A pioneer of 'gender-affirming care' has spoken out against the practice
On Monday in the Free Press, Riittakerttu Kaltiala issued a warning to US gender clinicians: “Gender-affirming care is dangerous. I know because I helped pioneer it.”
Kaltiala serves as chief psychiatrist in the department of adolescent psychiatry at Tampere University in Finland, and is the head of one of the country’s two nationalised gender services for youth. In the Free Press piece, Kaltiala describes her disillusionment with a “gender-affirming” approach to gender-distressed youth, starting with her initial scepticism about “being told to intervene in healthy, functioning bodies simply on the basis of a young person’s shifting feelings about gender”.
Kaltiala noticed early on that her patients did not look or sound like those which other clinics claimed to have treated with such success. More troubled, her patients’ distress often started at puberty rather than early childhood. Starting around 2015, Kaltiala noticed a sudden, unexplained surge in adolescent girls seeking transition. These new patients delivered scripted responses, “telling the same life stories and the same anecdotes about their childhoods, including their sudden realisation that they were transgender”.
Eventually, detransitioners started showing up at the clinic, too: “These were another kind of patient who wasn’t supposed to exist,” Kaltiala notes. She goes on:
Kaltiala set about researching her questions and concerns. What she found helped lead Finland to change course on youth gender medicine, but she observed that “instead of acknowledging the problems we described, [the field] became more committed to expanding these treatments.”
These dynamics produced the sprawling medical scandal we see today. At the 2022 World Professional Association for Transgender Health conference, clinicians praised themselves and one another for overcoming their reservations and doubts about providing “gender-affirming care” to an ever-widening group of patients. Naturally, the doctors did not put their accomplishments in those terms. Instead, they spoke of “checking their cisgender privilege” and “following [their] patients’ lead”.
One plastic surgeon took the microphone to recount the first time a patient requested “gender nullification” surgery, which initially unsettled him. He wasn’t sure it was wise — or ethical — to fulfil the request. Having overcome his reservations, though, he now performs “lots” of these surgeries. One of his colleagues chirped, “I feel like we’re all just winging it and maybe we can wing it together,” before proposing Pinterest boards as a way to keep track of unconventional surgical desires.
Another doctor lamented the fact that patients may be “forced to choose between dissociative identity disorder and gender dysphoria”, since so many clinicians baulk at operating on patients whose “alters” disagree about which surgical interventions to pursue.
It’s hard to think of another field that has gone so obviously off the rails. To get here, clinicians and medical organisations had to discard everything they knew about medical ethics, child development and literature on desistance. The conference was a fortress, buttressed against all doubts and challenges. Within the walls of the conference centre, no serious questions were raised. I got the sense that clinicians had worked hard to lull something inside themselves to sleep and now feared waking it.
At the European Professional Association for Transgender Health conference in Ireland earlier this year, outgoing president Joz Motmans said, “We respect everyone’s freedom of speech, but we choose not to listen to it.” The packed auditorium broke into applause.
The speech these organisations “choose not to listen” to is speech like Kaltiala’s, who comes bearing clear evidence of medical harm, regret, and detransition. “Medical organisations are supposed to transcend politics in favour of upholding standards that protect patients,” she writes. “However, in the US these groups […] have been actively hostile to the message my colleagues and I are urging.”
Kaltiala’s personal story is a remarkable one. It’s never easy to admit that one has taken a wrong turn, even without facing harassment and threats from trans activists for doing so. In the United States, the embattled mentality of gender clinicians and the ideological capture of medical professional associations makes it unlikely such a reckoning will come from the inside. But warnings and revelations from across the ocean may yet wash up on their shores.