Riittakerttu Kaltiala, M.D., Ph.D., BSc, is a professor of adolescent psychiatry in Tampere University and chief psychiatrist in the Department of Adolescent Psychiatry at Tampere University Hospital. She is a specialist in psychiatry, adolescent psychiatry, and forensic psychiatry. She has been clinically involved in carrying out research on adolescent gender identity issues since 2011 when one of the two nationally centralized gender identity services for minors was opened in Finland, in Tampere University Hospital. She has been actively involved in service development, continuing education, and scientific writing and collaboration nationally and internationally, and in her home country she has been invited as a member of major national initiatives related to transgender treatment guidelines and legislation. She has published numerous scientific articles on adolescent mental health epidemiology, psychiatric health services research, and clinical adolescent psychiatry.
Riitta tells us about the shift around 2010 in Finland in which health policymakers, politicians, activists, and human rights groups pushed for the inclusion of adolescent and child services for gender transition. The adolescent psychiatrists scrambled to accommodate these new demands but recognized that identity consolidation is known to take more time and they had concerns about such early interventions. Nevertheless, they began developing a program for childhood gender services based on the literature in other countries such as the UK and Netherlands. They were astonished and quite confused when the populations arriving at their services reflected a very different demographic in age, sex, and presentation of other comorbid psychiatric issues. They saw a shift again around 2015 which continued to confound the clinicians. Riitta tells us about reading the Littman ROGD research which accurately documented what she and colleagues were seeing. Dr. Kaltiala also tells us that predictions of improvement and symptom reduction reflected in the Dutch literature were not observed in their work, and describes how Finland has moved towards prioritizing psychological care and meeting all the needs of young patients who present with GD, rather than focusing only on the gender transition requests.
Links:
Dr Kaltiala’s Website:
Adolescent GD Current Perspectives:
Ncbi.nlm.nih.gov/pmc/articles/PMC5841333
Lisa Marchiano — Outbreak:
Tandfonline.com/doi/full/10.1080/00332925.2017.1350804
GD and ASD: A Narrative Review
Pubmed.ncbi.nlm.nih.gov/26753812
Extended Notes
Riitta talks about how she got into psychiatry and got to work in this field.
When did Riitta first come across gender identity? She shares the backstory.
Riitta talks about how it was decided in Finland in 2009 that children and adolescents also needed gender medical intervention. What was the motivation behind this?
It is during adolescence that young people seek and experiment with their identity. However, it is normal for them to change or evolve in 2‒3 years. It is part of the process of stabilizing their identity.
It’s hard to expect in adolescent psychiatry during the early phases of adolescent development that the person would already be ready with any aspect of identity.
In the beginning, most of society did not have an idea about gender identity issues so it was not discussed much, including in the medical field as only a small group had started to study it.
Riitta shares the unexpected phenomena she experienced about puberty blockers of gender identity when she first learned about it.
Social media and peer discussions usually precede gender distress cases in the U.S. and UK. Riitta shares what data they collected in this case for Finland.
People who came to their services had severe psychiatric problems and history and were suffering from mental disorders. This was one of the issues that inspired Riitta to further her research.
In the first years, professionals such as teachers, child welfare, psychiatrists, etc., who were around the young person when they started to express their gender dysphoria, felt insecure and uncertain about their competence on how to help them.
As contact with peers is very important for healthy adolescents, they have observed a lot of young people who displayed non-confirming gender behaviors isolated themselves as they were discriminated against and bullied.
What was the follow-up like from these services back in 2011? Where are those adolescents now and how are they doing?
Despite the changes hormonal treatments were producing being satisfying for the adolescent, they did little to relieve other psychiatric symptoms. Simply changing gender will not resolve all these problems.
Although a lot of professionals have failed helplessly in the past; this has completely changed in Finland. People working with adolescents nowadays are more well-equipped and competent.
What does Riitta think about the concept of Rapid Onset Gender Dysphoria?
Riitta shares that peer influence is valid as it is natural for adolescents to be susceptible to their peer groups. Similar to kids confirming their ideals in music and other interests, it can also happen with gender identity.
What was their approach to the population change in 2015 where the proportion of gender dysphoric girls was higher than boys?
They are not really doing identity work if after only short consideration the young person results that the only solution is to do physical treatments. There is a risk from escaping that and quickly holding on to a certain conclusion.
It’s good that young people are able to express themselves however they feel but making medical interventions for a healthy body must have a stronger consideration.
Riitta talks about how highly autistic children may lack the flexibility to deal with ambiguity as they tend to obsess and fixate on things. Is it playing a big role in their gender dysphoria?
Due to gender politics, was there an impact in Finland with their approach on how to address gender dysphoria?
The issue of pronouns is a non-issue in the Finnish language.
Riitta also talks about the heavy regulation of gender identity services in Finland and its effects.
With the recent changes in their legislations, were there activist groups that opposed the slowing down and prioritization of the psychological approach in Finland?
For young people still in their developmental years with all the external influences that surround them, it is important that there is identity work and exploration.
Riitta shares her advice to parents of gender-questioning children and her thoughts about the growing population of teens and adults who are detransitioning to close today’s episode.
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62 - Pioneers Series: Adolescent Identity with Riittakerttu Kaltiala