We were told cross-sex hormones and surgery would fix these young people's mental health. Finland checked. After the drugs and the surgery, far more of them needed psychiatric care, not fewer.
What Finland found
Finland sends every young person who wants a medical "gender reassignment" to one of two university hospital clinics, in Helsinki and Tampere. Researchers led by Dr. Sami-Matti Ruuska, an adolescent psychiatrist, and Prof. Riittakerttu Kaltiala, a professor of adolescent psychiatry at Tampere University, pulled the national health records for every one of them.
That's 2,083 people under 23 who went to those clinics between 1996 and 2019. Each was matched with eight people of the same birth year and hometown, 16,643 in all. Some were followed for up to 25 years. Their paper ran in Acta Paediatrica in April (Ruuska et al., 2026).
In Finland, specialist psychiatric care is only for serious mental illness. Mild and moderate problems are handled by family doctors. A patient leaves specialist care once they're well.
The new numbers
Critics claimed the first analysis might have counted people who hadn't had their drugs or surgery yet. So in September the authors ran it again, starting the clock only after each person's last step: cross-sex hormones, breast removal, or genital surgery (Ruuska et al., Sept. 2026).
- Before their first gender-clinic visit, 19.2% had needed specialist psychiatric care.
- After their last procedure, 48.9% did.
- Their matched peers went from 14.4% to 13.2%.
Compared with males from the general population, those who had the drugs or surgery were about six times as likely to need specialist psychiatric care. That was true for both sexes.
They started out healthier
Finland screens out young people with serious, unstable mental illness before it gives cross-sex hormones. So the ones who got them started out in much better shape than the other young people at the clinic.
The original paper shows what happened next (Ruuska et al., 2026):
- Males given cross-sex hormones or surgery: 9.8% had needed specialist psychiatric care before the clinic. Two or more years later, 60.7% did.
- Females given cross-sex hormones or surgery: 21.6% before. 54.5% after.
The healthiest went in. They came out about as sick as everyone else at the clinic.
"Psychiatric needs do not subside after medical gender reassignment," the authors concluded. They added that "in some individuals, medical GR appears to be linked to deterioration in mental health."
Nearly 50 critics. The authors didn't budge.
Nearly 50 researchers and clinicians signed a letter of concern to the journal, and other critics sent letters too. PsyPost reports the letter asked the journal to reconsider the paper.
The authors answered twice in print. In May they re-ran the numbers five or more years out and got the same result (Ruuska et al., May 2026). In September they did the after-the-last-procedure analysis above.
"Some of the critique seems to be driven by an attempt to discredit scientific findings that do not align with the critics' preferred agenda, typical in gender medicine," they wrote in May. "The scientific and ethical responsibility invoked is fulfilled not by withholding inconvenient evidence, but by ensuring that the scientific community has access to accumulating information."
The bottom line
The promise was that cross-sex hormones and surgery would ease these young people's suffering. Finland followed every one of them for up to 25 years. After their last procedure, half of them had needed specialist psychiatric care.
More on this study: Facts: Finland register study and our April story.
Sources
- Ruuska S-M, Tuisku K, Holttinen T, Kaltiala R. "Psychiatric Morbidity Among Adolescents and Young Adults Who Contacted Specialised Gender Identity Services in Finland in 1996–2019: A Register Study." Acta Paediatrica 115(7):1545–1553, 2026. doi:10.1111/apa.70533
- Ruuska S-M, Tuisku K, Holttinen T, Kaltiala R. "Response to the Critique by Edmiston et al., Banos et al. and Sandri et al. of Ruuska et al." Acta Paediatrica 115(9):2044–2045, 2026. doi:10.1111/apa.70618
- Ruuska S-M, Tuisku K, Holttinen T, Kaltiala R. "Response to the Critique by Banos et al. of Ruuska et al." Acta Paediatrica, Sept. 15, 2026. doi:10.1111/apa.70767
- Eric W. Dolan, PsyPost, Oct. 18, 2026
Cover photo: Tiia Monto, Tampere University Hospital, via Wikimedia Commons (CC BY-SA 3.0)