Gender treatment doesn't cut mental distress - and can make it worse, landmark study shows

Lucy Johnston
Fri, 10 Apr 2026 18:50:07 +0000

Trans youngsters who undergo gender reassignment are more mentally distressed afterwards than before, a landmark study has found.

A major 25-year study of youngsters with gender distress found those who went on to receive medical gender treatment - including hormones or surgery - saw sharp rises in mental health problems.

It found those most affected were youngsters transitioning from male to female who saw their need for specialist mental health care soar from 9.8 per cent before treatment to 60.7 per cent afterwards.

Those transitioning from female to male also experienced a steep increase - from 21.6 per cent to 54.5 per cent.

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The research calls into question why controversial medical and surgical treatments are being offered to gender distressed adolescents, as it suggests they do not improve mental health and may, in some cases, make it worse.

The findings are likely to fuel the fierce and ongoing row over youth gender medicine in Britain, which has divided experts, politicians and families.

The study, published in the Finnish journal, Acta Paediatrica, goes to the heart of the debate - whether gender medicine improves young people’s mental health, or does more harm than good.

The study, one of the most comprehensive of its kind, followed up every adolescent referred to gender clinics in Finland from 1996-2010 and involved 2,083 youngsters up to age 23 who were followed for an average of five years but in some cases as long as 25 years.

Almost four in ten (38.2 per cent) went on to have medical interventions such as cross-sex hormones or surgery.

Even after taking previous mental illness into account, this group remained far more likely to need mental health care than their peers - up to five times more likely in some cases.

The researchers concluded: “Psychiatric needs do not subside after medical gender reassignment,” and added treatment may even have “a negative impact”.

The study found the same overall pattern when looking at all young people referred to gender clinics - even if they did not go on to have treatment.

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Across this wider group, mental health problems were already high before any intervention and increased further over time.

Around four in ten (45.7 per cent) had serious psychiatric problems before referral, rising to more than six in ten (61.7 per cent) at least two years later.

Researchers compared the group referred to clinics for gender distress to 18,000 under-23s who had not been referred.

No similar increase in mental health problems was seen among this group. Among this group, only around 15 per cent needed specialist psychiatric care over the same period - far lower than the rates seen in those experiencing gender distress.

The findings are likely to fuel the fierce and ongoing row over youth gender medicine in Britain.

Health Secretary Wes Streeting is already under pressure to overhaul services following the landmark Cass Review, which raised concerns about the lack of strong evidence behind treatments such as puberty blockers.

Ministers are also facing calls to rethink a proposed clinical trial into gender treatments for children amid growing concerns over safety and long-term outcomes.

The issue has also been fought out in courts - including the case of de-transitioner Keira Bell, 28, whose high court case exposed serious concerns on how children were being treated after she argued she had been too young to give informed consent.

The study shows that young people, many of whom were struggling before being treated in a gender clinic, continued to struggle afterwards.

The researchers stressed that mental health conditions must be properly treated regardless of gender identity, adding: “Psychiatric disorders require their due treatment regardless of a young person's gender identity.”

Dr Louise Irvine from the Clinical Advisory Network on Sex and Gender said: “This research is unique due to its comprehensiveness and long-term follow-up.

“The research calls into question why medical and surgical treatments are being offered to gender distressed adolescents, as they do not improve mental health and may, in some cases, make it worse.

“Alternative treatments that address the mental health issues experienced by adolescents with gender related distress are needed both at the time of referral to clinics but also in the long term.

“That is where the focus of care should be, rather than medical and surgical intervention.”

Professor Carl Heneghan, Director of Oxford University's Centre of Evidence Based Medicine said: “This study highlights the significant unrecognised burden of mental health problems among trans youngsters.

“Radical interventions such as puberty blockers, cross sex hormones and surgery which can have irreversible and unwanted side effects are not a silver bullet to prevent these debilitating mental health problems.

“It is therefore vital other conditions are ruled out before any clinician would consider such treatments.”

He added: “The lack of long term data in this area is very worrying and the Government must set up a register to ensure anyone who has undergone gender treatment is part of that registry and followed up.”

Cross sex hormones have been linked to adverse effects such as bone loss, infertility, sexual disfunction, heart problems, strokes, blood clots, stroke, and breast cancer. Gender surgery is irreversible.