Study: Transition Does Not Reduce Suicide Risk – Psychiatric Problems Increase

One of the most politically powerful narratives in the transgender debate is the mantra "transition or suicide", repeated again and again. According to this claim, people denied gender transition are driven to take their own lives. It is also a striking argument frequently presented to parents by counseling services and doctors when they respond skeptically to their pubescent children’s requests for transition, puberty blockers or even surgical interventions and refuse consent.

"Do you want a trans child or a dead child" can be a frightening alternative. Describing it as emotional blackmail would arguably be more honest. No parent wants to risk being blamed for a potential suicide or accused of denying their child "life-saving" treatment.

From Narrative to Policy and Practice

For more than two decades, this narrative has persisted. It has influenced political decisions, transgender legislation and access to transition-related treatments in numerous countries, including for children and adolescents. In many places, child and adolescent therapists are now expected to treat young patients only in an "affirmative" manner, validating rather than questioning their expressed gender identity. This approach is also rooted in the same narrative.

Germany, for example, criminalized the supposed "conversion" of transgender patients when banning conversion therapy for homosexuals, as if it were the same thing whether someone is attracted to the same sex or believes they are in the "wrong body" and intends to alter and even mutilate it through hormones and surgery.

The law was passed even though numerous medical associations raised strong objections during the legislative process, warning that adequate treatment of children with gender dysphoria would effectively be criminalized. Policymakers nevertheless proceeded. Physicians were discouraged from questioning or verifying requests for transition and instead expected only to affirm them and implement them medically.

A new long-term study from Finland now unequivocally challenges this narrative and in fact turns it on its head. Among adolescents who underwent medical transition, the frequency of psychiatric morbidity increased markedly during follow-up, from 9.8% to 60.7% after feminizing treatment and from 21.6% to 54.5% after masculinizing treatment.

Rather than eliminating psychological problems, transition was associated with a sixfold increase among males and a near tripling among females. What is promoted as "life-saving" treatment instead appears to worsen patients’ mental stability.

In recent years, numerous studies have examined this question, often reaching fundamentally contradictory conclusions. Researchers have accused one another of producing only the results they expected. Many studies also showed methodological weaknesses, including small or non-representative samples. Follow-up periods were often short, making reliable long-term conclusions impossible. Participation frequently depended on voluntary cooperation, introducing bias. Patient data were missing, studies saw dropouts, and control groups were often absent.

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Clear Verified Data

The new retrospective Finnish study, published on 4 April 2026, is notable for its comprehensive registry data and long-term follow-up. Finland centralizes these treatments in two university hospitals. Reporting to national health registers is mandatory, and patients cannot opt out of follow-up. The register therefore captures all datasets of transgender patients in Finland.

Dr Sami-Matti Ruuska and co-authors examined 2,083 patients with gender dysphoria who were younger than 23 at referral to specialist clinics. Of those, 38.2% subsequently underwent medical interventions. No participants were lost to follow-up. In addition, a matched control group of 16,643 individuals from the general population was included.

Ruuska and colleagues are not newcomers in this field. In 2024, they published a similar study that concluded suicide among adolescents with gender dysphoria was relatively rare and that medical transition did not appear to reduce suicide risk. The findings already suggested that elevated suicide risk among gender clinic patients was not explained by dysphoria itself but rather by pre-existing psychiatric conditions.

The authors concluded: "Clinical gender dysphoria does not appear to be predictive of all-cause nor suicide mortality when psychiatric treatment history is accounted for. Clinical implications: It is of utmost importance to identify and appropriately treat mental disorders in adolescents experiencing gender dysphoria to prevent suicide."

Put simply, the problem was not the "wrong gender" but pre-existing psychiatric illness. Accordingly, transition cannot resolve the situation and may even worsen it because it does not address the underlying issue.

Co-author Professor Riittakerttu Kaltiala of Tampere University Hospital, who has led Finland’s youth gender clinic since 2011, also contributed to the study. She was a member of the advisory panel for the Cass Review commissioned by the United Kingdom’s National Health Service (NHS). That report found puberty blockers ineffective and risky and led to a halt and subsequent ban of such treatments in England.

Dysphoria as consequence, not cause

The Finnish researchers examined psychiatric treatment histories from the first visit to gender clinics until at least two years afterward. On average, patients were observed for five years, with some followed for up to 25 years.

The study distinguishes between two cohorts: patients treated between 1996 and 2010 and those treated between 2011 and 2019, a period during which case numbers increased exponentially worldwide.

The results confirm previous findings. The authors state that for some individuals medical interventions appear to be "associated with a worsening of mental health". The findings suggest that pre-existing psychiatric disorders play a greater role than dysphoria itself. The study recommends focusing on treatment of conditions such as depression and anxiety rather than primarily addressing dysphoria, which appears more likely a consequence than a cause of patients’ suffering.

The authors write: "In light of the present findings, severe psychiatric disorders do not appear primarily attributable to [gender dysphoria]. Psychiatric disorders require their due treatment regardless of a young person’s gender identity."

The study also notes that in some individuals medical transition appears linked to worsening mental health. Particular attention is drawn to estrogen treatment in males, which is associated with increased depression. This may explain the higher rate of psychiatric treatment among males undergoing transition compared with females.

The data provide no evidence that patients were better off after transition.

Among the cohort treated between 1996 and 2010, 66% still required specialist psychiatric care two or more years after the first visit. Among matched controls, the figure was 18%.

The cohort treated between 2011 and 2019 showed even higher reliance on psychiatric care than controls. At the first visit, 48% were already receiving psychiatric treatment, compared with 15.3% in the control group. During follow-up, 61.3% continued to require psychiatric care, compared with 14.2% of controls.

Comparing the two cohorts, the number of transgender patients presenting after 2011 with extensive psychiatric histories doubled, while the control population showed no comparable increase. The study concludes this suggests that more adolescents with severe psychiatric disorders were being referred to gender clinics.

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Alternative Explanation Rejected

Another narrative often invoked is that persistent psychological distress after transition is caused by discrimination and lack of societal acceptance. Under this theory, the problem lies not with the patient but with the environment. The Finnish researchers reject this explanation. Given increasing societal acceptance of sexual and gender minorities, psychiatric treatment would be expected to decline. Instead, it doubled. The researchers suggest that in some cases post-transition psychiatric treatment may "manifest as concerns regarding gender identity", indicating possible regret.

In summary, despite rising societal acceptance, the number of patients requiring treatment after transition increased substantially. The data suggest the post-2011 surge brought more adolescents with complex psychiatric conditions into gender clinics, that most patients did not improve after transition, some worsened significantly, and underlying psychiatric conditions often remained untreated while being reframed as gender-related problems.

It remains to be seen whether these findings will lead to changes in treatment approaches, similar to the Cass Review in England. What was until recently considered appropriate treatment for teenagers is now restricted. The Finnish study suggests that failing to offer adolescents with psychiatric problems appropriate therapeutic care, while instead opening the option of irreversible medical transition, risks leaving underlying conditions untreated.