A study published in Acta Paediatrica compared the frequency of specialized psychiatric care use among young people referred to gender identity clinics and their peers in the general population. The work covered all residents of Finland who contacted such clinics between 1996 and 2019.
Gender dysphoria is a condition in which a person experiences distressing tension due to a mismatch between biological sex and their inner sense of self. To alleviate this condition, people sometimes resort to medical sex change: hormone therapy and surgery.
The researchers analyzed data from 2,083 people under 23 years of age (mean age at first visit 18.5 years) who contacted two university clinics. Each was matched with eight peers of the same year and place of birth, for a total of 16,643 people in the control group. Follow-up lasted on average about 5.5 years, with a maximum of 25 years.
It turned out that even before the first clinic visit, 45.7% of the referred group had already received specialized psychiatric care, versus 15.0% in the control group. Two years or more after the visit, the share rose to 61.7%, while among peers it remained at 14.6%. The intensity of care also differed: 27.6% of those referred had more than 100 contacts with psychiatrists over their lifetime, versus 4.3% in the control group.
Among those who ultimately received hormones or surgery, psychiatric care before the clinic was less common than among those who did not change sex. However, after the start of medical transition, the share seeking psychiatric care rose sharply: for example, among biological males receiving feminizing therapy, from 9.8% to 60.7%. The authors emphasize that this is a statistical association, not proof that the treatment caused deterioration. They suggest the cause could be side effects of estrogen or unmet expectations, but stress the need for further research.
Lead author Sami-Matti Ruuska of Tampere University and the University of Eastern Finland said: "Severe mental health problems are very common among adolescents with gender dysphoria, and regardless of medical transition, the need for psychiatric care does not decrease." He also noted that in some young people problems arise only after treatment, which may indicate a possible negative effect on mental health.
Independent experts point to limitations of the work. This is an observational study (observation without intervention), so it cannot prove causation. Critics in letters to the editor note that counting psychiatrist visits reflects service use rather than illness severity, and that Finnish clinics require stabilization of mental state before approving treatment, so patients may conceal symptoms beforehand and seek help afterward. The authors conducted additional analyses, including a five-year period and accounting for completion of all procedures, and obtained similar results.
Ruuska emphasizes that the findings do not mean that transition will not help any adolescents with dysphoria. "The difficulty is recognizing those for whom it is truly indicated," he says. According to him, the message of the study is the need to pay careful attention to the mental health of such adolescents before and during possible treatment.