Gender Care in Finland

In 2020, Finland became the first Western country to openly move away from the gender-affirmative model for minors — four years before the British Cass Review was published. Based on a systematic evaluation of the evidence, the Finnish advisory body COHERE concluded that psychotherapy and treatment of comorbid conditions should be the first-line treatment, and that hormonal interventions are justified only in exceptional cases. Together with Sweden, Finland thereby set the tone for the re-evaluation of pediatric gender care in Northern Europe.

More on this site: Finland (2020) and Palko (Finland).

Subtopics are covered in PALKO Finland 2020 — Finnish policy change.

The role of Riittakerttu Kaltiala

A key figure in Finland's reorientation is Prof. Riittakerttu Kaltiala, head of the child and adolescent psychiatry center at Tampere University and for many years responsible for pediatric gender care in Finland. From 2015 onward, Kaltiala and her team published a series of studies showing that most Finnish young people with gender dysphoria had significant psychiatric comorbidity, that medical transition did not alleviate broader mental health problems, and that the patient population had rapidly changed in composition and size. These clinical findings formed the basis of Finnish policy. Later Finnish research describes nine detransitioners, all of whom had a serious psychiatric history.

The COHERE recommendation (2020)

COHERE (Council for Choices in Health Care in Finland, known as PALKO in Finnish) is the Finnish body that decides which medical treatments are reimbursed through the public healthcare system. In June 2020, COHERE published a recommendation on the treatment of gender dysphoria in minors. The full English summary is available through the Finnish government website.

The key points:

• Psychotherapy and psychosocial support are the first-line treatment for minors with gender dysphoria.
• Puberty blockers and cross-sex hormones are permitted only in cases of severe, persistent dysphoria following extensive diagnostics and the exclusion of comorbid causes, and solely in carefully considered individual cases.
• Genital surgery is not recommended for minors.
• Social transition is not a neutral intervention and may influence the natural course of development — a conclusion later also endorsed by the Cass Review.

Scientific basis

Finland based its policy on a thorough assessment of the international scientific literature, concluding that: (1) a substantial proportion of young people with dysphoria outgrow it during adolescence (desistance, see Steensma et al. 2013), (2) nearly all treated young people have comorbid psychiatric problems, (3) puberty blockers are not the neutral “pause button” they were long considered to be, and (4) the long-term effects of hormonal treatment have not been adequately studied. These findings run almost entirely parallel to the later conclusions of Sweden’s SBU and the Cass Review.

Practical consequences

In Finland, young people with dysphoria now first undergo an extensive process of psychological assessment, screening for autism, trauma and other comorbidities, and psychotherapeutic treatment of underlying problems. Only once it has been established that the dysphoria is severe and persistent — and that other treatments have been insufficiently effective — can a medical intervention be considered. In practice, this applies to a small minority. Finland has two specialized pediatric gender care centers: Helsinki University Hospital and Tampere University Hospital, both operating under the COHERE guidelines.

Legal gender change

Separate from medical care, Finland passed a new law in 2023 allowing adults to change their legal sex on the basis of self-identification, without medical requirements. The law applies only to adults; minors cannot change their legal sex. In Finland, the medical and legal pathways are explicitly separate.