Dr. Riittakerttu Kaltiala knows gender medicine. She is the top expert on pediatric gender medicine in Finland and the chief psychiatrist at one of its two government-approved pediatric gender clinics, at Tampere University, where she has presided over youth gender transition treatments since 2011. Her research has even been cited—though not accurately—by American supporters of “affirming care” for gender-dysphoric youth. She is one of the last people in the world who could be accused of being “reactionary,” a “transphobe,” or uninformed on the subject of trans health care.

Earlier this month, however, just a few days before Finland passed a law granting its adult citizens the right to have their self-defined gender recognized in government documents, Dr. Kaltiala gave an interview with Helsingin Sanomat, Finland’s liberal newspaper of record. Her comments were a sobering reminder of just how out of step the American medical establishment is with its European counterparts when it comes to treating minors who reject their sex.

The background to this interview is important. Finland was among the first countries to adopt the “Dutch protocol” for pediatric gender medicine, which prescribes—in certain restricted cases—the use of puberty blockers and cross-sex hormones to treat adolescent gender dysphoria. By 2015, however, Finnish gender specialists, including Kaltiala, were noticing that most of their patients did not match the profile of those treated in the Netherlands and did not meet the Dutch protocol’s relatively strict eligibility requirements for drug treatments. Due to the extremely high rate at which children with gender issues come to terms with their bodies (or “desist”) by adulthood, the Dutch protocol requires patients to have gender dysphoria that begins before puberty and intensifies in adolescence. It also requires them to have no serious co-occurring mental health problems, to undergo at least six months of psychotherapy, and to have the support of their family for hormonal treatments.