What happens to the mental health of adolescents who attend specialised gender identity services? A nationwide study carried out in Finland, published in Acta Paediatrica, has analysed medical records spanning more than two decades to answer this question with data, not opinions. The results, which have had wide international impact, confirm that these young people carry a very high psychiatric burden and, above all, that this need for care does not disappear after medical treatments.
How the study was carried out
The researchers used Finland’s health records, a country with a universal health system and very comprehensive databases. They identified 2,083 people under 23 years of age who had been referred to specialised gender identity services between 1996 and 2019, and compared them with 16,643 controls from the general population, matched by age and sex.
The follow-up extended at least two years after the first consultation, and severe psychiatric diagnoses attended to in the public health system were recorded.
A much higher psychiatric burden
The figures are compelling. Before the first consultation, 45.7% of the referred adolescents already had some psychiatric diagnosis, compared with 15% of the controls. Two or more years after the consultation, the proportion had risen to 61.7%, while in the general population it remained at 14.6%.
After adjusting for prior psychiatric history, all referred adolescents showed a risk of psychiatric morbidity approximately three times higher than female controls and five times higher than male controls.
The most striking finding
One of the most debated findings is that the need for psychiatric care increased during follow-up even among those who received gender-affirming medical treatment. Among people who underwent feminising treatment, psychiatric morbidity rose from 9.8% before treatment to 60.7% after; among those receiving masculinising treatment, from 21.6% to 54.5%.
The authors are cautious: this is an observational study and does not allow the conclusion that treatment causes that increase. But they do stress that, contrary to what is sometimes expected, mental health needs do not automatically decrease after medical interventions.
Adolescents in recent years arrive with greater needs
Another relevant result is the temporal trend. Young people referred after 2010, at the height of the rise in referrals, presented greater psychiatric needs than earlier cohorts, both before (47.9% versus 15.3%) and after (61.3% versus 14.2%) the consultation.
This finding fits with the international literature describing how adolescents referred in recent years tend to accumulate more mental health problems, probably because of changes in referral patterns and in the profile of those seeking care.
What this means for clinical practice
For the authors, the main conclusion is practical: adolescents who attend these services need a rigorous psychiatric assessment and continuous follow-up, which must not be interrupted when hormone or surgical treatment begins.
The study reinforces an increasingly accepted message in the medical community: gender identity care in adolescence is not only a matter of hormone treatment. Above all, it is a matter of comprehensive mental health, in which psychological and psychiatric support must accompany the person throughout the entire process and beyond.
Bibliographic reference:
Ruuska SM, et al. Psychiatric morbidity among adolescents and young adults who contacted specialised gender identity services in Finland in 1996–2019: A register study. Acta Paediatrica 2026. DOI: 10.1111/apa.70533.
View the publication: Acta Paediatrica.
