ABSTRACT Aim To examine the prevalence of severe psychiatric morbidity among gender‐referred adolescents, focusing on gender differences and outcomes related to medical gender reassignment. Methods Finnish nationwide cohort of all under‐23‐year‐old gender‐referred individuals between 1996 and 2019 ( n = 2 083) and 16 643 matched controls. Cross‐tabulations with X 2 statistics and Cox regression were used to analyse the data. Results Gender‐referred adolescents showed significantly higher psychiatric morbidity than controls both before (45.7% vs. 15.0%) and ≥ 2 years after referral (61.7% vs. 14.6%). Those referred after 2010 had greater psychiatric needs than earlier cohorts, both before (47.9% vs. 15.3%) and ≥ 2 years after (61.3% vs. 14.2%) referral. Among adolescents who underwent medical gender reassignment, psychiatric morbidity increased markedly during follow‐up—rising from 9.8% to 60.7% in feminising gender reassignment and from 21.6% to 54.5% in masculinising gender reassignment. After adjusting for prior psychiatric treatment, all gender‐referred adolescents had similarly elevated risks of psychiatric morbidity, with hazard ratios approximately three times higher than female controls and five times higher than male controls. Conclusion Severe psychiatric morbidity is common among gender‐referred adolescents and appears to be more prevalent in those referred after the recent surge in referrals. Psychiatric needs do not subside after medical gender reassignment.
Ruuska et al. (2026) studied this question.