Haldre, a gynecologist who leads the Ministry of Social Affairs' medical assessment committee for gender reassignment, said on ETV's "Hommik Anuga" that questions of gender identity have always existed.

She noted there have always been those assigned male at birth who don't feel like men and those assigned female at birth who don't feel like women, "but these days, people have been thinking about it more — and have more options."

The interdisciplinary committee brings together psychiatrists, psychologists, endocrinologists, urologists and gynecologists.

"There are four of us present at once to understand where each young — or older — person is on their journey," Haldre explained. Their role, she continued, isn't to diagnose but to guide.

At this stage, she said, "we look at what's already been done, what the person needs, how they feel, and then offer our recommendations on what comes next."

So far, about one in four cases reviewed hasn't clearly met the criteria for gender dysphoria. Experiences vary widely, Haldre said.

Intervention can be lifesaving

"There are people you just want to say to, 'Where have you been so long?' because the process can be lifesaving," she said. Others, especially young people facing mental health challenges, may need more time to think and talk things through.

Most people reaching out to the committee are around 24 or 25, and many with gender dysphoria also live with other mental health conditions.

"In a quick tally of the first 150 people who came to us, I found that before they even reached us — and I'm not talking about gender here — roughly 80 to 90 percent already had another psychiatric diagnosis," Haldre said.

She urged caution when starting medical treatment. "Because the evidence base isn't as strong as in other medical fields, we have to be careful about when and for whom to intervene with off-label treatments," she said.

Haldre also called for more long-term studies in Estonia to track outcomes. She highlighted examples from the U.S., where some people stopped treatment or suffered because other issues weren't identified.

"Here in Estonia, we don't want to be the kind of doctors who do something where a third of cases go wrong," she added.

For youth, Haldre said support should focus first on mental health and family relationships, including family therapy when needed. "Puberty blockers, hormones, or surgery — those should wait," she said.

The committee chief stressed that ideological debates should never drive medical decisions. "That's my biggest concern," she said. "Sometimes ideology starts creeping into professional practice."

How grownups speak matters

Above all, she said, maintaining trust at home is critical in the gender affirmation process.

"The key is keeping that trust," Haldre said. "Families should seek help, keep all doors open for the young person and support them and their mental health."

A lack of supportive adults in their lives can put young trans youth at serious risk, she warned.

"It's heartbreaking to see a young person suffering without the support of anyone around them," she said.

Adults also need to stay alert to signs of harm in every environment — at home, school or elsewhere.

"Sometimes grownups don't realize how damaging negative talk, including body-shaming, can be," she said. "We've heard shocking cases where even a mom or dad has said something cruel about [their child's] body."

Resources and support available

Several organizations exist in Estonia that represent and support trans and other LGBT+ people, including the Estonian Trans Alliance (ETÜ).

If you find yourself in crisis, are having suicidal thoughts or are otherwise struggling, help is available.

In case of emergency, call 112. On-call psychiatric care can also be reached by phone 24/7 in Tallinn at +372 617 2650, in Tartu at +372 731 8764 and in Pärnu at +372 447 3281.

The Eluliin emotional support hotline is open daily from 7 p.m. to 7 a.m. in Estonian (+372 655 8088) and in Russian (+372 655 5688).

Another emotional support hotline is available every day from 10 a.m. to midnight in Estonian, Russian and English at 116 123.

The Ohvriabi victim support hotline is available 24/7 in Estonian, Russian and English at 116 006.

The child helpline is also open 24/7 in Estonian, Russian and English at 116 111.

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