Study: Sharp Increase in Psychiatric Care After Gender-Affirming Treatment

A new Finnish study shows a sharp increase in specialist psychiatric care among young people who have undergone medical gender-affirming treatment. Among those who underwent feminizing treatment, the proportion receiving specialist psychiatric care rose from 9.8% to 60.7% after treatment.

The peer-reviewed study, published in the scientific journal Acta Paediatrica, is based on registry data from all young people who contacted Finland’s specialized gender identity clinics during the period 1996–2019. In total, 2,083 individuals under the age of 23 at their first contact with the clinic were included. They were compared with 16,643 individuals from the general population, matched by factors such as age and sex.

The researchers followed the individuals for up to 25 years with an average follow-up time of just over five years. Of the 2,083 individuals, 796 (38.2 percent) underwent some form of medical gender-affirming treatment, which could involve hormone therapy or surgical interventions.

Even before the contact with a gender identity clinic, the psychiatric burden was significantly higher than among the control group. 45.7 percent of the individuals in the gender dysphoria group had previously received specialist psychiatric care, compared to 15 percent among the controls.

After at least two years of follow-up, the proportion had increased to 61.7 percent in the gender dysphoria group. In the control group, the corresponding figure remained at around 15 percent.

Sharp Increase After Medical Treatment

The most notable difference appears when the researchers split the group based on whether individuals had undergone medical gender-affirming treatment.

Among those seeking transition from male to female who later underwent medical treatment, 9.8 percent had received specialist psychiatric care before the index date. At least two years later, this proportion had risen to 60.7 percent.

There was also a significant increase among those seeking transition from female to male. Here, 21.6 percent had received specialist psychiatric care before the index date, compared to 54.5 percent after at least two years.

The development was much less pronounced among those who did not undergo medical treatment. In the group seeking transition to female, the share receiving specialist psychiatric care rose from 53.1 to 59.7 percent. Among those seeking transition to male, the proportion increased from 65 to 67.2 percent.

Photo: MorgueFile : see [1], CC BY-SA 3.0

Different Explanations

However, the results do not mean that the researchers can definitely state that the medical treatment itself causes the increased mental illness. The study is a registry-based study and not a controlled experiment. Therefore, there are several possible explanations for the results.

The researchers point out, among other things, that those who undergo treatment differ from those who do not, and that existing psychiatric morbidity prior to treatment may affect who has access to medical treatment.

This is particularly evident since those who did not undergo treatment had considerably higher levels of psychiatric care already before their contact with the gender clinic. As a result, the researchers adjusted their analyses for factors such as prior psychiatric treatment.

The continued consumption of psychiatric care was still higher in the gender dysphoria group than among controls, but the results do not show that gender-affirming treatment per se is the cause of this trend.

Mental Health Issues Common Even Before Treatment

The study simultaneously shows how extensive the psychiatric problems are among young people seeking care for gender dysphoria.

Almost half had already received specialist psychiatric treatment before coming to the gender identity clinic. Among those who later received medical treatment, the figure was lower, which the researchers link to the fact that severe psychiatric problems may affect the possibility of receiving such treatment.

The researchers state in this context that the need for psychiatric care does not appear to decrease following medical gender-affirming treatment. They call for further research into the reasons for the high levels of psychiatric morbidity and stress the importance of psychiatric follow-up both before and after treatment.