing individuals with GD who experienced it from 1996-2010 and 2011-2019. Nearly half of the individuals in the second group (2011-2019) required specialist psychiatric care before contacting the gender clinic, which was double the rate of the first group (1996-2010). This is not reflective of improved diagnosis because the same rise was not observed in the control group.

 Minority stress theory would suggest psychiatric comorbidities would have been likely to decrease as acceptance increased and stigma decreased for the second group, according to the authors, but the opposite occurred. The researchers suggested that the high level of psychiatric comorbidities amongst the GD group could indicate that mental health challenges may manifest as issues with gender identity.

 The Supreme Court upheld Tennessee’s ban on gender affirming care services for minors last year, and last month, West Virginia upheld a decision to ban Medicaid coverage of “gender-affirming” surgeries.

 Judge Mustafa T. Kasubhai ruled against Secretary Kennedy’s declaration, although non-binding, because it was coercive and acted as a rule. The declaration stated, “Sex-rejecting procedures for children and adolescents are neither safe nor effective as a treatment modality for gender dysphoria, gender incongruence, or other related disorders in minors, and therefore, fail to meet professional recognized standards of health care.”

The Center for Medicare and Medicaid Services (CMS) submitted a proposed rule to halt federal funding to health care institutions that provide “sex-rejecting” or “gender-affirming” treatments to children, and the comment period ended in February. It hasn’t yet been approved, but is likely to be challenged, as it references Secretary Kennedy’s declaration, which has now been overturned by Judge Kasubhai.

When Judge Kasubhai was going through the Senate confirmation process, Senator Tom Cotton said he was uniquely unqualified. Cotton and others referred to a statement made by Kasubhai in 2021 when he said, “We have to set aside conventional ideas of proof when we are dealing with the personal and interpersonal work of equity, diversity, and inclusion. As a judge, I can appreciate the challenge of employing a different mode for understanding truth than that which most lawyers are accustomed to in our work.”

 In addition to that statement, Kasubhai wrote a 2021 essay where he reflected upon his privileges as a “cisgender man.” He founded the Oregon Mediator Diversity Project, which states there is historic systemic discrimination against diverse groups of people, including those who have varied gender expression or gender identity.

 In response to the overturning of Kennedy’s declaration, Children’s Minnesota announced it will be resuming gender affirming services for minors. It is unknown if more gender clinics and children’s hospitals across the country will follow suit after Judge Kasubhai’s ruling.