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Dr. Riittakerttu Kaltiala (Kaltiala-Heino)

Profile

  • Chief psychiatrist at Tampere University Hospital Department of Adolescent Psychiatry in Finland
  • Kaltiala’s CV (as of 22 Sep 2022)

2018

  • Kaltiala coauthored the article When gender is a problem for a young person [via Google Translate] (Kaltiala-Heino, Työläjärvi & Suomalainen, 2018).
  • November 1: Kaltiala’s experiences are described in an article by UK conversion therapist Robert Withers, posted by Timetodream (presumably Lisa Marchiano) on PAGDWG/gdworkinggroup.org.

Unfortunately, this reluctance to address psychological factors proved to be a feature of the conference. There was not a single talk on the role of psychological factors in the aetiology of gender dysphoria or gender identity. But Professor Riittakerttu Kaltiala-Heino, an adolescent psychiatrist from Tampere Finland, did acknowledged the importance of a psychodynamic perspective. She spoke about her clinical experiences- including her work with ‘adolescent onset gender dysphoria’, sometimes known as ‘Rapid Onset Gender Dysphoria (ROGD)’. She made several important points, observing for instance that in Finland, as elsewhere, psychological co-morbidities remain largely untreated because psychotherapists wrongly believe that only gender identity specialists should treat GD patients. In her experience, such co-morbidities are likely to persist if they are not addressed psychologically before medical treatment. Interestingly she also mentioned that several of her patients seemed to share an identity. Many of the young FtMs in her care claimed to have spent large parts of their childhood alone in the woods fantasising about being a male wolf for instance. She acknowledged privately that this was probably due to social contagion via the internet as people were encouraged to provide the sort of history that would facilitate their medical transition.

2019

However, Kaltiala et al. note that these youth were first diagnosed at a average age of 18.1 years (range 15.2-19.9) and all presented once the window for use of puberty blockers had passed, meaning all had experienced a gender-incongruent natal puberty. The authors cite this as a likely reason for the lack of change seen in the proportion showing good psychological functioning before and after treatment with hormone therapy

2020

One of the contributors, Professor Kaltiala-Heino (2018), a psychiatrist from Finland, spoke about something she called ‘shared identity’. In the gender clinic where she works, she noticed numerous young people shared identical accounts of their childhood. Several of the biological females she assessed, for instance, claimed to have spent significant portions of their childhood wandering alone in the forest imagining they were male wolves. When I asked her about the significance of this, she said that she thought it was probably the result of online coaching. Helpful trans-allies were able to point out the kind of childhoods these self-diagnosed trans-adolescents required to qualify for the medical treatment they had already decided they needed.

In a ground-breaking paper, Lisa Littman (2018) described, via parent report, a potentially new gender dysphoria presentation, referred to as ‘rapid onset gender dysphoria (ROGD)’. Trans-activists seem to be threatened by the paper and attempted to discredit it (Wadman 2018). But I have certainly seen cases where gender dysphoria has occurred suddenly around puberty as well as other cases where its onset has appeared more gradually and was long-standing. Other clinicians, including Kaltiala-Heino, agree. For her, a biological female’s genuine childhood history of playing in the woods as a lone male wolf, would indicate a long-standing GD and therefore be more likely to qualify the patient for medical treatment than an adolescent rapid onset case. Some fictional histories are clearly just that. But less obvious online coaching can make effective psychological assessment virtually impossible.

2021

We thank Richard Wakeford and Leena Järveläinen (information specialists, British Library and Turku University Library), Gillian Claire Evans (German translations), Sarah Peitzmeier, Sam Winter, Christina Richards and Riittakerttu Kaltiala (opinion leaders), Paul Seed (statistician), researchers who shared copies of their papers, the UK stakeholders who participated in the prioritisation exercise and the peer reviewers whose feedback improved the work.

  • September 26: Kaltiala authored a document opposing gender marker changes for youth under 18.

2022

Anyone under 18 should not be prescribed puberty blockers or hormone therapy.

3 . Summary of Finland’s New Policy Change (Dr. Kaltiala, Finland)

For Finland’s National Guidelines, a systematic review of evidence in transition care was performed to review evidence related to mental health outcomes in children and adolescents treated for gender dysphoria. The scientific evidence for medical or surgical interventions for child and adolescent gender dysphoria is of very low quality ,if not totally lacking. Particularly it has not been shown that medical gender reassignment during adolescent years would improve mental health, decrease psychiatric morbidity, or improve psychosocial functioning. Actually, Finland’s research shows that mental health of a considerable share of patients treated with “gender-affirming” care with hormones worsens.

Evidence for medical treatment of childhood onset gender dysphoria is questionable, but no studies that can advise about the natural course and optimal treatments of adolescent onset gender dysphoria, which is exactly the big issue nowadays. Huge numbers of adolescents have recently started to question their gender, and we have no knowledge of the natural course of such personal crisis, nor the outcomes of any treatment.

In adolescence, identity consolidation, personality development, and decision-making competency are still in the making. Most of the adolescents seeking for gender reassignment present with severe psychiatric disorders that further delay their identity consolidation, personality development and competence.

Because of this, the national guidelines in Finland are relatively conservative. After the onset of puberty, the first line intervention is psychosocial intervention promoting identity exploration, and if necessary, appropriate treatment of comorbid psychiatric disorders into remission.

If after this, considering medical gender reassignment interventions is warranted, a thorough assessment by the nationally centralized multidisciplinary gender identity teams is carried out. This comprises excluding severe psychiatric disorders and urgent child welfare needs that may complicate identity development; assessment of identity development as a whole; and helping the young person and their family to prepare for the medical transition, if appropriate.

If medical transition appears appropriate, hormonal interventions can be initiated during adolescent years, but we do not allow for surgical treatments for those under the age of 18.

Because of lack of evidence and accumulating negative clinical observations, it is of outmost importance that treatment decisions are based on careful assessment and made case by case. In Finland, we do not consider saying “no” to a teenager who eagerly wishes to receive hormones to be discrimination. We consider it prudent medical care to assess each case individually. For a considerable number of young people, we will recommend delaying hormonal interventions until their identity stabilizes, which for a number of patients does not happen for several years after reaching the legal age.

2023

According to her, it has been known for a long time that some children identify strongly with the other gender at some point.

However, four out of five children who identify with the opposite sex feel differently in adolescence.

That’s why it’s wise to monitor the situation, give the child peace of mind and treat the family’s anxiety and possible related problems, says Kaltiala.

 

The important thing is to accept the child as himself, says Kaltiala.

“Acceptance is saying that you are a boy who feels like you are a girl. It’s okay and you can be who you are and let’s see what happens when you grow up.”

On the other hand, the child is not accepted whole if his experience or physical body is denied . If we are told to do as a boy should, we deny the experience. If it is said that you are actually a girl, the body is denied, explains Kaltiala.

In both cases, the child gets the message that there is something wrong with him, says Kaltiala.

Also, according to him, changing the legal gender marking in youth is not a formality in which a fact is stated, but a strong psychological and social intervention that guides the youth’s development.

“It’s a message in the direction that this is the right path for you.”

 

A young person can be unconditional and sure of their own trans identity. In adolescence, identity is still fragmented and situational, says Kaltiala.

“The young person tries out different identities and is prone to suggestion. In one situation he feels he is one and in another another. It’s normal in adolescence.”

He reminds us that young people have always expressed different identities and belonging to a group through, for example, clothing, hairstyles and language.

If they want to use the signs of the other gender, there is no reason to restrain it, but it is not to be confirmed either.

“Youth development tasks are not promoted by supporting and directing the youth’s self-expression from the outside,” says Kaltiala.

The environment should also not commit to identity experiments in a way that might make a later change of direction oppressive.

 

Kaltiala says that psychiatric and developmental problems, learning difficulties and situations requiring child protection measures must be handled regardless of the experience of the young gender.

However, many young people cling to the idea offered in the media and social media that their other problems also stem from a gender discrepancy and will be solved if others start seeing them in the right gender. However, that is not the case, says Kaltiala.

“The balance of the mind does not come from making others do and see what you want.”

 

In youth gender identity research units, it has often been observed that a small town has suddenly received a disproportionate number of referrals compared to the population.

Research has shown that all patients are from the same school or even from the same circle of friends.

“Especially for girls, sharing things with a circle of friends is really important,” says Kaltiala. According to her, it is common for psychiatric symptoms to spread among girls in the same hospital ward.

 

Activists and organizations that demand hormone treatments and legal gender confirmation for minors, such as Seta, often repeat that trans youth have an increased risk of suicide and therefore urgently need treatment and support.

“It is purposeful disinformation that is irresponsible to spread,” says Kaltiala.

 

Kaltiala is silent for a moment when she is asked who emphasizes the suicide of young people and why.

“I would kindly like to think that adults who themselves have received help with gender reassignment have wanted to go and save children and young people. But they lack the understanding that a child is not a small adult.”

Unknown time

  • 2022 or earlier: Kaltiala worked with Dr. Patrick K. Hunter in Finland, as described in Hunter’s 2 May 2022 expert declaration in Eknes-Tucker v. Ivey.

17 . My research has given me the opportunity to work with experts in the field of gender medicine from all over the world, including Sweden, Finland, England, Australia, Canada, and the United States. I have lectured with Dr. Rittakerttu Kaltiala, a child and adolescent psychiatrist and a leading world expert in transgender care for youth. Dr. Kaltiala was instrumental in recently changing Finland’s national transgender practice guidelines, when they recognized the harms being done to youth.

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Last updated on 22 Mar 2023 by Zinnia Jones