For the first time since 1992, the organization issued a major revision to its international manual of diagnoses and, among other things, a major shift in the way transgender people are treated. The 11th revision of the International Classification of Diseases (ICD) reframes “gender identity disorder” as “gender incongruence”, moving it from a mental health disorder to an issue of sexual health. Codes issued by the ICD are used by countries to determine where to invest resources as well as how to set certain insurance billing standards.
The agency says there is now enough evidence suggesting that being transgender is not a mental disorder and classifying it as such can cause “enormous stigma” for those who identify themselves as transgender. The move will reduce stigma while also ensuring access remains for necessary health interventions.
“All available evidence was reviewed and discussed by an external advisory group, together with the scientific basis of this condition and the feedback from the professional community and concerned communities formed the basis of this decision,” said Dr Lale Say, WHO coordinator for the Department of Reproductive Health and Research, in a Q&A.
Also known as gender dysphoria, gender incongruence is defined as a condition where a person feels a conflict between their physical or assigned gender and the one that they identify with. It’s important to note that not every transgender person has gender incongruence.
Historically, transgender people have been treated as having a mental disorder, often resulting in bullying, harassment, or discrimination that would incite mental health problems not necessarily inherent in being transgender. The Trans Murder Monitoring Project recorded more than 1,700 murders of transgender people between 2007 and 2014, many that were brutal, sometimes involving torture and mutilation. In some countries, it is still illegal to “pose” as the opposite sex. Experts hope this new framework will help change the way the world views transgender people.
“[It] is expected to reduce stigma and will help better social acceptance of individuals living with gender congruence," said Say. "In terms of healthcare provision, we don’t expect much change because this category will still have a place in ICD. In fact, it may even increase access because it will reduce stigma and it will help individuals to seek care more.”
Similarly, homosexuality was removed almost 30 years ago.