Evaluations › COHERE · Last reviewed 2026-05-16
COHERE Finland (June 2020)
Co-architect: Riittakerttu Kaltiala. Position in chronology: timeline 2020-06.
Summary
The Finnish Council for Choices in Health Care (COHERE / Palveluvalikoimaneuvosto) was the first national health authority to formally diverge from the Dutch Protocol for minors. The binding recommendation of June 2020 made psychotherapy the first-line treatment, restricted hormonal interventions to selected cases and explicitly distinguished early-onset from late-onset gender dysphoria.
Key points
- Psychotherapy and psychosocial interventions as first-line treatment.
- Hormone treatment only for "clearly established gender dysphoria" and only with expert assessment.
- No surgery in minors.
- Explicit acknowledgement of uncertainty about long-term effects.
Rationale
COHERE motivated the guideline with (i) the sharp rise in adolescent referrals, (ii) the reported increase in comorbid psychiatric problems among referred youth and (iii) the lack of robust evidence for long-term effectiveness of hormone treatment in adolescents with non-early-onset dysphoria.1
See also
- People register — Riittakerttu Kaltiala.
- International comparison — Finland in table form.
- Timeline 2020-06 — position in chronology.
- Clinical context in Finland: Finland — COHERE guideline 2020.
- Criticised age thresholds: Age criteria of the Dutch Protocol.
- Early-onset vs adolescent-onset distinction: Inclusion criteria.
- Comparable national revisions: SBU 2022 (Sweden), Cass Review 2024 (UK).
- International comparison 2025: Worldwide status.
- FAQ · Glossary · For parents.
Footnotes
- Palveluvalikoimaneuvosto (COHERE). Medical treatment methods for dysphoria associated with variations in gender identity in minors — recommendation. 11 June 2020.