Medical gender reassignment in minors. Why are we cautious in Finland?

Gender identity assessments—sometimes leading to medical gender reassignment (GR) during developmental years— were made available to minors in Finland in 2011. However, the profiles of patients referred to gender identity services (GIS) differed from those suggested in international literature at the time. The outcomes of medical interventions were more modest than anticipated, despite internationally optimistic expectations. Meanwhile, the number of young people seeking medical GR increased rapidly.

This gap between expectations and observed realities, as documented in our published research, underscored the need for national guidelines, which were issued in 2020. Due to the lack of a strong scientific evidence base for early medical intervention, the guidelines designated psychosocial interventions as the primary approach to treating gender dysphoria (GD) among minors.

Subsequent research has not strengthened the evidence base of medical gender reassignment initiated during developmental years. I will describe these developments, research findings following the issuance of the Finnish guideline, and current challenges in pediatric gender medicine. As young people presenting in specialised gender identity services are a heterogeneous group with a variety of needs, a holistic assessment and individualised treatment plan is warranted.