PALKO Finland 2020 — Finnish policy change

In June 2020, the Finnish Council for Choices in Health Care (PALKO/COHERE) published a recommendation on medical treatment for gender dysphoria in minors.

The main article on this subject is Gender care in Finland.

PALKO report

In June 2020, the Finnish Council for Choices in Health Care (PALKO/COHERE) published a recommendation on medical treatment for gender dysphoria in minors. The recommendation emphasized that psychosocial support should be the first-line approach, and that hormonal treatment should take place only in specific cases and within a research setting.

Rationale

The report stated that evidence for the long-term benefits of puberty blockers and cross-sex hormones in young people is limited. It also highlighted the changing patient population — a sharp increase in adolescent girls presenting at a later age.

Influence

Finland was the first Western country to adopt this cautious approach. The report influenced policy reviews in Sweden, Norway and the United Kingdom.

What the recommendation prescribes

For minors, psychosocial support is the first step, together with treatment for co-occurring psychiatric problems. Only once those problems are under control and the gender dysphoria persists can a young person be referred to one of the two university hospitals where care is concentrated, in Helsinki and Tampere. There, each case is assessed to determine whether puberty blockers or hormones should be considered. Surgery is not part of treatment for minors. The recommendation describes the medical treatment of minors as an experimental practice. A brief explanation of the advisory body and its change in direction can be found at transplek.nl.

Background

Finnish gender clinics for young people opened in 2011 and initially operated according to the Dutch Protocol. The clinicians soon saw that their patients did not resemble the group described in the Dutch studies. Most of the young people were girls whose distress had begun only during puberty, and a substantial proportion had serious psychiatric problems that had already existed for some time. Child and adolescent psychiatrist Riittakerttu Kaltiala, head of the clinic in Tampere, began publishing on the subject in 2015 and played a central role in the review. A later Finnish study also found a significant psychiatric history among nine detransitioners.

Difference from other guidelines

The Finnish recommendation differed from the guidelines of WPATH and the Endocrine Society, which describe treatment with blockers and hormones as standard care. Finland placed the emphasis on the young person’s mental health and on whether their identity was already stable. See also the timeline and the overview of systematic reviews.

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