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COHERE Directive Finland (2020): the first to take back the card

In 2020, Finland became the first Western country to issue a new guideline: psychotherapy is primary care for juvenile gender dysphoria; blockers and hormones are the exception. The signal to the rest of Europe was clear. Four years later, the Cass Review and the NHS reached the same conclusion. Finland had already seen it back then — based on its own clinical data.

What is COHERE?

The Council for Choices in Health Care (COHERE Finland) is the official advisory body of the Finnish Ministry of Social Affairs and Health. In June 2020, COHERE published a guideline on gender dysphoria in minors — for the first time in a Western context, a guideline that did not automatically recommend hormones, but was based on what its own clinical data showed.

Key recommendations

• Psychotherapy is primary care, not hormones.
• In the case of ROGD presentation (rapid onset during puberty, with a social context), medical intervention is not indicated.
• Comorbid conditions are treated first.
• Social transition in children before puberty is discouraged.
• Hormones only after extensive multidisciplinary evaluation.

The work of Kaltiala-Heino — honest clinical data

Riittakerttu Kaltiala-Heino, head of Tampere's gender dysphoria team, published her own research demonstrating that: (a) gender dysphoria in young people often improved without medical intervention, (b) comorbidity was dominant, (c) the Finnish population differed significantly from the old Dutch cohort on which the entire Dutch Protocol rested. That research formed the empirical basis for COHERE. Kaltiala-Heino is not an activist; she is a physician who took her own long-term data seriously — something her Dutch and British WPATH colleagues never did.

International resonance — early but ignored

COHERE was early and received little attention at the time. It was only after Sweden (SBU 2022) and the Cass Review (2024) that it became clear how prescient the Finnish guideline was. Norway (Ukom 2023) and Denmark (2023) followed. Four Scandinavian countries plus the UK — all four reached the same conclusion based on evidence review. Finland is proof that a health authority can act on the basis of evidence without being guided by WPATH activism .

What it says about ROGD and the youth-girls peak

COHERE explicitly identifies the sudden peak in adolescent girls — the pattern Lisa Littman described in her ROGD research . Instead of denying that pattern ("ROGD does not exist"), Finland took it seriously and stated that medical intervention should not be the first line of treatment for this profile. That is what careful medicine does: treat an identifiable new clinical picture as a signal, not as an identity.