Episode 62

62 - Pioneers Series: Adolescent Identity with Riittakerttu Kaltiala

Published on: 11th February, 2022

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.


Dr Kaltiala’s Website:



Adolescent GD Current Perspectives:



Lisa Marchiano — Outbreak:



GD and ASD: A Narrative Review


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 field as only a small group had started to study it.
  • Riitta shares the unexpected phenomena she experienced about puberty blockers of gender identity when she first learned about it.
  • Social media and peer discussions usually precede gender distress cases in the U.S. and UK. Riitta shares what data they collected in this case for Finland.
  • People who came to their services had severe psychiatric problems and history and were suffering from mental disorders. This was one of the issues that inspired Riitta to further her research.
  • In the first years, professionals such as teachers, child welfare, psychiatrists, etc., who were around the young person when they started to express their gender dysphoria, felt insecure and uncertain about their competence on how to help them.
  • As contact with peers is very important for healthy adolescents, they have observed a lot of young people who displayed non-confirming gender behaviors isolated themselves as they were discriminated against and bullied.
  • What was the follow-up like from these services back in 2011? Where are those adolescents now and how are they doing?
  • Despite the changes hormonal treatments were producing being satisfying for the adolescent, they did little to relieve other psychiatric symptoms. Simply changing gender will not resolve all these problems.
  • Although a lot of professionals have failed helplessly in the past; this has completely changed in Finland. People working with adolescents nowadays are more well-equipped and competent.
  • What does Riitta think about the concept of Rapid Onset Gender Dysphoria?
  • Riitta shares that peer influence is valid as it is natural for adolescents to be susceptible to their peer groups. Similar to kids confirming their ideals in music and other interests, it can also happen with gender identity.
  • What was their approach to the population change in 2015 where the proportion of gender dysphoric girls was higher than boys?
  • They are not really doing identity work if after only short consideration the young person results that the only solution is to do physical treatments. There is a risk from escaping that and quickly holding on to a certain conclusion.
  • It’s good that young people are able to express themselves however they feel but making medical interventions for a healthy body must have a stronger consideration.
  • Riitta talks about how highly autistic children may lack the flexibility to deal with ambiguity as they tend to obsess and fixate on things. Is it playing a big role in their gender dysphoria?
  • Due to gender politics, was there an impact in Finland with their approach on how to address gender dysphoria?
  • The issue of pronouns is a non-issue in the Finnish language.
  • Riitta also talks about the heavy regulation of gender identity services in Finland and its effects.
  • With the recent changes in their legislations, were there activist groups that opposed the slowing down and prioritization of the psychological approach in Finland?
  • For young people still in their developmental years with all the external influences that surround them, it is important that there is identity work and exploration.
  • Riitta shares her advice to parents of gender-questioning children and her thoughts about the growing population of teens and adults who are detransitioning to close today’s episode.

This podcast is sponsored by ReIME and Genspect. Visit Rethinkime.org and Genspect.org to learn more.


For more about our show: Linktr.ee/WiderLensPod

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About the Podcast

Gender: A Wider Lens Podcast
Two therapists explore the expanding concept of "gender" from a psychological depth perspective.
Gender dysphoria has become a minefield for public discussion, with many afraid to express their views or question the narrative. Our mission is to examine this important and complex topic from a range of perspectives, but always through a psychological lens. By openly considering and examining gender identity, transition, and the transgender umbrella, we hope to give all interested parties permission to engage these fascinating topics with less fear and more honesty. Interviews and discussions will involve clinicians, medical professionals, academics, transgender people, parents, detransitioners and other interesting individuals whose lives have been touched by the concept of gender.

Conversations between two practicing therapists give listeners an opportunity to contemplate gender from a depth perspective not currently taken up in most of today’s accessible debates. As a result of their work with gender dysphoric therapy clients as well as their personal divergent experiences with gender, Stella and Sasha hold a refreshing and informed perspective.

Is gender identity a facilitation of development and expression of creativity, or can it be a defense against painful existential realities of living in a human body? What can we discover about masculinity, femininity, identity, gender performance, and sexuality when we peer beneath the surface and dive into a deeper psychological exploration? What is the relationship between body, mind, identity, culture, and psyche?

This podcast engages listeners in an intimate and fascinating behind-the-scenes inquiry about a topic as taboo as it is salient today.

Thank you to our sponsors:
Genspect - an international organization which offers an alternative to WPATH. Providing a range of education, resources and supports to anyone impacted by gender distress, Genspect unites many different organizations globally, and gives voice to 1,000s of previously untold stories. For more info, visit genspect.org.

GETA - an association of therapists who believe that individuals experiencing gender related concerns ought to be treated using a whole person approach. GETA connects like minded clinicians, provides educational resources and trainings, and helps people with gender dysphoria find support. For more info, visit genderexploratory.com.
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About your hosts

Stella O'Malley

Profile picture for Stella O'Malley
Stella O’Malley is a psychotherapist and author who works in private practice in Ireland. Her work focuses on parenting, family dynamics and working with teenagers.

Much of Stella’s counselling and writing focuses on mental health and the importance of well-being and she is a regular contributor to the media. She is also the resident psychotherapist for the current TV series, Raised by the Village, a family programme that helps troubled teenagers reconnect with themselves and their families.

Stella's first book, Cotton Wool Kids, was released in 2015 while Bully-Proof Kids: Practical tools to help kids grow up confident, resilient and strong was released in 2017. Stella’s latest book Fragile, was released in 2019 and focuses on overcoming anxiety and stress.

Stella was the presenter of the documentary Trans - Kids: It’s Time To Talk broadcast on Channel 4 in November 2018 and she contributed a chapter to the 2019 book, Inventing Transgender Children and Young People.

The Jungian analyst, Lisa Marchiano, and Stella launched Secrets of the Motherworld in September 2019, offering thoughtful exploration of the most intimate aspects of motherhood in a bid to help mothers feel less alone.

Stella is a Clinical Advisor for the Society for Evidence-based Gender Medicine and a founding member of the International Association of Therapists for Desisters and Detransitioners. She is also the lead facilitator for the Gender Dysphoria Support Network.

Stella holds a B.A. in Counselling and Psychotherapy and a M.A. in Cognitive Behavioural Therapy.

Sasha Ayad

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Sasha Ayad is a Licensed Professional Counselor who works in private practice, and has treated adolescents for over 10 years. Her work focuses on teens and young adults struggling with issues of gender dysphoria and gender identity.

She became interested in the sharp rise in teenagers who declare a trans identity for the first time during adolescence. She discovered, through working with hundreds of families, that many teens were developing gender dysphoria only after adopting a transgender identity. She questions the practice of medical transition for children and teenagers, and her clinical work focuses on developmentally appropriate, least-invasive-first talk therapy.

Sasha is also a founding member and Clinical Advisor in the Society for Evidence-based Gender Medicine and a founding member of the International Association of Therapists for Desisters and Detransitioners.

Sasha’s previous work experience includes:
- School counselor for middle and high school students at a charter school for underserved communities

- Behavioral therapy with children on the autism spectrum

- Individual and group counseling for women and children impacted by domestic abuse and sexual violence

- Developed and ran the first counseling program at a large state supported living facility for adults with intellectual disability

Sasha holds a B.S. in Psychology and an M.Ed. in Counseling Psychology.