A major long-term Finnish register study has found that psychiatric treatment needs among adolescents and young adults referred to gender identity services rose sharply over time — particularly among those who received medical gender reassignment — adding weight to concerns about the long-term effectiveness of “gender-affirming care” for minors. The study further reinforces Alberta Premier Danielle Smith’s recent changes to Alberta’s policies on gender-related medical interventions for minors.
Published this month in Acta Paediatrica, the study examined national health data on 2,083 individuals in Finland who first contacted specialized gender services before age 23 between 1996 and 2019. Researchers tracked severe psychiatric morbidity (need for specialist-level mental health treatment) before referral and at least two years afterward, comparing outcomes to matched population controls.
The findings are striking:
Gender-referred youth already showed much higher psychiatric morbidity than controls before referral (45.7% vs. 15.0%).
That rate rose further to 61.7% in follow-up, versus just 14.6% among controls.
Among the subset who underwent medical interventions (puberty blockers, cross-sex hormones, or surgery), the increase was especially pronounced: from 9.8% to 60.7% for those pursuing feminizing treatments and from 21.6% to 54.5% for masculinizing treatments.
The authors observed that psychiatric needs did not decrease following medical transition and, in some cases, appeared linked to further deterioration. They noted the high rate of co-occurring mental health conditions and suggested that gender dysphoria may, for some youth, be secondary to other underlying psychological challenges.
These results align with systematic evidence reviews conducted in Europe, including the UK’s Cass Review, which found the evidence base for puberty blockers and cross-sex hormones in minors to be weak, with uncertain benefits for mental health and potential risks including impacts on fertility, bone density, and cognitive development. Several European countries — Finland, the UK, Sweden, and Norway — have since moved toward greater caution, prioritizing comprehensive mental health assessment and psychosocial support over routine medicalization.
Alberta’s Policy Response
In 2024, Alberta Premier Danielle Smith’s United Conservative Party government implemented restrictions on gender-related medical interventions for minors. The policies prohibit puberty blockers, cross-sex hormones, and surgeries for those 15 and under (with narrow exceptions for patients already in treatment), require parental consent along with enhanced medical and psychological safeguards for 16- and 17-year-olds, and emphasize thorough evaluation of co-occurring mental health issues.
Premier Smith justified the measures by citing emerging European evidence reviews and the need to protect vulnerable youth from interventions with uncertain long-term benefits. The Alberta NDP strongly opposed the changes. Party leaders described the restrictions as “cruel,” politically motivated, and harmful to transgender youth, arguing they interfered with private healthcare decisions between families, patients, and providers. NDP criticism have centered on themes of inclusion, rights, and potential harm to vulnerable young people, without citing specific long-term studies or systematic reviews supporting continued routine medical affirmation for minors.
While the Finnish study is observational and cannot establish direct causation — youth who pursued medical pathways may have presented with more severe or complex conditions — its population-wide, registry-based design provides valuable long-term insight that contrasts with many shorter-term studies. It underscores the importance of addressing underlying mental health comorbidities rather than assuming medical transition will resolve distress.
Premier Smith’s government framed its approach as evidence-driven caution aimed at safeguarding minors. The latest data from Finland lends further support to policies that prioritize mental health evaluation and restraint in the use of irreversible interventions for youth.
