The WHO Will Stop Classifying Transgender Identity as a Mental Health Condition

The World Health Organization has announced a major shift in how the agency views transgender people. The latest version of the International Classification of Diseases, or ICD, has moved what the WHO refers to as “gender incongruence” from the section covering mental health disorders to the section for sexual health disorders.

This reflects sustained advocacy on the part of transgender people, although not everyone is happy with the change.

You may also hear gender incongruence referred to as gender dysphoria. Both terms reflect a situation in which someone’s experience of gender conflicts with their assigned sex. For example, a man may have been assigned a female gender at birth because of his genitals, or may be presumed female because he has breasts or other secondary sex characteristics associated with femininity.

Some transgender people decide to pursue “transition,” living in a way that aligns with their experience of gender; a trans woman might change her name, take hormones to change her appearance, get gender affirmation surgery or pursue other steps to live as a woman. There’s no “right” level of transition for anyone: Some people don’t want to transition at all or can’t afford it, while others only want to take some steps.

Trans people argue — correctly — that being transgender is not a pathology. It doesn’t indicate that something is wrong with you, although it has historically been treated as a mental disorder — not just by the WHO, but also other authorities.

Originally, being trans was treated as a sign of deviance that needed to be “fixed” by suppressing someone’s gender expression, just as homosexuality was treated as something wrong and broken. Today, many authorities agree that trans people who pursue social and sometimes medical transition tend to lead happier, fuller lives.

But if being trans doesn’t mean there’s anything wrong with you, accessing transition in many cases requires transgender people to “prove” their trans-ness to some degree.

Maybe that means presenting documentation to change their name and gender on identification, for example, or getting a referral letter so insurance will pay for costly elements of medical transition. Depending on where someone seeks care, it may also be impossible to get hormones or surgery without medical documentation — though some clinics have taken an “informed consent” model where people seeking transition care can review risks and benefits with a care provider and start treatment without needing to jump through hoops.

And that’s where documentation like the ICD comes in. Some trans people need to receive a medical diagnosis in order to get the care they need, but classifying transgender identity as a mental health condition is stigmatizing: It doesn’t have anything to do with mental health — although trans people have higher rates of mental illness, sometimes associated with lack of access to transition.

Some trans people have expressed concerns about this move, arguing that this stigmatizes mental health conditions or ignores intersections between transgender needs and mental health. Suggesting that the two need to be separated, they argue, implies that being mentally ill is wrong — or that mentally ill people are suffering and need to be “managed” in a way that trans people do not.

Let’s be clear: There’s nothing wrong with being mentally ill. But when we classify medical issues, we have to think about the implications of where we place them. The suggestion that being transgender is a mental health condition has led to conversion therapy, institutionalization and other abuse to “fix” trans people. And trans people should support the work of mental health activists who rightly resist the use of barbaric and forced treatments on people with conditions like schizophrenia and bipolar disorder, whether or not they’re classified as “mentally ill” by the medical establishment.

Reclassifying gender incongruence as a sexual health disorder makes more sense, short of creating an entirely new category. Other conditions that require transition-like services, such as endocrine disorders that require supplementary hormones, are classified there.

Ultimately, of course, the goal would be to remove gender dysphoria from listings of medical conditions in the first place — but doing that requires substantial changes in the way society thinks about trans people. It will also necessitate reforms to the health care system, as right now transition is sometimes inaccessible without a formal diagnosis. But this step — aligning trans health care more closely with gender and sexual health — is a great start in the eyes of many advocates.

Photo Credit: Tony Webster/Flickr

40 comments

Marie W
Marie W3 months ago

Thanks for sharing.

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Caitlin L
Past Member 6 months ago

thanks

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Danuta W
Danuta W7 months ago

Thanks for sharing.

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Lesa D
Past Member 7 months ago

thank you s.e. ...

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JoAnn Paris
JoAnn Paris7 months ago

Thank you for this very interesting article.

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Clare O'Beara
Clare O'Beara8 months ago

th

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Emma Z
Past Member 9 months ago

thanks for the update

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Toni W
Toni W9 months ago

TYFS

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Toni W
Toni W9 months ago

TYFS

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Janis K
Janis K9 months ago

Thanks for sharing.

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