You Must Be Some Kind of Therapist

210. Finnish Study
===

Stephanie: [00:00:00] If you spend years engaged in an obsessive compulsive mental state, you're not taking care of yourself. You're not cultivating an internal locus of control. You believe that your wellbeing is in the hands of others. You believe you need to be qualified to get this medical procedure. You need other people to call you, sir, or to call you, ma'am.

I mean, there's so much unhealthy thinking just. Baked into the transgender ideology. These are youth who have already been practicing some really bad mental hygiene habits, and unfortunately, being denied services isn't necessarily just going to be that wake up call for all of them. That I can be happy now.

I can find a way to get comfortable in my own skin. I can do things that are good for me even if I never got the thing that I think I wanted. There's a fundamental problem with how they're. Thinking in the first place. That makes it difficult to adapt. That positive mentality where, what can I do today to make my life just 1% better?

You must be some kind of therapist[00:01:00]

for today's episode. I am bringing you something different. There's been a lot of talk on the gender critical side of the internet about this new finished study. Showing worsening psychiatric outcomes for youth who went through gender transition services. No big surprise to anyone who's been following the evidence or using common sense for any period of time.

A lot of people more qualified to comment, uh, than someone like me who's not a medical doctor, have already done so, and I'm thankful for all the work that they're putting into researching and speaking about this. That being said, I did analyze the study and I started working on something when it first came out, only to be kind of paused and derailed by more urgent projects.

However, there's a lot of work that I put into illuminating some aspects of this finished study that you might not know about. Um, and also putting my own kind of [00:02:00] spin on things because where I specialize is the psychological aspect of things and there's. Couple interesting points I wanted to make, uh, not just on what the study says, but what I would speculate that certain things might mean.

So what I'm going to do for this episode is I'm going to go to where I left the article sitting in my drafts, uh, which I haven't opened for about a week and a half as of recording date. I was really focused on this project and then I had to switch gears and do something else before I could finish writing this article.

So I'm gonna revisit what I was working on and then I'm going to read it to you. And just interrupt myself as I go. If there's something that I want to clarify or. Anything like that, it's gonna be a little bit of a risk because again, the essay's just a draft. There might be some unpolished pieces, maybe some redundancy.

Um, I did use AI in writing this article, but not in a lazy [00:03:00] way. It was more like I used AI back and forth through an iterative process to help me break down and analyze different pieces just to make sure I was really understanding things. And so. There's a lot of different sections of this article, each one reflecting something I was working on understanding about that study, what it means, what it doesn't mean, what we know, what we don't know.

And again, I'm going to ask you to go ahead and give this a listen. Um, even if you've already read some takes on that finished study, because I have a perspective on a few parts that I'm not sure is being addressed anywhere else. All right, so I'm just going to read this to you and then I'll interrupt myself when I feel like it.

All right. Summary of key findings from a recent finished study. This study followed 2083 adolescents and young adults under 23 at outset, who sought gender identity assessments at Finnish gender clinics between [00:04:00] 1996 and 2019. Comparing them to 16,643 aged matched population controls through June, 2022, because Finland centralizes gender identity assessments to just two university hospitals.

This is a rare, truly nationally representative dataset. The mean age of participants at first contact was 18 and a half, but the age of the youngest is not known. About the controls. Each participant was matched with four male and four female age matched controls. Note the eight to one ratio in the numbers I presented earlier.

This is significant because females who identified as males were not compared exclusively to females or exclusively to males and vice versa. So in other words, there's no way to say, oh, they used the wrong controls 'cause they used people of the same sex or the opposite sex or anything. It's like, no.

Every single participant in this [00:05:00] study had four same sex and four opposite sex controls that they were matched to. Timeline follow-up began at each participant's first appointment at the gender identity clinic. And ended either at death or June, 2022 when the dataset was compiled. So those who were seen earlier in the study period closer to 1996 had much longer follow-up than those seen more recently.

Therefore, while mean and medium follow-up times were both around five years, maximum was 25 years. Notably, mortality data was not discussed. So what I mean by that is that earlier it says, you know, they stopped following them if they died, but we don't know much about the people who died, how the gender referred group is defined.

The study's gender referred group consists of anyone who attended a first appointment at one of Finland's two nationally centralized gender identity clinics before the age of 23. [00:06:00] At any point between 1996 and 2019, that first appointment serves as the index state. The starting point from which all follow-up measurement begins.

The inclusion criterion is in essence showing up once notably absent from this definition is any requirement for a formal gender dysphoria diagnosis, a minimum number of clinic visits, completion of the assessment process, or an expressed desire for medical intervention. A single appointment was sufficient for inclusion.

So what that means is they tracked everyone, whoever showed up at one of their two, one of the country's two gender identity clinics. What this definition captures well, because Finland routes all gender identity assessments through just two university hospitals, that first appointment represents a meaningful and [00:07:00] administratively consistent threshold across the entire country.

The full three decades study period. This is a strength. It means the gender referred group is comprehensive and unlikely to be systematically skewed by referral patterns at individual clinics or regional variation. In practice where the definition introduces ambiguity, the single appointment threshold means that the gender referred group almost certainly contains individuals at very different points along the clinical spectrum.

It includes those who went on to complete full assessment and pursue medical intervention, but it also includes those who attended once and never returned, whether because they decided gender services were not relevant to their situation because a clinician determined further assessment was not warranted because their concerns resolved, or for reasons the data cannot capture.

All of these individuals are [00:08:00] counted equally in the gender referred group, and their subsequent psychiatric outcomes contribute equally to the findings. This is not a flaw unique to this study. It reflects the inherent challenge of using administrative registry data, which records contacts rather than clinical trajectories, but it is worth bearing in mind when interpreting the psychiatric morbidity features.

The 45.7% pre-referral psychiatric treatment rate for incidents represents the full spectrum of everyone who ever walked through the door of a gender clinic in Finland during that time period. Not only those who were ultimately diagnosed with gender dysphoria or who pursued so-called treatment practical implications for how the study should be cited.

Readers and clinicians should be careful not to conflate. Gender referred with, diagnosed with gender dysphoria or actively pursuing [00:09:00] gender reassignment. The gender referred group is broader than either of those categories. This does not diminish the study's findings, which remain striking even under a conservative interpretation, but it does mean that claims about the psychiatric burden of gender dysphoria specifically as opposed to gender clinic attendees broadly.

Should be made with appropriate precision how psychiatric care is defined. The study specifically tracked contacts with specialist level psychiatric services drawn from Finland's Mandatory National Health Registry. This is a high bar in Finland specialist Psychiatric care is only accessible via accepted referral.

Indicates severe mental disorder, not everyday anxiety or garden variety. Depression, primary care visits, generalist therapy and [00:10:00] psychiatric medication alone did not count. The finished school system also routinely screens all students for mental health concerns, reducing the likelihood that problems went undetected in either group.

This means the findings almost certainly underestimate the full psychiatric burden. Subclinical distress therapy with non-specialist counselors and undiagnosed struggles wouldn't appear in these numbers at all. Furthermore, it's worth noting that the psychiatric morbidity outcomes were defined as treatment needs occurring two or more years after the initial referral.

The study allowed some runway for medical interventions to take effect before measuring outcomes. The finding that psychiatric needs increased rather than stabilized or declined is therefore harder to dismiss, is simply reflecting the adjustment period around treatment. If this finding reveals anything, it's where these youth end up after the honeymoon phase is [00:11:00] over.

How medical gender reassignment is defined in this study and what that means for interpreting the data. This study defines medical gender reassignment as having undergone one or more of the following, masculinizing or feminizing hormone treatment, chest masculinization, mastectomy, or genital surgery, vaginoplasty, foip plasty, or maop plasty by this definition.

38.2% of the gender referred group, which is 796 out of 2083, individuals were classified as having undergone medical gender reassignment. Okay, so let's break that down one more time. We're talking about testosterone estrogen, which is usually used in commonly. Combination with an androgen blocker such as spironolactone sometimes used with something like progesterone.

So that's the, you know, testosterone is what they call masculinizing treatment, uh, [00:12:00] estrogen with spironolactone, progesterone, whatever combination. That's what they mean by feminizing treatment. I don't like the word treatment, but you know, it's like the technical term. Um, chest masculinization. Okay, that's a radical elective.

Double mastectomy. You have to decode these things, right? But you're gonna find out more about what's not included in this category as we keep going. So at first, that number, that 38.2% number appears hopeful as it would seem to indicate that six out of 10 patients. Presenting with gender issues did not proceed with medicalization, but we will get into some nuances later that muddle the picture a bit.

For now, let me caution you not to succumb to the temptation to interpret this as over 60% of youth with gender dysphoria desisted. That's not exactly what the data says, how each type was tracked. Hormonal treatment was identified through Finland's National Prescription Registry, specifically by the purchase of Masculinizing or feminizing [00:13:00] hormones under a special reimbursement code.

This code is only available to individuals who have been diagnosed with F 64.0, the ICD 10 code for transsexualism at one of Finland's two nationally centralized gender clinics, and only after hormone use has continued for at least one year. Surgical gender reassignment was tracked through the care register for healthcare, which documents all specialist healthcare visits, including procedures.

What this definition captures well. Because Finland centralizes gender identity assessment to just two university hospitals, and because the reimbursement code system creates a clear administrative trail, the study captures medicalization through official channels with a high degree of completeness for the time period studied this, likely represented the large majority of gender related medical treatment among Finnish youth.

What this definition may miss several categories of medical intervention would not be captured by this methodology. Readers should bear these in mind when interpreting the [00:14:00] 38.2% figure. Okay, so this is what I mentioned earlier, right? Here's what is not counted. So short-term or discontinued hormone use, the one year threshold for the reimbursement code means that adolescents who began hormone treatment but discontinued before reaching the one year mark for any reason would not be counted.

As having undergone hormonal gender reassignment, their experiences and outcomes are absorbed into the non-gender reassignment group without distinction. Okay. Does that make sense? So out of the 62% of people who were considered to have not medicalized, some of them might have been on hormones short term.

Also not included hormones obtained outside the official system. The reimbursement code requirement means only individuals who went through the centralized clinical pathway are counted. Anyone who obtained masculinizing or feminizing hormones through other means, private prescriptions, online sources, or care obtained abroad would not appear in the hormonal gender reassignment category [00:15:00] regardless of how long they used them or what effects they experienced.

That being said. Outside of system access in Finland was considerably more limited than it would be in the United States. Finland's healthcare is highly centralized. Telehealth hormone providers like gender GP faced significant regulatory barriers to serving Finnish patients and could not ship medication directly to Finland.

Private gender related care was expensive and rare. And obtaining hormones through unofficial channels required either illegal sourcing or international travel. The result is that the Finn Registry almost certainly captured the large majority of hormone use in this population, making it a far more complete dataset than would be possible in the American context, where informal access through informed consent clinics, online prescribers, and Planned Parenthood locations.

Is widespread, geographically fragmented and largely [00:16:00] untracked. Also not included in this definition of medical, gender, reassignment, puberty lockers. The study does not appear to separately track the use of GNRH analogs, puberty blockers, such as Lupron, which are often the first medical intervention offered to younger adolescents.

Whether puberty blocker use was captured under another category or excluded entirely is not addressed. Meaning an early phase of medicalization may be invisible in the data again, in that 38.2% figure. And finally, another medical category not counted in this study as medical gender reassignment is non genital feminizing surgeries.

So this surgery. Category captures genital surgeries and radical double mastectomies, but does not appear to include other surgical interventions sometimes pursued by males such as facial feminization surgery or breast implants, or tracheal shave, which would typically occur outside of the centralized hospital [00:17:00] system.

Why this matters? The practical effect of these gaps is that the study's gender reassignment and non-gender reassignment groups are not as cleanly distinct as they might appear. Some individuals classified as non-gender reassignment may have undergone medical intervention that wasn't captured, such as puberty blockers, not followed by hormones, hormones taking for less than a year or facial feminization surgery, findings about psychiatric outcomes in the GR plus group, the gender reassignment group.

Should be understood in that context. All right, now for the key findings, what you've all been waiting for, high preexisting psychiatric burden. Nearly half of gender referred adolescents 45.7% had already required specialist psychiatric care before their first gender clinic visit compared to 15% of controls, a threefold difference.

The psychiatric treatment these youth received also had typically been more intensive. Suggesting longstanding or severe [00:18:00] symptoms, not ri mild or recent onset. Again, so to recap, specialist psychiatric care means a very particular thing in Finland, as we discussed. Almost half of the kids who showed up even once.

To any gender clinic had seen this kind of specialist before they walked through the door. So these are high distress kids to begin with compared to 15% of age matched controls. Next psychiatric needs don't improve. After medical invention intervention, who would've thought two or more years after their initial referral?

61.7% of gender referred adolescents needed specialist psychiatric care up from that 45.7% figure before referral. Controls held essentially steady at 14.6%. Medical gender reassignment did not reduce this burden. Also, the post 2010 surge brought more vulnerable youth among youth referred. After 2010, the rate [00:19:00] of prior psychiatric treatment had doubled compared to earlier cohorts.

No similar trend appeared in the general population suggesting this isn't simply a reflection of broader youth mental health trends or improved detection. It reflects a change in who is being referred. Elevated risk persisted even after controlling. For prior psychiatric history, after accounting for preexisting psychiatric treatment, birth year and index year, all gender referred adolescents still had hazard ratios.

Roughly three times higher than female controls and five times higher than male controls for subsequent psychiatric treatment needs. Regardless of whether they underwent medical intervention or not, those who underwent medical reassignment showed the sharpest increases among males who pursued feminizing reassignment.

Psychiatric morbidity rose from 9.8% before referral to 60.7% afterward. So from less [00:20:00] than 10 to over 66 0% among females who pursued Masculinizing reassignment, it rose from 21.6 to 54.5. But we're gonna get into some caveats on those numbers in a little bit. So keep listening. The authors note that estrogen has known associations with depressive symptoms, which may partly explain the feminizing group's trajectory, but psychiatric needs increased markedly in the Masculinizing group as well.

The next section explains some important context in forming those last two points, psychiatric outcomes after medical intervention, what the data show and why context is essential. Before examining how the medicalizing and non medicalizing groups fared psychiatrically. It is essential to understand something about how Finland's gender clinics operated during this study period, because it changes how the numbers should be read.

In Finland, severe psychiatric illness was treated as a clinical contraindication for proceeding with medical [00:21:00] gender reassignment. In other words, adolescents who were already struggling significantly with mental health were less likely to be approved for hormones or surgery. Assessment was centralized gate kept and intended to screen out those for whom medical intervention was deemed inappropriate or premature.

This stands in sharp contrast to the so-called informed consent model that has become increasingly common in the United States and other Western English speaking countries. Which patients can access hormones often without extensive psychiatric evaluation simply by declaring their gender identity and consenting to treatment.

Under so-called informed consent, there is no formal psychiatric threshold that must be cleared before medicalization proceeds. Whether that consent is truly informed is a subject for another time. This distinction matters enormously for interpreting the finished data as it means. The two groups in this study, those who medicalized and those did, who [00:22:00] did not, were not randomly assigned, they were sorted, at least in part by psychiatric severity.

The sickest kids were disproportionately kept out of the medicalizing group. What the raw numbers show, with that context established here is what the data actually found. Among those who did not proceed to medical intervention, psychiatric treatment rates were already high before referral and remained high afterward.

Males seeking so-called feminizing treatment who did not medicalize, 53.1% had needed psychiatric care before referral, and 59.7% needed afterward for females seeking Masculinizing treatment. Who did not Medicalize? 65.0% before and 67.2% afterward. Among those who did proceed to medical intervention, the starting point looked very different, but the end point did not.

Those who went underwent feminizing [00:23:00] treatment. So males only 9.8% had needed psychiatric care before referral rising to 60.7. Afterward, a more than sixfold increase. Those who underwent Masculinizing medical treatment, so females. 21.6% before referral rising to 54.5% afterward roughly a 2.5 fold increase.

In other words, in this finished study, the Medicalizing Group started out as the psychiatrically healthiest subset of gender referred youth for reasons we discussed earlier. This makes sense given that Finland was actively screening out those with severe mental illness. Again, this is different from what's happening in the United States, Canada, Australia, the uk, and all the other countries.

People contacted me for help from, and yet by follow up, these youth's, psychiatric treatment rates had risen dramatically to land at roughly the same level as the group that had been [00:24:00] considered too psychiatrically, unwell to medicalize in the first place. Why this is the more important finding. It would be tempting to look at the non medicalizing groups higher absolute numbers and conclude that those who didn't get treatment fared worse.

But that interpretation gets causality backwards. Those kids were sicker to begin with. The more meaningful observation is what happened to the group that cleared the psychiatric bar and proceeded with medical intervention. Their psychiatric needs increased sharply and converged toward the same elevated rates seen across the gender referred population.

Broadly, when the researchers ran statistical models that controlled for preexisting psychiatric history, essentially asking what happens when you mathematically level the playing field between the groups. The elevated risk of subsequent psychiatric treatment was similar across all gender referred adolescents.

Regardless of whether they had medicalized or not, all groups ended [00:25:00] up with psychiatric treatment needs roughly three times higher than the average girl their age and five times higher than the average boy their age. How we might interpret the data on gait kept patients the untested hypothesis.

Pausing to bring you a mini article within an article. What's my subtitle of this section? Okay, so here I'm gonna explain a little something. This is where I kind of interrupt my own data analysis, which I'm doing. You know, again, I'm not a doctor, I'm not a researcher. I'm feeding stuff into ai, asking questions, making sure that I understand what the study says, what we can meet, take from that, what we can't take from that.

That's how I wrote everything that came before. Now I'm taking a little break in the middle of all of that to say, let me talk about what is in my wheelhouse. Okay? So that's where we're about to go is a little bit more into the psychology, and this is where I'm speculating. This is not in the study. This is me speculating about what the study means.

I feel the need to stop and point out something here because [00:26:00] while most of this article has simply focused on breaking down the data every now and then the data points to a psychological phenomenon, I want to explain. This is where we enter what's truly my wheelhouse, as we've just discussed, patients who wanted to medicalize but were prevented from doing so by authorities who deemed their psychiatric comorbidities too severe and gender reassignment, thus contraindicated by finished standards.

Continued to remain psychiatrically distressed. Their levels of distress rose slightly, but not nearly as dramatically as those who began from a milder baseline proceeded to medicalize and then got significantly worse. None of this is surprising. Here's an important psychological consideration to bear in mind when thinking of this cohort.

They're trapped by what I often refer to as an untested hypothesis. A kid holds a belief. I feel terrible now, but it's because I'm trans. I'll feel better when I medicalize. I just need the system to cooperate. This [00:27:00] belief reflects an external locus of control. Their happiness is in the hands of others.

This kid has no way of knowing from personal experience whether or not their prediction is true. Think of it this way, as a mature adult, when you are grumpy, you might reasonably predict that you'll feel better after any of these things. A shower, a workout, a meal, A good night's sleep. A walk with your dog, a vent with your best friend.

A hug from your spouse. A weekend at the lake cabin, a hot cocoa. Why? Because you've reregulated yourself with each of these activities countless times. You know yourself and you know how to take care of yourself. You've been through these cycles before. Now, contrast that practical wisdom with the experience of an immature teenager or 20 something who's not done much self care for years.

They stay up until 2:00 AM on Reddit and Roblox. They forget to hydrate. Their [00:28:00] diet is garbage. The only exercise they get is from walking from one class to the next. All of their so-called friends are online. You get the picture. This isn't every trans kid, but it's a lot of them. This kid's parents regularly preach the virtues of a balanced lifestyle and try to get them involved in more constructive activities, but they've learned to pick their battles.

Here's the thing to keep in mind about this kid's mental state. They don't want to believe that the key to feeling less anxious and depressed could really be found in basic normy stuff like sleep hygiene, proper nutrition and gratitude journaling. If they could simply do all these things and be happier than their egosyntonic, gender distress might start to lose its grip.

This kid has really thought themselves into a trap. Through obsessive compulsive feedback loops, they've created a self-fulfilling prophecy. They believe so strongly that they will be miserable until they transition, [00:29:00] that they've made it practically true for all intents and purposes. And the solution the way out is an irreversible medical procedure performed by an active third party on a passive version of themselves who only needs to allow the.

Treatment to magically do the work on them. This is what I mean by the untested hypothesis. There's no real life feedback loop here. No real self-knowledge, self-care, self-agency, self-regulation. There's just a fantasy that something magical and beyond the individual's own doing the magical substance or procedure.

The external validation of strangers who give one the fleeting euphoria of passing will transform their inner experience. Even though our inner experience takes place in our brains, and that's not actually how our brains change. So what does all this have to do with the study? Well, I'm getting there, but I'm [00:30:00] glad I took this detour because I've been meaning to articulate this concept in the course for a while.

See the kids who are psychiatrically sicker at the outset and were thus barred by medical authorities from proceeding with medicalization due to how the finished system works. Never got to test out their hypothesis. They were blocked again by an external entity from proceeding down the path that they strongly believed would alleviate their distress.

And because by this point, they had spent years reinforcing their anxious and depressive mental states as evidence of being trans, reinforcing that ego, syntonic, mental illness and external locus of control. When the authorities said no, they simply felt worse. It reinforced the depressive, paranoid, hopeless, helpless worldview they'd spent years cultivating.

It remained someone else's fault that [00:31:00] they couldn't get better. Their locus of control remained external hitting that wall. No, you may not proceed. Didn't change their brains. It didn't serve as a light bulb moment. They didn't think thoughts like these. When one door closes, another opens. Rejection is God's protection.

I wasn't too sure about that path. Anyway, some part of me wanted out. Maybe this isn't meant for me. Maybe I'm not even trans. You know what? Maybe there's something I can do to improve my life and my mental health today, starting right where I am. Something that doesn't depend on any doctor or authority figure or on anyone to recognize me as the gender I wanna be seen as.

Maybe I can even be happy without being seen as my desired gender. Today is the day I start training for a marathon. Maybe I'll adopt a rescue dog. That's what they're not thinking. I don't know that this description I just gave is entirely factual. It certainly can't describe everyone in that cohort. I can't get [00:32:00] inside every single person's head, but this is an educated guess that I can offer based on my unique perspective on these kids.

And it probably at least describes some of them to some extent. And that's part of why it's so messed up that society went along with the madness in the first place. Your trans identified kid won't listen to reason, because reason isn't what they need right now. They need a parent who knows how to communicate in an empathic yet strategic manner.

Our OGD repair gives you over 120 lessons in the psychology and communication tools that actually work when normal parenting doesn't. Plus Repair bot. Your 24 7 AI coach trained on my entire body of work. Ready to help you navigate tough moments in real time. Visit rog d repair.com and use code some therapist 2026 to take half off your first month.

Back to the main thread and the study at hand, what this means for [00:33:00] American practice. This finding is particularly sobering when considered alongside the American, so-called informed consent model. Finland's medicalizing group represents young people who were carefully assessed, screened for psychiatric contraindications, and approved for so-called treatment through a rigorous centralized system.

Even under those conditions, medical intervention severely increased psychiatric distress. Under so-called informed consent practices, adolescents with active severe psychiatric illness, the very population Finland was specifically excluding may be proceeding directly to hormonal treatment without equivalent screening.

If the psychiatrically healthiest gender referred youth in Finland still showed sharply rising psychiatric needs after medical intervention. The question of what outcomes look like for a less screened population is one. American medicine has yet to adequately answer what this study does and does not tell us [00:34:00] about desistance.

The Finnish register study by Ska Etal 2026 is frequently cited as a large high quality data set on gender referred use, and it is, but has significant limitations when it comes to the question of desistence specifically. The study cannot tell us. The study reports that 61.8 of gender referred adolescents did not proceed to medical gender reassignment as defined.

However, this figure cannot be interpreted as a desistence rate. The non-medical group almost certainly contains several distinct populations whose outcomes the study cannot separate. So a lot of this we've been over already. Um, as you can tell, I was kind of like out of order in my process of putting all these pieces together.

So the groups not included. Our youth as we were just talking about, who were denied treatment due to severe psychiatric content indications. Um, youth who still in the assessment pipeline when the dataset closed, youth [00:35:00] who desisted or DET transitioned, that is who no longer identified as transgender or chose not to pursue medicalization after reflection.

And again, let me put another little asterisk on that, right? We're talking about that 62% group, so we know some of them desisted. And the ones who det transitioned, there would be Detransition who might, who were on hormones for less than a year, or who got hormones on the black market or who were on puberty blockers, but not hormones.

Um, 'cause earlier we talked about how if they were on hormones for more than a year, if they had a mastectomy or genital surgery, then they would be counted in that GR group. So the detransition in this study are people typically who are either on puberty blockers or in hormones for a short period of time, or who didn't do any of that, but had something like facial feminization or tracheal shave.

All right. Youth who pursued hormones outside the officialized system, which would not appear in the registry, and youth who began hormones, just like I was saying, okay, but discontinued before the one year threshold required for the special reimbursement code to be recorded. [00:36:00] So because the study cannot distinguish between these pathways, the 61.8% figure tells us only that the majority of referred youth did not complete medical intervention through official channels.

It tells us nothing reliable about how many of these youth ultimately identified as transgender. How many came to understand their distress differently over time, or how many would describe themselves as having de, what I would really like to know is what was the percent of kids who. Were held back because their psychiatric distress was too high.

What the study does suggest indirectly the dramatic increase in preexisting psychiatric morbidity among those referred after 2010 with rates doubling compared to earlier cohorts. Lends some indirect support to the clinical observation that the more recent referral population includes a meaningful proportion of adolescents whose gender distress may be secondary to other mental health challenges.

The authors themselves note this [00:37:00] possibility explicitly. If that is the case, a higher rate of non medicalization in the post 2010 cohort might partly reflect clinical gatekeeping, or it might reflect youth who, once their underlying mental health needs were addressed, no longer experienced or identified with gender dysphoria.

Again, the data cannot confirm this, but is consistent with it. This study is not a desistance study and should not be cited as one robust conclusions about desistance. Rates in this population would require longitudinal data tracking gender identity over time, not just treatment uptake, along with information about why individuals did or did not proceed with medicalization.

What the study does contribute powerfully is evidence that the psychiatric needs of gender referred youth are severe, persistent, and not resolved by medical intervention, but actually worsened by it, which is a clinically important finding in its own right, independent of the assistance question, what the authors conclude, what.

The authors are [00:38:00] careful but pointed. For some adolescents, gender dysphoria may be secondary to underlying mental health challenges, you think rather than the primary driver. The considerable psychiatric morbidity present before these youth ever contacted gender services and it's increase over time suggests that mental health struggles are not simply a product of gender distress waiting to be resolved by a transition.

Psychiatric needs must be thoroughly assessed and adequately treated before and after any irreversible medical transition. Well, that's okay. So that's the end of the draft of the article that I have so far. And of course, you know, of course, authors of scientific study are always so cautious in making meaning of their findings.

But of course. So just to recap the most significant findings, this is a very comprehensive data set in a country with a much different. System than ours, where the people who were the most mentally ill at outset were not [00:39:00] allowed to proceed with what they call medical gender reassignment. And so everyone ended up equally bad.

So the people who were prevented from going on with medical gender reassignment went from bad to worse. And the ones who were allowed to. Not everyone did, right? Not everyone who passed the psychiatric wellbeing threshold did choose to go on, but of those who did, they got much, much worse. And we know that this is essentially concretizing a temporary problem.

So I really felt like I wanted to fill in the missing piece with that sort of mini essay within an essay about the untested hypothesis, which is a concept I've been wanting to articulate for a while anyway in ROGD repair. So I'm glad I had an opportunity to do it here. Right? So we have a population. Of kids who [00:40:00] thought this was what they wanted and were able to go through with it because they passed the screening criteria and then they got worse.

They needed more intensive, specialized psychiatric care. Again, this is not routine depression and anxiety. This is not routine A DH ADHD meds prescribed by your gp. This is kids who needed an intensive level of services, so if they passed the screening criteria. Then they needed those services a lot more at the end.

And if they didn't pass those screening criteria, then their needs also went up a little bit. Right? And so again, that untested hypothesis part that I'm inserting is a possible explanation. That's just part of how I think about these things psychologically, right? That if you spend years, uh, engaged in an obsessive compulsive mental state, you're not taking care of yourself, you're not cultivating an internal locus of control.

You believe that your wellbeing is in the hands of others, you believe you need to be. You know, qualified to get this medical procedure and you, you [00:41:00] need other people to call you, sir, or to call you, ma'am. I mean, there's so much unhealthy thinking just baked into the transgender ideology that, oh, I need strangers to see me a certain way.

Like that's a recipe for disaster no matter who you are, right? So if you spend crucial developmental years building an unhealthy brain. Exercising neuroplasticity in a way that's not likely to lead to good long-term outcomes. You know, building that external locus of control, feeling like you can't move on with your life, you can't get comfortable in your body, you can't date, you can't find a personal style of.

Styling and grooming that makes you look good and feel good. You can't get in your body. You have to be dissociated. Why? Because all of it is evidence that you're trans. And if, if you take the time to get comfortable in your body now and accept that, okay, I wasn't approved for these services. I'm never gonna get the, the drugs and surgeries I wanted.

Maybe there's another way, [00:42:00] right? So, so I'm saying. Sorry, I'm having a difficult time completing sentences, but I'm saying these are youth who have already been practicing some really bad mental hygiene habits. Right. And unfortunately. Being denied services isn't necessarily just going to be that wake up call for all of them, that I can be happy now.

I can find a way to get comfortable in my own skin. I can do things that are good for me even if I never got the thing that I think I wanted. There's, there's a fundamental problem with how they're thinking in the first place that makes it difficult to adapt. That positive mentality where, what can I do today to make my life just 1% better?

It's the young people with the mentality of what can I do today to make my life a little bit better? What can I do to get comfortable where I am, even while working towards something bigger and better in the future? Those are the youth who are most likely to succeed mentally, physically, spiritually, financially.

Right? So. This is what is so psychologically abusive about the ideology in the first place, is that [00:43:00] it reinforces people's external locus of control. Their sense, their happiness lies in the hands of doctors and strangers and how they're perceived, and how they're called and things like that, which actively disincentivizes them, right?

Once they bought into this, oh, it's because I'm trans, then. Then they don't wanna get comfortable. It's like if someone took you to hotel. And said, you know, you can stay here, but it's not a safe or comfortable place, and really soon we're gonna help you move into this really glamorous apartment. Well, you wouldn't even unpack your bags, right?

If they told you this hotel is unsafe and filled with cockroaches and rowdy neighbors, you'd probably be hypervigilant. You wouldn't be sleeping very well. You wouldn't even unpack your toiletries, right? You'd have your bag packed to be ready to go. At any moment you're not settling and you're not making that hotel room comfortable.

Especially when you think that, well, pretty soon I'm moving in this glamorous apartment. It's gonna be safe, it's gonna be beautiful. That's where I'm really gonna unpack and settle in. I don't wanna even like begin to try to make myself at home here 'cause I need to be ready to leave at any moment. [00:44:00] The hotel room is the body, the apartment, the.

Is the fantasy body, the artificial self that they've constructed, right? This is what gender ideology does to people. It says, don't settle in, don't unpack, don't get comfortable here. We're gonna help you get to a better place. This is not the right place for you. You should not feel comfortable here. If you feel comfortable here, it's evidence.

You're not really trans, so don't get comfortable. You have to keep feeling uncomfortable here because that's evidence that you're really trans. You see the problem, the incentive structure is whack. So that's what's psychologically abusive about all this, and that's why sadly, it does not surprise me. The kids who were so-called denying treatment didn't get better, right?

'cause how were they being spoken to? What were the messages from society and from providers? That was my 2 cents that I wanted to insert into the conversation about the finished study. I hope this has been helpful. Thanks for listening. Thank you for listening to you Must Be some kind of therapist. If you enjoyed this episode, kindly take a moment to rate, review, share, or comment on it using your platform of choice.[00:45:00]

And of course. Please remember, podcasts are not therapy and I'm not your therapist. Special thanks to Joey Rero for this awesome theme song, half Awake and to Pods by Nick for production. For help navigating the impact of the gender craze on your family, be sure to check out my program for parents, ROGD, repair.

Any resource you heard mentioned on this show plus how to get in touch with me, can all be found in the notes and links below. Low rain or shine. I hope you will step outside to breathe the air today in the words of Max Airman. With all its sham, drudgery and broken dreams, it is still a beautiful [00:46:00] world.