Finland (2020)
On June 11, 2020, the Finnish Council for Choices in Health Care (COHERE, or PALKO in Finnish) adopted a recommendation on medical treatments for gender dysphoria in minors. The council works with the Finnish Ministry of Social Affairs and Health and advises on which services should be covered by public healthcare. The recommendation therefore dates from 2020, not 2023.
The main article on this subject is Gender care in Finland.
What it says
Psychosocial support comes first and should be available close to home, supplemented with psychiatric treatment and psychotherapy where necessary. Diagnosis and medical treatment are concentrated at the university hospitals in Helsinki and Tampere. Puberty blockers may be started on a case-by-case basis after careful assessment and diagnosis. Before the age of eighteen, hormones that alter sex characteristics are considered only when the identity is persistent and causes severe dysphoria. Surgery is not part of treatment for minors.
Background and scope
On the same day, the council adopted three recommendations: one concerning adults with a transgender identity, one concerning adults with a non-binary identity and one concerning minors. The recommendation on minors clarifies the division of responsibilities between local healthcare services and the two specialized centers. According to the council, psychosocial support should be provided through school and student healthcare and primary care, which should have sufficient expertise to do so. Children who have not yet reached puberty and experience persistent, severe symptoms may be referred to one of the centers for a consultation; further support remains the responsibility of their own region. In addition to puberty blockers, the recommendation also mentions suppressing menstruation as a medical option.
Psychiatric conditions and consent
An important section concerns young people who also have other psychiatric problems. Those problems should first be treated in their own region. According to the council, no conclusions can be drawn about the stability of a gender identity as long as a psychiatric disorder is interfering with development. A gender assessment may be considered if the need for one persists after the other problems have resolved and development has returned to normal. A later Finnish study on the psychiatric history of people who reversed their transition is discussed on the page about the Finnish detransition study. In addition, for hormone treatment, the young person must be able to understand what irreversible treatments entail and what the benefits and drawbacks of lifelong hormone therapy are. Initiating and monitoring hormone treatment remains the responsibility of the two university centers. Later developments in neighboring countries are covered in this archive under Denmark (2023) and the Swedish SBU report.
Why it is included in this archive
The council notes that the research evidence is limited and calls for more knowledge about effects, disadvantages and regret. The recommendation is frequently cited in the scientific debate and in overviews of policy by country.