The latest Kaltiala study is filled with fatal methodological flaws, and does not support claims made about trans youth care lacking efficac
Erin Reed at Erin In The Morning:
A new study circulating on social media falsely claims that gender-affirming care for youth and adults under 23 does not improve mental health outcomes—and may have even worsened them. The study, published in the low-impact journal Acta Paediatrica, comes from Riittakerttu Kaltiala, a Finnish psychiatrist with extensive ties to at least one anti-LGBTQ+ hate group and a history of anti-trans political advocacy. The study uses Finnish registries and psychiatric visit data to support these conclusions. However, a closer examination reveals the study to be fatally flawed: it does not actually measure what it claims to measure, its headline finding is a massive artifact of surveillance bias, the clinics practices were abusive, and it operates within a system where its findings were essentially baked in from the start—regardless of what the actual mental health impacts of gender-affirming care might be.
The study looks at 2,083 people who walked into one of Finland's two gender identity clinics between 1996 and 2019, before turning 23. These patients were split into those who ultimately received gender-affirming care and those who did not. The study sets its point of comparison—what it calls the "index date"—at the date of a patient's first appointment at the clinic, not the date any treatment began. It then looks at whether each person had any visit to a specialist psychiatrist before and after that date, which it labels "specialist-level psychiatric treatment." Its headline finding: among trans girls and women who received gender-affirming care, "psychiatric treatment" went from 9.8% before to a staggering 60.7% after. The numbers sound devastating—except the study commits several fatal errors. Its central finding is not supported by its own data. The outcome variable conflates merely visiting a psychiatrist with actual psychiatric deterioration, something the study had the data to disentangle but chose not to. Most damningly, Finland's own medical journal documented that trans people were monitored every 3-6 months "in close cooperation with the adolescent psychiatry unit"—visits that register in the very same database the study uses as its outcome measure.
A closer examination shows that the study’s conclusions are entirely unsupported by its own data. This is part of a pattern from Kaltiala, who published a similarly flawed study in 2024 that used proxy variables and buried its own positive findings to claim gender-affirming care does not reduce suicide—when its data actually showed the opposite. That the current study landed in Acta Paediatrica, a journal with an impact factor of just 2.1—far below top-tier pediatrics journals like JAMA Pediatrics or Pediatrics—suggests it may not have survived scrutiny at more rigorous outlets. This fact check will address the study’s most severe methodological shortcomings, to counter the misleading narrative already spreading across social media and anti-trans policy circles.
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The Study Measures Psychiatric Appointments That Are Virtually Guaranteed, A Case Of Massive “Surveillance Bias”
The study measured a single binary variable to determine if gender-affirming care impacts transgender youth negatively: did this person have any contact with specialist-level psychiatric services, yes or no? If a person had even a single contact with a specialist-level psychiatric service, they were recorded as needing psychiatric care. Notably, the study calls this variable “need for specialist-level psychiatric treatment”—but the registry it draws from, the Care Register for Health Care, records visits, not treatments, and the study itself notes this limitation:” A limitation of this study is that more detailed information on patients' reasons for using the psychiatric services could not be analysed.” What this means in practice is that a single routine monitoring appointment with a psychiatrist registers identically in this dataset to a psychiatric hospitalization. A pre-surgical psychological evaluation—required under Finnish law for anyone seeking gender reassignment—counts the same as an emergency crisis intervention. The very pathway that the gender-transition program in Finland puts transgender people on virtually guarantees psychiatric visits.
This is because Finland's gender identity services for minors are not housed in a general medical setting—they are located within the departments of adolescent psychiatry at both Tampere and Helsinki University Hospitals. The assessments are conducted by psychiatric teams: an adolescent psychiatrist, a psychiatric nurse, a social worker, and a psychologist. In other words, the gender care pathway in Finland IS a psychiatric pathway and deeply enmeshed with the psychiatric system. Patients were required to check in for a potential psychiatric visit every 3-6 months during the study period. It is no surprise, therefore, that those in the Finnish system therefore see an increase in psychiatric visits.
Notably, most transgender youth in the program will be subject to psychiatric appointments, both before, during, and after the “index date.” Anything found during these appointments will require continued care and evaluation. This is a textbook case of surveillance bias—a well-known problem in epidemiology where a group under clinical observation appears sicker than a comparison group simply because they are being watched more closely. Trans youth in Finland’s gender care system are, by design, in constant contact with psychiatric services.
Erin In The Morning delivering another fact-check to an anti-trans “study.”
