Abusive Practices And Conversion Therapy Ties: The Right Latches Onto Finnish Doctor Kaltiala

Finish Doctor Riittakerttu Kaltiala published an article in Bari Weiss' The Free Press, stating she helped "pioneer" trans care. The reality is more akin to a horror story for patients at her clinic.

On Monday, Bari Weiss' platform, “The Free Press,” published an article by Dr. Riitakerttu Kaltiala, the chief psychiatrist in the department of adolescent psychiatry at Finland’s Tampere University Hospital. Dr. Kaltiala claims to reveal the “truth” about gender-affirming care, contending that this truth is being “silenced” by esteemed organizations like the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychology. What she omits, however, are the troubling allegations of misconduct within her own gender clinic in Finland, her associations with conversion therapists and anti-trans entities, how those practices have found their way into her clinic, and her involvement in lobbying against trans care in the United States. Ultimately, the story’s title as well as its assertions are false: gender affirming care is not dangerous, and to many of her patients, the only thing she has pioneered is their suffering.

Dr. Kaltiala initiated her medical journey in forensic and adolescent psychiatry, ultimately ascending to the position of chief psychiatrist of adolescent psychiatry at the university hospital. In 2011, despite her prior research portfolio having little to nothing to do gender medicine, she was tasked with establishing a gender clinic. For years, details of her clinical practice remained obscure to American audiences. At the time, the urgency of anti-trans legislation in the United States had not even begun, and the operations of a chief psychiatrist in a Finish gender clinic seemed of marginal concern to the public eye.

This dynamic shifted in the early 2020s when the surge of legislation targeting trans people reached its zenith. Proponents of these measures, eager to deflect claims that their stance was rooted in religious discrimination, searched for ways to give their position a veneer of scientific credibility. A handful of Nordic clinics, such as Dr. Kaltiala’s, became invaluable to the anti-trans right, offering an appearance of scientific authority to support their cause.

Simultaneously, alarming testimonials from Dr. Kaltiala's patients regarding their clinic encounters started circulating. The Finnish LGBTQ+ platform, Kehrääjä, solicited information from many of the clinics patients. What it found was shocking.

The publication detailed an alleged incident where a clinician asked a young girl to “describe to me how you masturbate,” an allusion to the discredited theory of transgender identity being a fetish, once used as a way to invalidate many transgender people. Additionally, a transgender boy was allegedly cautioned that bottom surgery “seldom functions correctly,” and was remarked upon his stature, being told he would “be quite short for a man.” His treatment was subsequently put on hold after being told that his hobbies were “too girlish.”

Numerous patients have reported being addressed by their old names in the clinic, a practice that apparently persisted irrespective of legal name changes. While the clinic denies these claims, Dr. Kaltiala’s statements reflect a similar stance. She is on record opposing the validity of transgender people’s gender identities, once stating, “Acceptance means saying, 'So you're a boy who feels like you're a girl,’” to a transgender girl. These assertions are consistent with patient accounts that children were referred to by their sex assigned at birth, regardless of any legal name changes or if they had been living in accordance with their gender identity prior to arriving at the clinic. Similarly, she opposes allowing trans youth to change their IDs, stating that “it would be irresponsible to cement their gender self-identification in state documents” to Leor Sapir, an activist from the Manhattan Institute opposing care.

“How does it feel knowing you’ll never be as good as real man?"

The clinic apparently utilizes gatekeeping methods not used in modern standards of care that were more common decades ago. One patient reports being told, “how does it feel knowing you’ll never be as good as a real man." The patient likewise claimed to Kehrääjä that he was always expected to display traditional, strong masculinity that would then be judged by the staff. The clinic required “real life experience” in your gender identity to obtain care, but that “real life experience” did not begin until after diagnosis, according to some patients. The mandatory requirement of “real life experience” combined with enforcement of gender stereotypes is more akin to how trans people were treated in the 1970s than modern times. These practices have been decried by Amnesty International.

Perhaps the most disconcerting aspect is the clinic's endorsement of what appears to be “gender exploratory therapy,” a new form of conversion therapy. This method, increasingly favored by right-wing opponents of trans healthcare, aims to postpone transition indefinitely while attributing a trans identity to factors other than a person's authentic experience of gender. As a result, necessary care is perpetually deferred until trans youth feel that transitioning is no longer viable or they age into adulthood. This form of conversion therapy, endorsed by many in the Christian right in the United States, has also been advocated by the American College of Pediatricians — an organization with a deceptive name that has been identified as a hate group by the Southern Poverty Law Center (SPLC).

Here are a list of supposed “causes of being trans” that gender exploratory therapy seeks to “explore,” all while putting off transition indefinitely. The list is from “Parents of ROGD Kids,” and patient reports from Dr. Kaltiala’s clinic show that the clinic tries to explain trans identification on many of these unsupported “causes” of being trans. You can see that the number of “truly transgender people” is listed as a tiny speck, with the implication that most people who identify as transgender are not “truly trans.”

“Causes” of being transgender by “Parents of ROGD Kids.” There are many reports of Dr. Kaltiala’s clinic exploring several of these.

“It feels like the whole process is about searching for various reasons why the child is transgender. The option that transgender identity could be an innate, unchangeable trait is considered only as a last resort,” one family told Kehrääjä. Numerous accounts of experiences at the clinic detail delayed transition and denial of care until adulthood, with many stating the experience was traumatic or harmful.

Dr. Kaltiala claims that gender affirming care is dangerous, but in reality, it is her practices that are dangerous to her patients. She has explicitly endorsed gender exploratory therapy, stating that “at this hospital, we provide… exploratory intervention” when delivering a speech to the Florida Board of Medicine advocating the banning of gender affirming care. The harms of this institutionalized, therapeutic gaslighting are evident in patient reports solicited from others who have undergone exploratory therapy.

The clinic's lengthy waiting lists have reportedly inflicted harm on patients. In search of timely care, some have reportedly sought treatment beyond the nation's frontiers. One family, for instance, obtained a diagnosis from a private doctor who legally prescribed puberty blockers. Despite this, the clinic reported the patient to child protective services and filed a criminal complaint. These actions resulted in no legal repercussions; however, Dr. Kaltiala’s clinic subsequently terminated the patient's care.

Gender affirming care is not “dangerous,” it saves lives. A recent report from the esteemed medical journal, The Lancet, published on July 26, highlights that gender affirming care constitutes a form of preventative healthcare. It is associated with an improved quality of life and plays a crucial role in the well-being of transgender youth. Numerous studies have shown that it leads to positive psychological outcomes and reduces suicide rates significantly—some studies report a remarkable 73% decrease in suicide rates. The endorsement of gender affirming care is supported by a collection of over 50 papers compiled by Cornell University, all of which underscore its beneficial effects.

Dr. Kaltiala’s engages in numerous other falsehoods in her article. She claims, for instance, that up to 80% of transgender children will "desist" from their gender identity—a claim based on decades-old data that has been widely debunked by newer studies. She endorses the idea of "social contagion" as a driver behind transgender healthcare, proposing that "gender clinics around the world" are diagnosing "social contagion-linked gender dysphoria." Yet, on average, transgender youths have a longstanding awareness of their gender identity, often 4-8 years, before they reveal it to their parents. The invocation of "Rapid Onset Gender Dysphoria" and similar concepts, which insinuate that transgender youths' gender dysphoria emerges suddenly due to social contagion, has been repudiated by over 60 leading psychological organizations.

She also leans heavily into the idea that gender affirming care lacks “high quality” evidence, according to an analysis using the GRADE technique done by those in the country. This point has been heavily refuted by medical experts as well as several courts in the United States, including federal courts in Arkansas and Georgia. It would be impossible to conduct a study that obtains a “high quality” score because it would require a randomized controlled trial, which is not ethically possible for gender affirming care. In fact, most medical care does not have “high quality” GRADE scores because if a treatment is known to be likely lifesaving from clinical experience and observational data, it would be difficult to obtain approval to withhold that care.

See this portion of a judgement by a federal court in Georgia which evaluates this very claim:

Georgia court ruling that “GRADE” scores and misleading statements about “evidence quality” are inappropriately being used to justify trans care bans.

Dr. Kaltiala cannot be characterized merely as an impartial medical researcher; she has emerged as a key figurehead for an anti-trans movement. She has been deeply involved with many of the key players in trans care bans. She’s appeared in a podcast by Genspect, an entity known for opposing gender affirming care up to the age of 25, teasing transgender children on social media, and promoting Moms for Liberty—a staunchly conservative anti-LGBTQ+ "parental rights" organization in the U.S. In the her appearance on a Genspect podcast, Dr. Kaltiala was featured alongside Stella O’Malley, founder of Genspect, who has labeled trans girls as "porn induced" fetishists and stated they warrant "no empathy." She similarly has worked with the Catholic Medical Association’s Patrick Hunter, a Desantis-handpicked Florida Board of Medicine member who was integral to the care bans in the state. She testified at the Florida Board of Medicine hearing to help ban care.

Were Dr. Kaltiala a single chief adolescent psychiatrist in a private medical hospital in the United States, it would warrant concern. Instead, she runs the gender program of one of only two hospitals that serve trans youth in Finland. Her rise to her position and the outdated methods she employ for trans youth in her clinic’s care means she can have outsized influence on policy. That influence then gets magnified and singled out to help ban care in the United States.

Likewise, her willingness to promote harmful policies towards trans patients has given her purchase in the biggest circles opposed to transgender rights. JK Rowling retweeted her story. It was shared by Leor Sapir of the Manhattan Institute. The far-right Alliance Defending Freedom blasted the story. So did Seth Dillon. Even Elon Musk has joined in the discussion about her.

The prevailing narrative for the past few years has painted Finland as a "progressive place" for transgender healthcare that later retracted its approach following a "careful examination of evidence." However, there has been scant scrutiny of the actual practices at the country's primary clinic. Now, the stories of those on the front lines—the patients grappling with a healthcare system rife with mistreatment and political agendas—are coming to light.