By Erin Reed | HELSINKI, Finland – A new study in Finland, which is garnering attention among anti-trans activists, is being used to claim that gender-affirming care “is not lifesaving.” Journalist Benjamin Ryan explicitly stated this claim when discussing his article published in The New York Post.
However, leading researchers, including Dr. Meredithe McNamara from the Yale University School of Medicine and epidemiologist Gideon Meyerowitz-Katz, argue that the study’s methodology fails to support this conclusion.
They point out critical flaws, such as the study controlling for the variable it aims to measure and relying on outdated data from a time before “gender dysphoria” was even recognized as a diagnosis. Moreover, a detailed examination of the study reveals that, despite these issues, gender-affirming care likely reduces the risk of suicide—those who do not receive care face a risk three times higher than controls. Surprisingly, the study’s authors do not address this finding.
The new study examines Finnish health data from 1996 to 2022, exploring the connection between gender-affirming care and suicide. Numerous studies have demonstrated that gender-affirming care significantly reduces suicidality, with some showing a decrease in suicidality by up to 73%.
However, this study introduces an additional factor: visits to psychiatric specialists. It concludes that, after adjusting for psychiatric specialist visits, the suicide rates among those who undergo medical gender reassignment “did not statistically significantly differ from that of controls.” Therefore, the study asserts that the data “does not support the claims that [medical gender reassignment] is necessary to prevent suicide.”
Shortly after publication, nearly every organization opposed to gender affirming care publicized the findings widely. Genspect, an organization which has engaged in online teasing of transgender youth, stated the study put the “suicide myth” to rest.
Transgender Trend used the study to claim that “medical transition is ineffective in preventing suicide.” Leor Sapir of the Manhattan Institute used the study to claim “the suicide narrative is baseless.” Meanwhile, journalist Benjamin Ryan published a story in the New York Post and claimed the study showed “gender-transition treatment is not life saving.”
A closer examination of the study reveals that it does not support such conclusions. Now, in a thorough and comprehensive fact-check, leading experts refute these assertions by highlighting critical flaws that directly oppose these claims.
Ultimately, despite these shortcomings, the study actually suggests that gender-affirming care is lifesaving. This is despite statistical missteps and issues with data sources which, whether intentionally or not, obscure the conclusion supported by the extensive body of research indicating that gender-affirming care saves lives and decreases suicidality.
The majority of data within the Finish study does not actually look at gender dysphoria, but instead looks at gender identity clinic referrals from 1996 to today. Importantly, gender dysphoria did not exist as a diagnosis until 2013. Prior to 2013, “gender identity disorder” covered a broad range of gender-related issues and was considered pathological in nature. People referred to a gender identity clinic prior to 2013 could include, for instance, feminine boys or masculine girls whose gendered behavior did not conform to social standards of the time.
Importantly, prior to 2013, you did not need to desire “to be the other sex” in order to be diagnosed with gender identity disorder. Gender dysphoria as a diagnosis in the DSM-V, however, now requires this desire. You can see the new criteria here:
In the new Finish study, this is particularly problematic because the vast majority of people included in the study do not obtain gender affirming care – only 38% do. Though we do not know how many people referred fell under the old diagnostic criteria or the new diagnostic criteria, this suggests that many likely did not identify as transgender.
This could have been partially controlled for, according to Dr. McNamara, by including a “year of diagnosis” variable, to account for changes in diagnostic criteria, but such a variable was not included.
A central assertion of the study is that suicide rates are unaffected by gender dysphoria or gender-affirming care. To support this claim, the authors control for visits to psychological specialists. Dr. McNamara, however, identifies this as a critical flaw “amounting to a tautology.” Essentially, by adjusting for suicide in research aimed at determining the effect of gender-affirming care on suicide, the authors inadvertently controlled for the very outcome they sought to measure. This is because individuals at higher risk of suicide are more likely to have had “psychiatric contact.”
In an illustrative example, Dr. McNamara compares controlling for psychiatric contact in a study on suicide to controlling for variables such as “hours worked” in a study on the gender pay gap and using it to claim that a gender pay gap does not exist. If women work less hours due to gendered expectations, then controlling for hours worked “controls for the pay gap itself because they are so intrinsically connected.” Despite this, there have been similar attempts to over-control for the gender pay gap in order to try to erase claims that it exists.
One can imagine several more examples of controlling for variables that actually measure the outcome. If one wanted to erase the impact of CO2 on climate change, for instance, you could control for ice thickness and claim that it’s actually polar ice that determines the temperature of the earth rather than CO2 output, even though ice thickness and temperature are intrinsically connected. If you wanted to erase the impact of smoking on death, you could control for specialist doctor visits while claiming that “it’s actually visits to the doctor that predict death, not smoking.”
Therefore, it’s not surprising that the study concludes psychological specialist visits correlate with suicide deaths, causing the connection with gender-affirming care and gender dysphoria to seemingly vanish. This overlooks the evident fact that those at higher risk of suicide are indeed more likely to have interactions with psychological specialists and amounts to a critical flaw in the article’s central premise.
While the vast majority of the article only looks at those referred to Finland’s gender identity clinic, the impact of gender affirming care is tucked away in one paragraph and is the only part of the results section where the researchers do not include a table comparing the model with and without psychological referrals.
See the following excerpt (emphasis added):
To explore the role of GR, models accounting for sex, year of birth, and psychiatric treatment were repeated by dividing the GR group into those who had and those who had not proceeded to GR. Adjusted HRs for all-cause mortality were 1.4 (95% CI 0.6 to 3.3; p=0.5) in the GR- group and 0.7 (95% CI 0.2 to 2.0; p=0.5) in the GR+ group, as compared with the controls. Adjusted HRs for suicide mortality were 3.2 (95% CI 1.0 to 10.2; p=0.05) and 0.8 (95% CI 0.2 to 4.0; p=0.8), respectively.
Essentially, the paragraph states that for suicide, those who did not receive gender affirming care saw a 3x higher suicide rate than controls – and this is with overcontrolling for psychological treatment visits. Those who did receive care had no significant difference in suicide rates from controls. Dr. Meyerowitz-Katz, epidemiologist, stated of these findings, “The authors in their discussion focus on the fact that this difference was not statistically significant (presumably the p-value was 0.051-0.054), but that’s not a useful distinction. There’s a lot of uncertainty here, but the increased risk is still remarkable!”
Notably, this is the only section where the researchers withhold the model that doesn’t include visits to psychological specialists. It’s likely that the correlation between receiving gender-affirming care and a decreased suicide risk would be even more pronounced in a model free from the issue of overcontrolling.
If the researchers had presented such a finding, it would fundamentally challenge the basis of their paper… that gender-affirming care indeed saves lives. Even in attempts to dilute this relationship with confounding variables, the signal around gender affirming care remains strong!
Several other shortcomings challenge anti-trans interpretations of the study. Although the study discusses adolescents, the median referral age is 19, with more than half of the participants older than this. While 19-year-olds technically fall within the “adolescent” category, the discourse around gender-affirming care predominantly centers on individuals under 18 and the importance of early intervention. For the population examined in the study, many of the critical effects of puberty and unaddressed gender dysphoria would have already manifested. Consequently, the study lacks any basis to assert the impact of gender affirming care on trans youth.
The study also asserts that “gender dysphoria does not seem to predict suicide mortality” and organizations like SEGM handwave the positive gender affirming care findings by stating that suicide is “low” for gender dysphoric trans people. On a cursory glance, one might accept this claim – only 20 suicides are recorded in the Finnish dataset. However, this claim stretches far beyond what the study can actually conclude, as it solely focuses on individuals who have been formally referred for specialized gender identity services.
This approach neglects a significant portion of the population: youths with non-affirming parents, those who haven’t disclosed their gender identity to their parents, and individuals not seeking a formal diagnosis – all groups that may be much more likely to experience suicide. Claims suggesting low suicide rates among those with gender dysphoria overlook transgender individuals in unsupportive environments, who are seldom if ever recorded as “transgender” in any official death records.
Lastly and separately from issues with the study itself, a disclosure issue exists with at least one of the study’s authors. Dr. Riittakerttu Kaltiala is the chief psychiatrist at Finland’s Tampere University Hospital and has a long history with allegations of misconduct in her hospital’s gender clinic. She has regularly been involved with the anti-trans organization SEGM and was one of the main witnesses called to defend a gender affirming care ban proposed by the Florida Board of Medicine. Notably, the Southern Poverty Law Center has mapped out extensive ties between SEGM and anti-trans extremist groups, including shared funding streams with the Heritage Foundation and the Alliance Defending Freedom. Similarly, the Florida Board of Medicine was stacked by Governor Ron DeSantis to ban care.
Dr. Kaltiala’s patients have shared stories of conversion therapy and abusive statements. Finnish LGBTQ+ platform, Kehrääjä, has outlined many stories of trans people’s negative experiences with Dr. Kaltiala’s clinic, including accusations of transgender identity being a fetish, telling patients that bottom surgery “seldom functions correctly,” and trans men being being denied care for being too short or having hobbies that are “too girlish.” Numerous patients report being addressed by their old names in the clinic, and Dr. Kaltiala opposes allowing trans youth to change their gender markers and IDs. Her clinic even allegedly reported a patient’s parents to child protective services and filed a criminal complaint when they obtained care legally at another clinic.
Dr. Kaltiala cannot be characterized as an impartial medical researcher; she has emerged as a key figurehead for an anti-trans movement. She has been deeply involved with many of the key players in trans care bans. She’s appeared in a podcast by Genspect, an entity known for opposing gender affirming care up to the age of 25, teasing transgender children on social media, and promoting Moms for Liberty—a staunchly conservative anti-LGBTQ+ “parental rights” organization in the U.S.
In her appearance on a Genspect podcast, Dr. Kaltiala was featured alongside Stella O’Malley, founder of Genspect, who has labeled trans girls as “porn induced” fetishists and stated they warrant “no empathy.” She similarly has worked with the Catholic Medical Association’s Patrick Hunter, a Desantis-handpicked Florida Board of Medicine member who was integral to the care bans in the state.
Ultimately, the study fails to demonstrate that gender-affirming care is ineffective, particularly for transgender youth, and might even contribute to the body of evidence supporting the efficacy of such care. The study contains the same deep flaws as other research that relies on outdated diagnostic criteria from a time before “gender dysphoria” was recognized as a diagnosis and transgender identities were pathologized.
Moreover, it also overcontrolled for suicide by including a variable that is implicitly highly linked to suicide—mental healthcare visits—so as to erase the impact that gender affirming care has on suicidality.
Given that the study’s cohort predominantly consists of adults, it offers little insight into the effects of gender-affirming care on transgender youth, even without these methodological flaws. Similarly, it fails to address the experiences of transgender youth with unsupportive parents who are denied a gender identity diagnosis.
Nevertheless, the study appears to be providing anti-trans activists with exactly what they need: a study that lets them make a claim, however flimsy, that “gender affirming care does not save lives.” This narrative should be approached with skepticism, especially when propagated by individuals with ties to anti-trans groups or those involved in clinics where trans patients have reported mistreatment.
Contrary to such claims, gender-affirming care is indeed life-saving and associated with reduced rates of suicidality, even in this flawed study. Assertions to the contrary are challenged by more than 50 studies that affirm the positive impact of gender-affirming care.
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Erin Reed is a transgender woman and researcher who tracks anti-LGBTQ+ legislation around the world and helps people become better advocates for their queer family, friends, colleagues, and community. Reed also is a social media consultant and public speaker.
The preceding post was previously published at Erin in the Morning and is republished with permission.
