Psychiatrické potřeby se zvyšují po změně pohlaví

Psychiatrická morbidita mezi dospívajícími a mladými dospělými, kteří kontaktovali specializované služby pro genderovou identitu ve Finsku v letech 1996–2019: Registrová studie

Kohortové & registry studie Duševní zdraví & sebevražednost

Authors: Sami-Matti Ruuska, Katinka Tuisku, Timo Holttinen, Riittakerttu Kaltiala
Journal: Acta Paediatrica
Year: 2026
Source: onlinelibrary.wiley.com/doi/10.1111/apa.70533

Summary

Using Finland's national records, researchers followed every young person referred to youth gender services from 1996 to 2019, each matched with eight peers. Gender-referred youth used specialist mental health care about 3 to 4 times as often as their peers, both before and after referral. Those referred after 2010 had twice the earlier rate before referral. Young people who went on to hormones or surgery had fairly low use of mental health care before referral but high use afterwards, similar to those who did not transition. The authors conclude mental health needs do not ease after medical transition, and that for some, gender distress may stem from other mental health problems. The records are complete and national. But they show links in use of care, not the effects of treatment, and published letters dispute how the data were analysed and what was measured.

Key findings

Z 2 083 osob mladších 23 let odeslaných kvůli genderu potřebovalo 45,7 % před odesláním specializovanou péči o duševní zdraví, oproti 15,0 % z 16 643 odpovídajících vrstevníků; o dva a více let po odeslání to bylo 61,7 % oproti 14,6 %.
Mezi odeslanými v letech 2011 až 2019 (1 897 lidí) byl tento druh péče před odesláním dvakrát častější než u odeslaných v letech 1996 až 2010 (47,9 % oproti 23,7 %), zatímco vrstevníci takový nárůst neukázali.
Mezi 796 (38,2 %), kdo dostali hormony nebo operaci, vzrostla specializovaná péče o duševní zdraví z 9,8 % na 60,7 % ve feminizující skupině a z 21,6 % na 54,5 % v maskulinizující skupině.
U těch, kdo lékařskou tranzici nepodstoupili, to bylo již před odesláním 53 % až 65 % a změnilo se to málo.
Po zohlednění minulé péče o duševní zdraví měla každá skupina odeslaná kvůli genderu asi 5 až 6krát vyšší pravděpodobnost než mužští vrstevníci a 3 až 4krát vyšší než ženské vrstevnice, že později bude potřebovat specializovanou péči, ať už lékařskou tranzici podstoupila, nebo ne.
27,6 % skupiny odeslané kvůli genderu mělo za život 101 a více návštěv specializované péče o duševní zdraví, oproti 4,3 % vrstevníků.
Autoři uzavírají, že po lékařské tranzici nenásledovaly menší potřeby duševního zdraví, že se u některých zdá být spojena se zhoršením a že duševní potíže by měly být plně posouzeny a léčeny před léčbami, které nelze vzít zpět, i po nich.

Abstract

Aim: To examine the prevalence of severe psychiatric morbidity among gender-referred adolescents, focusing on gender differences and outcomes related to medical gender reassignment. Methods: Finnish nationwide cohort of all under-23-year-old gender-referred individuals between 1996 and 2019 (n = 2 083) and 16 643 matched controls. Cross-tabulations with X² statistics and Cox regression were used to analyse the data. Results: Gender-referred adolescents showed significantly higher psychiatric morbidity than controls both before (45.7% vs. 15.0%) and ≥ 2 years after referral (61.7% vs. 14.6%). Those referred after 2010 had greater psychiatric needs than earlier cohorts, both before (47.9% vs. 15.3%) and ≥ 2 years after (61.3% vs. 14.2%) referral. Among adolescents who underwent medical gender reassignment, psychiatric morbidity increased markedly during follow-up—rising from 9.8% to 60.7% in feminising gender reassignment and from 21.6% to 54.5% in masculinising gender reassignment. After adjusting for prior psychiatric treatment, all gender-referred adolescents had similarly elevated risks of psychiatric morbidity, with hazard ratios approximately three times higher than female controls and five times higher than male controls. Conclusion: Severe psychiatric morbidity is common among gender-referred adolescents and appears to be more prevalent in those referred after the recent surge in referrals. Psychiatric needs do not subside after medical gender reassignment.

Conclusion

Regardless of gender, adolescents suffering from GD present with excessive psychiatric morbidity. Subsequent to medical GR, psychiatric treatment needs appear to increase. It should be noted that in some individuals, medical GR appears to be linked to deterioration in mental health. Possible mechanisms and vulnerable subgroups should be explored in future studies. The effects of medical GR and the expectations of the patient must be addressed before commencing the treatment. 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. 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.

Methodological limitations

Shows links, not causes: The study compares groups based on whether they eventually transitioned. It shows patterns in use of care, but cannot show whether treatment improved or worsened mental health.
Who got treatment was not random: Those who transitioned had much less mental health care before referral (9.8% to 21.6%) than those who did not (53% to 65%), probably because serious mental illness ruled people out (the authors agree). The later rise may partly be this group catching up to the usual level for gender-referred youth, not an effect of treatment.
Timing of treatment not tracked: Transition was treated as a fixed label, and follow-up started at the first clinic visit, not when treatment began. So it is unknown whether mental health visits came before or after hormones or surgery. Letters by Edmiston et al. and others in Acta Paediatrica (2026) raised this concern.
A rough measure: The study only recorded whether someone had any specialist mental health contact two or more years after referral (yes or no). It did not measure diagnosis, how severe symptoms were, daily functioning or number of later visits. Critics argued that seeing a specialist does not equal being seriously unwell.
More contact may mean more referrals: Young people at gender services may be more likely to be sent to or kept in mental health care (for assessment, monitoring or to qualify for treatment), which would boost their numbers. The authors argue Finland's school health checks make this less likely.
Family income not considered: The authors note that family and income factors known to affect mental health were not accounted for.
How treatment was recorded: Hormone treatment was only recorded when hormones were bought under a special state refund code after a year of treatment. So short or privately paid treatment may have been counted as no treatment.
Mixed ages, partly adults: The average age at referral was 18.5 and people up to 22 were included. So the results are not specific to younger teens or to puberty blockers.
Short follow-up for many: Average follow-up was 5.5 years (typically 4.9), and most people were referred after 2010. This limits what can be said about long-term results.
Many comparisons and analysis choices: The study made many group-by-group comparisons, using a stricter bar for chance findings. Some matching details were left out of the main analysis; the authors say including them did not change results.
Published critiques: Letters by Edmiston et al. ('Concerns Regarding Data Modelling and Interpretation in Ruuska et al.'), Banos et al., Sandri et al., Bragazzi et al. and Bahry were published in Acta Paediatrica in 2026. The authors replied, including a further analysis over five years, but did not give more detailed visit data.
Authors' views and links: Senior author Riittakerttu Kaltiala has led the youth gender service at Tampere University Hospital (one of the two services studied), sat on the Cass Review advisory board, and has been paid for talks by groups including the Society for Evidence-Based Gender Medicine. She is a well-known critic of affirming youth gender medicine. These were declared.

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Summary

Key findings

Abstract

Conclusion