Aspects of the gender affirmation model followed by American physicians have failed, are not evidence-based, and are “extremely unethical”, a Finnish expert in gender medicine has said. In a blistering article in The Free Press, Dr Riittakerttu Kaltiala, the chief psychiatrist in the department of adolescent psychiatry at Finland’s Tampere University Hospital and the author of more than 230 papers, says that “gender transition has gotten out of hand”.

Finland has parked the trans train on a siding after its national medical body, COHERE, concluded in 2020 that “that the studies touting the success of the ‘gender-affirming’ model were biased and unreliable—systematically so in some cases.”

But if this is the case, why have paediatric gender clinics multiplied in the United States? The first opened in Boston in 2007; now there are more than 100. Dr Kaltiala attributes it to toxic groupthink. She complains that two panels favouring her approach at the annual conference of the American Academy of Child and Adolescent Psychiatry were rejected. “This is highly disturbing,” she writes. “Science does not progress through silencing. Doctors who refuse to consider evidence presented by critics are putting patient safety at risk.”

The article summarises the unease felt by experts in paediatric gender medicine in the Nordic countries and the UK. It is must-read. Here are a few key excerpts:

[Gender-affirmative doctors] asserted that not only would the feelings of gender distress immediately disappear if young people start to medically transition, but also that all their mental health problems would be alleviated by these interventions. Of course, there is no mechanism by which high doses of hormones resolve autism or any other underlying mental health condition…

The young people we were treating were not thriving. Instead, their lives were deteriorating. We thought, what is this? Because there wasn’t a hint in studies that this could happen. Sometimes the young people insisted their lives had improved and they were happier. But as a medical doctor, I could see that they were doing worse. They were withdrawing from all social activities. They were not making friends. They were not going to school. We continued to network with colleagues in different countries who said they were seeing the same things…

Anyone, including physicians, researchers, academics, and writers, who raised concerns about the growing power of gender activists, and about the effects of medically transitioning young people, were [sic] subjected to organized campaigns of vilification and threats to their careers…

I have been particularly concerned about American medical societies, who as a group continue to assert that children know their “authentic” selves, and a child who declares a transgender identity should be affirmed and started on treatment.

I am also disturbed by how gender clinicians routinely warn American parents that there is an enormously elevated risk of suicide if they stand in the way of their child’s transition. Any young person’s death is a tragedy, but careful research shows that suicide is very rare. It is dishonest and extremely unethical to pressure parents into approving gender medicalization by exaggerating the risk of suicide.