Finnish treatment recommendations as a basis for anti-gender politics in the United States, state by state

The list is not comprehensive, and new cases keep appearing. For example, while writing this I came across a case from Idaho, where families of transgender children dropped a challenge to a school bathroom law after one young person left school and another died. Finland is mentioned 23 times and Kaltiala 10 times in the ADF legal filing. The first link is to the legal document, if available, and I add an explanatory link at the end when possible. It is notable that many of the expert witnesses belong to this small group, several of whom Kaltiala has worked with. Cases that have reached the Supreme Court are their own topic; in one of them, a conservative justice even cites the Finnish Ministry of Social Affairs and Health in the decision. This list is also not comprehensive, but it includes information on the cases.

Note: Most of the links are PDF files, some of them hundreds of pages long. If a link has broken, the Wayback Machine may help.

At the circuit court level

At the circuit court level, which sits between the states and the Supreme Court, several states belong to the same circuit.

• A conversion-therapy organization opposes placing children in homes that follow an affirmative model - Kaltiala and the Finnish treatment recommendations are mentioned right at the beginning. Later in the document, it also discusses successful religious conversion therapy for sexual orientation in a religious context, which gives some indication of the people involved.

• An early bathroom-law case (2018) - Cantor's statement. This case predates the explosive rise of anti-trans laws. A school denied a 16-year-old trans boy access to the boys' bathroom and instructed him to use a separate gender-neutral bathroom instead. Kaltiala's research is cited to argue that mental-health problems should be addressed before drawing conclusions about gender identity. The policy was found unlawful.

• 21 states support Arkansas's ban on transgender healthcare for minors - In addition to the treatment ban, the law allows insurers to refuse to cover gender-affirming care for people of all ages. Finnish treatment recommendations are presented as a counterweight to the positions of major American medical associations. Also included is the Wall Street Journal open letter Youth Gender Transition Is Pushed Without Evidence, whose first two signatories are Kaltiala and Takala. The law is in force, but litigation is ongoing.

• 23 states support Idaho's ban on transgender healthcare for minors, carrying a penalty of up to 10 years in prison - Similar to the previous example, but in addition to PALKO and Kaltiala/Takala, it also cites Kaltiala's essay Gender-Affirming Care Is Dangerous. I Know Because I Helped Pioneer It. According to the ACLU, the law is unconstitutional.

• 21 states support Indiana's ban on transgender healthcare - Similar quotations from the PALKO recommendations and the open letter. The ACLU is challenging the law in a higher court.

General statements by right-wing organizations

• "States May Protect Minors By Banning Gender Affirming Care" - The Heritage Foundation compares restrictions on transgender healthcare for minors to restrictions on abortion rights as a matter of "protecting children". Finnish treatment recommendations are used as justification.

• "The Scientific Case for Counseling Choice for LGBTQ Identified Youth" - ACPeds argues for the "right" of LGBTQIA youth to choose conversion therapy. Finnish recommendations on care for minors and Kaltiala's research are cited as sources.

Alabama

• Alabama's ban on transgender healthcare for minors - Patrick Hunter's statement discusses his relationship with Kaltiala and presents Finnish treatment recommendations as an alternative to American practices.

• ADF report and James Cantor's statement - Cantor uses Finnish registry studies to argue that transgender healthcare does not benefit those who receive it. Also includes pseudoscientific views and links to the conversion-therapy debate.

Arkansas

• Levine's expert declaration - Finnish treatment recommendations are discussed for about a page.

• Hruz's expert declaration - Claims that young people's gender identity is changeable and cites Zucker and Bradley's conversion-therapy-supporting ideas.

California

As a more progressive state, California passed a law stating that affirmation of gender identity is to be considered part of assessing an environment that promotes a child's health, safety, and wellbeing.

• A pro-conversion-therapy organization opposed the law - It refers both to parents' religious freedom and to liberal countries such as Finland, which it claims have restricted minors' transition after finding that gender-related distress often stems from mental-health disorders and can be treated with therapy. The source is PALKO's website.

Connecticut

Also as a relatively progressive state, the statements relate to a law intended to strengthen privacy and legal protections for patients and healthcare professionals, including in connection with abortions, because other states are trying to restrict access to abortions obtained out of state. Similar efforts are being made regarding bans on transgender healthcare, and this was also added to the law.

• Ophthalmologist Bentivegna's statement - According to him, transgender healthcare for people under 21 should be banned. He then recounts the internationally circulated Kaltiala narrative, quoting her Free Press essay.

• Statement by the hate group ACPeds - Finland is used as an example in the narrative, with a link to the PALKO website.

• Dr. Cretella's testimony - Finland is mentioned five times, and Kaltiala's writing is also cited.

• Walt Heyer's statement - Ex-trans, now active in extremely religious circles. Same as above, including: "She says her vindication came in 2020 when Finland’s national medical body, COHERE, released its findings and recommendations regarding youth gender transition..."

Florida

Of course, Kaltiala served as an expert witness here.

• Ban on care for minors - "In Finland, the Palveluvalikoima issued guidelines in 2020 stating that sex reassignment in minors “is an experimental practice” and that “no irreversible treatment should be initiated.”"

Idaho

• Idaho defends law protecting children from harmful medical procedures

• Idaho's transgender healthcare ban is before the Supreme Court - Finland and Kaltiala are mentioned repeatedly in the proceedings, in this and other documents.

Indiana

• Indiana Medical Circuit Amicus Brief

• A teacher's religious freedom not to respect students' gender identity - ADF is behind this as well. The teacher should, according to the argument, have the right to misgender students if doing so is based on religious conviction. In addition to religious conviction, Kaltiala's polemic is cited in the argumentation.

Kansas

• Heritage Foundation: Why Kansas is Right to Restrict “Gender Transition” Procedures for Minors - Finland is mentioned four times in support of the argument, and Kaltiala is also quoted.

Kentucky

• Matt Sharp's testimony

• Youth transgender healthcare ban

Missouri

• Ban on care for minors - "Similarly, the health authority in Finland, concluded that the use of these interventions 'is an experimental practice' and cannot 'be considered evidence-based.'"

• Ban on care for minors - Refers to Finland's service selection body. "One could scarcely dream up a more radical organization to outsource the regulation of medicine to than WPATH..."

• Several conservative states support Missouri's transgender healthcare ban - Quotes PALKO, including: "Finland recently described these interventions in minors as “experimental” and said “treatment should seldom proceed beyond talking therapy.”

Maine

• A pro-conversion-therapy organization opposes progressive Maine's law protecting gender-affirming care from political attacks - Quotes Finnish treatment recommendations and Kaltiala's activism.

Michigan

• A pro-conversion-therapy-ban organization opposes a conversion-therapy ban - Finland and Kaltiala are mentioned.

Mississippi

• Opposition to a federal health-insurance nondiscrimination rule - Mentions Finnish treatment recommendations and Kaltiala. This is the kind of waters we are in: "Under ME LD1735, children can be kidnapped by parents who lost custody of their child in another state..."

Nebraska

• Transgender healthcare ban - Part of a law that also restricted abortion rights. According to the ACLU, legislators are aiming for a total abortion ban. This is a clear example of how treating these as "only trans issues" is possible only if one is unaware of the international context.

Ohio

• Conversion-therapy-ban law - Opposed by citing both Kaltiala's Free Press article and the Helsingin Sanomat interview.

• Law affecting transgender minors - Bans trans girls from participating in elementary and secondary school sports and includes a broad healthcare ban. Finland is mentioned in other documents too, but in this ADF paper the Finnish treatment recommendations and Kaltiala more generally are invoked. Human Rights Campaign's comment on the law.

Oklahoma

• OCPA / Do No Harm amicus brief

• Defendants’ response to plaintiffs’ motion for preliminary injunction

Oregon

• Conversion-therapy ban - The ban is opposed by citing, among other things, Kaltiala's interview in Helsingin Sanomat.

• Statement by a pro-conversion-therapy organization opposing the ban - Kaltiala and Finland/PALKO are mentioned.

Texas

Texas is the most populous state where gender-affirming care for minors is banned, and doctors can lose their licenses if they violate the law. The ACLU has challenged the law, and Loe v. Texas is currently ongoing. Many Christian conservative organizations are on the side of the state of Texas.

• Do No Harm - An organization originally created to oppose anti-racism in healthcare, now generally opposes "woke healthcare". Finnish treatment recommendations and Kaltiala are used as sources, quoted in ways that give a misleading picture of transgender healthcare.

• ADF is also involved, with more than one hundred pages including sources - The English-language description of PALKO's recommendations for minors is included.

• Public comments - Finnish treatment recommendations are familiar to many Texans. Also includes the quotation: "Dr. Kaltiala, described as one of Finland’s leading experts on Pediatric gender medicine says four out of five gender questioning children eventually accept their bodies if no medical interventions are carried out."

PFLAG v. Abbott is another ACLU challenge to Texas's healthcare ban. PFLAG is an organization for parents of LGBT+ children, and Greg Abbott is the conservative governor of Texas, who has also tried to initiate investigations into families of transgender children, claiming that the use of puberty blockers amounts to child abuse.

• Texas's response - Refers to only one of Kaltiala's studies and its highly misleading numbers, but it happens to be a study that cites Cantor, who also served as an expert witness in this case. Note also the prayer sections.

• Broader case materials - Cantor's expert report cites Finnish treatment recommendations and refers to Kaltiala dozens of times.

Utah

• Opposition to a conversion-therapy ban - The Mormon Church repeatedly refers to Kaltiala while opposing a bill banning conversion therapy for minors.

Washington

• HHS-OS-2022-0012-68192 attachment 15

West Virginia

The right of a high-school trans girl to participate on her school's running team: B.P.J. v. West Virginia. The ACLU is on the girl's side in this case. The case is ongoing and headed to the Supreme Court.

• Lambda Legal document including deposition transcript - "I want to put on the record this document about Finland also appears to be a translation from the original by the Society for Evidence Based Gender Medicine whose website describes it as an unofficial translation. So I just want to note that for the record." Guess which side relies on them.

• James Cantor's expert declaration - Kaltiala's name is mentioned 14 times; Finnish treatment recommendations are also used as a source.

• Levine's expert declaration for ADF - Kaltiala's studies are cited several times.

Ban on transgender healthcare for minors:

• Statement from an organization lobbying against bans on conversion therapy - A statement citing Finnish treatment recommendations and Kaltiala. According to Wikipedia, IFTCC is a lobbying organization that has also influenced the Nordic countries, and is part of both SPLC's anti-trans disinformation network and Health Liberation Now's anti-trans conversion-therapy network.

Wisconsin

• Wisconsin AB465 testimony and materials