World Health Organization considers major change to transgender status

The World Health Organization is reconsidering how it classifies transgender people.

The World Health Organization is reconsidering how it classifies transgender people. Erin Rook

The World Health Organization is considering changing the way it classifies transgender identity following calls from researchers and advocates to remove it from the WHO’s list of mental disorders, The New York Times reports.

The proposal is getting a boost from a recent study conducted in Mexico and published Tuesday in Lancet Psychiatry, which found that transgender people experienced more stress around societal responses to their transgender identity than they did as a result of personal gender dysphoria:

They found that while most had felt distress related to their gender identity during adolescence, almost a fifth of them had not. And among those who felt distress or experienced dysfunction at work, home or school, most was attributed to how they were treated — being rejected or violently attacked — rather than to their gender identity itself, the authors reported.

 “The intention is to reduce barriers to care,” said psychologist Geoffrey Reed, who is coordinating the relevant sections in the new edition of the WHO’s codebook, the International Classification of Diseases. The ICD, as it’s known, is similar to the U.S. codebook the Diagnostic and Statistical Manual of Mental Disorders (DSM), which recently changed its transgender listing from “gender identity disorder” to “gender dysphoria.”

While it’s tempting to compare the depathologization of homosexuality and transgender identity, the latter cause has unintended consequence to consider. In the United States and other countries without government-provided healthcare, access to the medical care is typically contingent on a related diagnosis. Because gay, lesbian, and bisexual folks don’t generally have medical needs specifically tied to their sexual identities, there’s nothing to be lost in ditching the diagnosis. But many transgender folks access gender-related medical services and must have a diagnosis to do so.

“In France, they said, ‘Just leave us alone, we don’t need your stinking classification,’” Reed told The NY Times, noting that similar studies are being conducted in France, as well as Brazil, India, Lebanon, and South Africa. “But they live in a society where access to health care is conceptualized as a right.”

Another sticking point in the proposed revisions is the suggestion that transgender identity be moved to the section on “conditions affecting sexual health” since, experts point out, being transgender has nothing to do with sex. Unlike the DSM, the ICD has sections for general medical health, not just mental health.

“I think there is a bit of a problem with the idea,” said Dr. Griet De Cuypere, a psychiatrist and board member of the World Professional Association for Transgender Health. “If it’s possible to have it more separately, it would be better.”

The WHO is also considering what to call the “condition” associated with being transgender. One challenge is finding a phrase, or phrases, that translates similarly in many different languages. For example, “gender incongruence” may sound neutral in English, while a phrase translating to “gender discordance” might go over better in Spanish. So far, the group working on the issue hasn’t landed on mutually agreeable language.

“The terminology is difficult because nobody likes anything,” Reed told The NY Times. “People have made suggestions that have been all over the map. One of the people at one of the meetings said we could call this ‘happy unicorns dancing by the edge of the stream’ and there’d be an objection to it.”

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