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2018: World Health Organization
(WHO) no longer considers being
transgender as a mental disorder.

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There has been little consensus on how to classify transgender identity:

  • About 99.4% of the adult population are cisgender: Their current gender identity is the same as their gender assignment at birth.

  • About 0.6% of the adult population are transgender: Their current gender identity is different from their gender assignment at birth. Usually they identify as being of the opposite gender. Sometimes as having no gender; or a gender intermediate between male and female, or as changing gender from time to time.

  • Many religious and social conservatives continue to view transgender persons and transsexuals as being "gender confused." The implication is that all they need to do is to seek counseling in order to be straightened out, cured, and change their gender identity to be the same as it was identified at their birth. In practice, this advice seems to be not useful. The cure rate of therapy from persons who are distressed by their gender identity is either zero or essentially zero. Many conservatives believe that parents or school curricula inject the concept of being transgender into children's minds; the former are are very critical of the adults involved.

  • Researchers have found differences in the brains of cisgender males and females. Robert M. Sapolsky, in an article in The Wall Street Journal, described:
  • "... an obscure brain region called the forceps minor -- a part of the corpus callosum, a mass of fibers that connect the brain's two hemispheres. On average, among nontranssexuals, the forceps minor of males contains parallel nerve fibers of higher density than in females." 1

During the 1990s, scientists started to study the brains of transgender adults. They found that female-to-male (FTM) transsexuals did not have the forceps minor nerve fiber density of females -- the gender with which they were identified at birth. Rather their nerve fiber density in that brain structure matched that of males -- the sex that they currently identify as being.

This observation supports the very common belief among FTM transsexual persons that they posses a "female body and a male brain" -- or vice-versa for MTF transgender persons. Their comment appears to be literally true. Actual physical structures in their brains are telling them that they are of the opposite gender to their birth-identified gender. That message appears to be immune to counseling and therapy.

MTF transgender persons are the reverse.

  • The entry for transgender identity in American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders" has been changed. In 1968. transgender identity was listed under "sexual deviations." This was changed to "psychosexual disorders" in 1980, and to "sexual and gender identity disorders" in 1994. That term was widely regarded as stigmatizing because of the presence of the word "disorder." The implication was that being transgender is a form of mental illness. The term was changed to "gender dysphoria" in 2013. This new designation only applies to those transgender persons who are experiencing distress or dysfunction because of their transgender status.

"Dysphoria" is a psychiatric term that means: "a state of unease or generalized dissatisfaction with life." In other words, the fundamental problem was not that a person identifies as a gender different from their birth-identified gender. It is that they can be profoundly negatively affected by that change. If untreated, it can lead to serious depression and even suicidal ideation.

In a study published in Lancet Psychiatry, Dr. Geoffrey Reed and co-authors reported on their interviews of 250 patients at a clinic that provides transgender health services in Mexico City. 7They found that while most had felt distress related to their gender identity during teenage years, almost a fifth of them reported none. 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. Similar studies were being conducted in Brazil, France, India, Lebanon, and South Africa.

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Similarities between sexual orientation and gender identity:

In the past, lesbians and gays went through a similar sequence in terms of classification of their minority sexual orientation:

  • Historically, homosexuality was long viewed by Christianity as a great sin -- one that would prevent persons who are sexually active with members of the same gender to attain Heaven after death. Most conservative Christians still retain this belief today, mainly because they believe the Bible to be inerrant -- without error.

  • To be openly homosexual during colonial times in the U.S. was to risk being arrested, tried, convicted, and executed. The death penalty remains on the books in many countries of the world, predominately those with a majority Muslim population.

  • Researchers started to study sexual orientation in the late 19th century. Initially, mental health practitioners viewed homosexuality as a mental disorder. However, this conclusion appears to be false, because the gays and lesbians studied were psychiatric patients.

  • Evelyn Hooker (1907-1996) had the novel idea in the 1950's to compare a group of gay males from the general population with a comparable group of heterosexual males. She:

    "...published the first empirical research to challenge the prevailing psychiatric assumption that homosexuality was a mental illness. Her work was the cornerstone for an entire body of research. ..." 2

  • Her research eventually led to the American Psychiatric Association's (APA) decision in 1973 to change the reference to homosexuality in their Diagnostic and Statistical Manual of Mental Disorders. It became "sexual orientation disturbance" in 1973. This implied that homosexuality itself was not a problem. It sometimes caused problems that people had in accepting their sexual orientation. It was later changed again to "ego-dystonic homosexuality." In 1987, it was removed entirely.

    Homosexuality, bisexuality, and heterosexuality are now widely regarded by therapists as normal, natural, and unchosen sexual orientations that are fixed in adulthood. It has been found in over 1,500 species of social birds and mammals -- particularly among sea mammals and primates. 8

  • Public opinion followed suit decades later, to the point where, in early 2016, about 60% of U.S. adults favor marriage equality for persons of all sexual orientations. It continues to increase.

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World Health Organization's (WHO) reclassification of transgender persons and transsexuals:

The WHO publishes a book called the "International Classification of Diseases," or "I.C.D." It is informally referred to as the "WHO Codebook." It classifies diseases, disorders, and treatments. The current edition classifies transgender individuals as suffering from a mental disorder.

Professor Geoffrey Reed, a professor at the National Autonomous University of Mexico is an author of a new transgender study, and is coordination the mental health and behavior disorders section of the new I.C.D.

He noted that:

"The intention is to reduce barriers to care,"

and that removing transgender from the mental disorder category was:

"... not getting opposition from the WHO."

Dr. Michael First is a professor of clinical psychiatry at Columbia University and the chief technical consultant to the new edition of I.C.D. He said that the removal is:

"... sending a very strong message that the rest of the world is no longer considering it a mental disorder. One of the benefits of moving it out of the mental disorder section is trying to reduce stigma."

One suggestion was that it be moved to a new category: "Conditions related to sexual health." That way, "transgender" would remain in the codebook and could still be used for billing and insurance coverage. However there is opposition. Dr. Griet De Cuypere is a psychiatrist at the Center of Sexology and Gender at University Hospital in Ghent, Belgium, and a board member of the World Professional Association for Transgender Health. He said:

"I think there is a bit of a problem with the idea of putting it in a chapter on sexual health because it has nothing to do with sex. If it’s possible to have it more separately, it would be better."

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A second problem is that some professionals want to change the description of the term "transsexual" to "gender incongruence." This presents a problem in some languages. Dr. Reed said:

"In English it sounds kind of neutral -- my association is with geometry. But in Spanish it sounds very bad, it sounds kind of psychotic. ... 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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2018-JUN-20: The World Health Organization (WHO) reclassified transgender identity:

WHO has issued an updated edition of its International Classification of Diseases [ICD].

Gender Incongruence -- that is, being transgender, is now described as being:

"... characterized by a marked and persistent incongruence between an individual’s experienced gender and ... [their birth] assigned sex.

Dr. Jennifer Conti, a fellow at Physicians for Reproductive Health described a male to female (MTF) transgender individual as:

"... a person who was born with a penis and is biologically male but identifies as female. ... We’ve historically misclassified a lot of conditions in medicine because of a combination of stigma, fear and misunderstanding. ..."

"By changing the class of this condition, the WHO is effectively saying to everyone and to the world that this is not a mental disorder and we support people who are transgender. It’s a really meaningful step because it promotes inclusivity; it promotes acceptance."

It has now been reclassified as a "sexual health condition."

Dr. Lale Say, coordinator of WHO's Adolescents and at-Risk Populations team, said:

"It was taken out from the mental health disorders because we had a better understanding that this wasn't actually a mental health condition and leaving it there was causing stigma. So in order to reduce the stigma while also ensuring access to necessary health interventions, this was placed in a different chapter."

According to WHO:

"... there remain significant health care needs that can best be met if the condition is coded under the ICD. That makes it easier for transgender people to seek hormonal or surgical treatment." 5

The transgender support group, WhyWeMarch.LGBT tweeted:

"Great news! The World Health Organization (WHO) has finally announced it will declassify being Transgender as a mental disorder in the new [edition of the] International Classification for Diseases (ICD), the ICD-11.

Ann Travers, a sociology professor and author at Simon Fraser University in British Columbia, Canada, who is herself transgender, said:

"There’s a long, long history of looking at gay and lesbian and trans people as depraved, criminal, mentally ill, and we seem to be witnessing a significant sea change. It’s one in a long line of positive changes that move us away from viewing sexual and gender diversity as pathological. ... I grew up thinking there was something terribly wrong with me, both for being attracted to women and not being gender conforming. ... What does this mean in terms of insurance and access to insurance etc., to cover health care? That’s my concern," 5

Tessa Vikander, writing for The Star/Vancouver, said:

"Elizabeth Saewyc, director of the UBC School of Nursing and a lead researcher on transgender health, participated in WHO’s consultation process about two years ago when the change was being discussed. She thinks it makes more sense to treat trans people from a physical body approach, than a mental illness approach, and said trans people who are experiencing mental health issues will still be able to access that care, but being trans in and of itself, will no longer 'automatically' be something that requires mental health treatment.

'Some of the mental health disparities we’ve seen for transgender people are due not to the gender identity issues but rather to the stigma and discrimination and really unpleasant treatment that they’re getting from the wider society and from family and friends,' she said." 5

Some transgender health experts expect gender dysphoria to be removed from the next issue of the American Psychiatric Association's "Diagnostic and Statistical Manual" (DSM).

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2018-SEP-17: The American Academy of Pediatrics (AAP) published a policy statement on transgender children and youth:

The AAP issued a policy statement, saying:

"In its dedication to the health of all children, the American Academy of Pediatrics strives to improve health care access and eliminate disparities for children and teenagers who identify as lesbian, gay, bisexual, transgender or questioning (LGBTQ) of their sexual or gender identity.

Despite some advances in public awareness and legal protections, youth who identify as LGBTQ continue to face disparities that stem from multiple sources, including inequitable laws and policies, societal discrimination, and a lack of access to quality health care, including mental health care. Such challenges are often more intense for youth who do not conform to social expectations and norms regarding gender."

Among the recommendations made by the AAP are:

  • Transgender and gender-diverse children, their parents, caregivers, and siblings should be allowed to access family-based therapy and support.

  • Transgender youth have the right to be referred to and treated according to their gender identity.

  • Insurance plans should cover transition-related care, including hormones and even potential surgery, that have been ruled medically necessary. 6

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References used:

The following information sources were used to prepare and update the above essay. The hyperlinks are not necessarily still active today.

  1. Robert M. Sapolsky, "Caught Between Male and Female," The Wall Street Journal, 2013-DEC-06, at: http://www.wsj.com/
  2. "Evelyn Hooker, PhD," at: http://psychology.ucdavis.edu/rainbow/html/hooker.html
  3. Pam Belluck, "W.H.O. Weighs Dropping Transgender Identity From List of Mental Disorder," New York Times, 2016-JUL-26, at: http://www.nytimes.com/
  4. Caroline Simon, "Being transgender no longer classified as mental illness. Here's why," USA TODAY, 2018-JUN-20, at: https://www.usatoday.com/
  5. Tessa Vikander, "WHO move to reclassify transgender identity will reduce stigma and increase access to health care, B.C. advocates say," The Star/Vancouver, 2018-JUL-04, at: https://www.thestar.com/
  6. John Riley, "American Academy of Pediatrics calls for “gender-affirming” approach to treating transgender youth," Metro Weekly, at: https://www.metroweekly.com//
  7. G.M. Reed et al., "Gender incongruence of childhood in the ICD-11: controversies, proposal, and rationale. Lance Psychiatry, 2016, Voiume 3, Pages 297 to 304.
  8. "List of mammals displaying homosexual behavior," Wikipedia, as on 2018-OCT-07, at: https://en.wikipedia.org/
  9. "1,500 animal species practice homosexuality," News Medical, 2006-OCT-23, at: https://www.news-medical.net/

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Copyright 2018 by Ontario Consultants on Religious Tolerance
Original posting: 2016-OCT-18
Latest update : 2018-OCT-18
Author: B.A. Robinson

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