Okay, so practical question, I expect somebody Oh, there are my slides. Nice to see you here. And all exactly as I would say, Finland is pretty much normal this field now, which is a great surprise to us, because basically in Finland, FBI, very small nation in the far corner of Europe that become very, very astonished that somebody knows that we exist. So this is a great surprise to me, that so many know that they exist. I call that in Finland the center identity services that may be the route to medical temporary assignment are nationally, centralized, and they are there are diagnostic assessment teams in two of the five University Hospitals, separate things for adults and minors. Possible medical interventions are started by the vulnerable interventions. They are initiated and balanced in these centralized services, and when imbalance, the aftercare is transferred to local services. Surgical interventions are accessed through these centralized fields, operated in different places, but clinical surgeries are only operating in the Lung Center and national level, in order to ensure the caseload that maintains the case of emergency as of April, 23 legal adults can change their identity documents by a life administrative procedure before that, the assessments in this nationalism was also the route to changing identity document. Of this is not the case anymore. Chasing identity level recommend is not available for minors. National guidelines for treatment were issued in three different versions. Are only focusing on a guideline for minors in this presentation, the guidelines, but previously no medical intervention is provided on identity, gender identity basis. Psychosocial support has to be provided as appropriate, because some children have complex needs. Some have simple needs. Local Services have to take care of their of this inter level of care which is appropriate to the child's needs. First line treatment for gender dysphoria in minus which is exploratory psychotherapy, intervention in local services, and this is the responsibility of any service working with adolescents, and again, according to the in the level that corresponds to the severity of the need of adolescents. So it can be the universal services, such as school welfare services and primary care differential services. Or if the other side has more complex needs, assessment of health needs, this intervention can take place along the treatment of the psychiatric disorder as appropriate, appropriate treatment of possible psychiatric comorbidities and management of associated needs, such as pedagogical needs, child health care needs and services and so on, is required before considering a referral to gender identity units that then would initiate the gender identity aspect, many example, medical gender reassignment. And if considering medical gender reassignment after the first time intervention appears appropriate, and finally, then the referral to nationally, centralized services can be issued, and it also, in this case, the treatment, but any associated difficulties remains in the responsibility of the local services that can, of course, better provided for this people in the school or time welfare and so on, because by we are a very small nation in the park, then the territory is actually quite big, so it's more than 1000 kilometers, and we cannot handle all kinds of needs, from venison, recent health services, possible medical interventions for minors after the gender identity assessments have been completed, are mentioned in this slide. So in childhood, on the gender dysphoria that intensifies in puberty and has no severe psychiatric comorbidities and has appropriate self development or support. So when things are going well, GnRH analogs can be used to help fever, club development. They can be considered after early stages of puberty. In practice, from about 13 years and cross sectional loss can be considered from age 60 about age 16, if desired. However, over time, the treatment desires have grown more conservative, as I also later in adolescent also gender dysphoria, which nevertheless presents with most likely stable and persistent cross gender identification, no and no severe psychiatric comorbidities, and the adolescent has appropriate developmental support so things are normalizing, then cross section hormones can be considered from about age 16, and that can be taking place or without a bush out, depending the previous blockers, depending on the focus of the common polygamy. However, all the time, also in adolescent onset gender dysphoria, the treatment systems are actually called. Opportunity so and surgeries are not indicated with the gender identity indication for minors. When we started the service, this did not arise from Finnish and adolescent psychiatry. This was actually challenging to us to start with, because in our thinking, identity consolidation is the outcome of adolescent development, not its starting. So it was quite a bit of a change in thinking to consider that gender identity, which is a concept of identity in general, could be so consolidated in early stages of adolescence that it would form a basis for medical intervening in a healthy function in a developing body. There are identity theories in psychodynamic and more sociological branch of thinking and academic study. But all the identity theories I am aware of in general are not necessarily focusing in general identity development, important identity consolidates or takes form or is achieved in a process, in the process of interaction between the individual and the environment. I have illustrated here some basic concepts according to the identity from the thinking of page Ericsson and later scholars in the same line. But I'm not going to in detail to this now, however, then the learn about this, this losing thing about the gender identity, it had not been discussed in English rather than other psychiatry at home. It came rather from the adult psychiatry and political and societal pressures, so we familiarize ourselves with the literature that was available, then read everything that had been published about this quickly learned where this practice has been available for a longer time over the more established centers in Europe and in North America, there might be experts who have a longer experience of working with this kind of issues, and make contacts, because work is so small our risk so we conducted more established symptoms, we get the thing that was available, and based on the knowledge gain in this process, we expect to see Very few minors, because our population is so small, Finland has only 5.3 million inhabitants. So we thought it would be a handful of young people who would come back this kind of a service they would maybe have, based on the knowledge we have gathered, childhood consistencia That would have intensified in puberty, we expected that they would be pregnant among the young people with male sex, with only life or secondary psychopathology, and maybe they would lead with concern upset parents who would be maybe, maybe even aggressive. Related to this question, however, then the young people that started to come in, they were totally different from what we had expected based operations and consultations. So in two first years, we saw totally different patient population that had been expected based on the pre existing knowledge. And this is why we then reported this in this first paper of our group called two years of service for minors and the title already tells that we have great over representation of biological girls with severe problems in adolescent development. I summarize here more than the characters of the patient population that we were seeing. The millage at admission was about 16 years. 85% had young people with female sex two of those have a history of psychiatric specialist level psychiatric treatment, which means severe psychiatric disorders, because in Finland, you don't access specialist level psychiatric treatment severe problems, you cannot sell for your it is based on a doctor's referral, and only the preservatives are provided for severe disorders, mild, moderate medical health problems are treated in the primary care, school care services and drug services. So this indicates the severe problems and two thirds have history specialist, general psychiatric treatment, and almost always specific psychiatric treatment. Stated that recruitment, state in fact, far before any concept of gender concerns in these young people, there has great over representation of autism, depression, anxiety disorder, suicidal ideation, as others have also published, as compared to epidemiology of these problems in adolescent population, at large, a minority only about 10% clearly had a childhood concept gender dysphoria. And even of these young people, about half of them had severe psychiatric treatment history related to, for example, autism or psychological.