Riittakerttu Kaltiala, M.D., Ph.D., BSc, is a professor of adolescent psychiatry in Tampere University and chief psychiatrist in the Department of Adolescent Psychiatry at Tampere University Hospital. She is a specialist in psychiatry, adolescent psychiatry, and forensic psychiatry. She has been clinically involved in carrying out research on adolescent gender identity issues since 2011 when one of the two nationally centralized gender identity services for minors was opened in Finland, in Tampere University Hospital. She has been actively involved in service development, continuing education, and scientific writing and collaboration nationally and internationally, and in her home country she has been invited as a member of major national initiatives related to transgender treatment guidelines and legislation. She has published numerous scientific articles on adolescent mental health epidemiology, psychiatric health services research, and clinical adolescent psychiatry.

Riitta tells us about the shift around 2010 in Finland in which health policymakers, politicians, activists, and human rights groups pushed for the inclusion of adolescent and child services for gender transition. The adolescent psychiatrists scrambled to accommodate these new demands but recognized that identity consolidation is known to take more time and they had concerns about such early interventions. Nevertheless, they began developing a program for childhood gender services based on the literature in other countries such as the UK and Netherlands. They were astonished and quite confused when the populations arriving at their services reflected a very different demographic in age, sex, and presentation of other comorbid psychiatric issues. They saw a shift again around 2015 which continued to confound the clinicians. Riitta tells us about reading the Littman ROGD research which accurately documented what she and colleagues were seeing. Dr. Kaltiala also tells us that predictions of improvement and symptom reduction reflected in the Dutch literature were not observed in their work, and describes how Finland has moved towards prioritizing psychological care and meeting all the needs of young patients who present with GD, rather than focusing only on the gender transition requests.

Links:

Dr Kaltiala’s Website:

Riittakerttu.fi

Adolescent GD Current Perspectives:

Ncbi.nlm.nih.gov/pmc/articles/PMC5841333

Lisa Marchiano — Outbreak:

Tandfonline.com/doi/full/10.1080/00332925.2017.1350804

GD and ASD: A Narrative Review

Pubmed.ncbi.nlm.nih.gov/26753812

Extended Notes

• Riitta talks about how she got into psychiatry and got to work in this field.
• When did Riitta first come across gender identity? She shares the backstory.
• Riitta talks about how it was decided in Finland in 2009 that children and adolescents also needed gender medical intervention. What was the motivation behind this?
• It is during adolescence that young people seek and experiment with their identity. However, it is normal for them to change or evolve in 2‒3 years. It is part of the process of stabilizing their identity.
• It’s hard to expect in adolescent psychiatry during the early phases of adolescent development that the person would already be ready with any aspect of identity.
In the beginning, most of society did not have an idea about gender identity issues so it was not discussed much, including in the medical

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