Gender diagnoses

For trans and gender diverse people wanting to access medical affirmation, this care sits in an unusual position. Unlike someone who is sick with a mental or physical illness, or has a disease that requires surgery, many of us seek medical support without being ill at all.

Historically, the trans experience has only been considered a mental illness and has been associated with diagnoses including ‘Gender Dysphoria’, ‘Gender Identity Disorder’, and ‘transsexualism’.

This page shows current developments that move away from pathologisation and towards affirmation in health and other settings, and the history of diagnoses and healthcare that has lead us to this point

Gender Incongruence

In 2019, the World Health Assembly of the World Health Organization (WHO) endorsed two new diagnostic codes: Gender Incongruence in Adults and Adolescents, and Gender Incongruence in Childhood, for the 11th edition of its International Classification of Diseases (ICD-11).

This endorsement takes the medicalisation of trans people out of the Mental Health chapter and into a newly established Sexual Health chapter, alongside other hormonal and urogenital related issues.

Part of this is a move away from requiring trans people to be experiencing distress or pain (ie. In the case of Gender Dysphoria), and a recognition that misery isn’t synonymous with being trans. In healthcare settings, treatment provided for distress is captured by the ICD-11 codes related to anxiety and depression, and not as an inherent part of trans experience.

This is part of the global shift in healthcare toward recognising that access to gender affirmation should be facilitated, and is medically necessary, for any person whose gender is different to what was presumed for them at birth. For those accessing surgery, this change encompasses the breadth of experience held by trans people wanting and requiring surgeries.

The WHO ICD-11 codes are as follows:

Gender Incongruence of Adolescence and Adulthood is characterized by a marked and persistent incongruence between an individual´s experienced gender and the assigned sex, which often leads to a desire to ‘transition’, in order to live and be accepted as a person of the experienced gender, through hormonal treatment, surgery or other health care services to make the individual´s body align, as much as desired and to the extent possible, with the experienced gender. The diagnosis cannot be assigned prior the onset of puberty. Gender variant behaviour and preferences alone are not a basis for assigning the diagnosis.

HA60 Gender incongruence of adolescence or adulthood - WHO ICD-11

Gender incongruence of childhood is characterized by a marked incongruence between an individual’s experienced/expressed gender and the assigned sex in pre-pubertal children. It includes a strong desire to be a different gender than the assigned sex; a strong dislike on the child’s part of his or her sexual anatomy or anticipated secondary sex characteristics and/or a strong desire for the primary and/or anticipated secondary sex characteristics that match the experienced gender; and make-believe or fantasy play, toys, games, or activities and playmates that are typical of the experienced gender rather than the assigned sex. The incongruence must have persisted for about 2 years. Gender variant behaviour and preferences alone are not a basis for assigning the diagnosis.

HA61 Gender incongruence of childhood - WHO ICD-11

Gender incongruence is the latest in a long lineage of words that have been used by or applied to trans people, and it is unlikely to be the last either. But don’t worry - we will keep TransHub updated as guidelines and language shift.

The diagnostic labels used by and for trans people have changed dramatically over the last century. In many parts of the world today our communities claim and use the words that best fits who we are, and we are actively contributing to how language is formed to describe us, and our needs.

In the past, this language was almost always created by cis doctors or researchers, and trans communities were rarely part of the process. For instance, the words ‘transgender’ and ‘transsexual’ were given to us by doctors.

Even though trans people have existed throughout human history, language for diagnosing trans people accessing medical affirmation is relatively new, because the notion that we need and deserve medical care is also new.

Historically we have been considered perverted anomalies, requiring comprehensive psychiatric treatment. Many of our forbears suffered through experimental and violent interventions that sought to change or remove their trans experience to that of being cis. It didn’t work and is now broadly accepted as harmful. An affirmative model of care is increasingly popular across both the trans and medical communities, as is the growing numbers of expert physicians, policy makers, and researchers who are also trans.

Hey! The following section includes words that some people consider to be slurs. We have blacked-out every letter after the first one, and you can see the word by hovering over them.

  • 1910
    Physician and advocate Dr. Magnus Hirschfeld coins the word ‘transvestite’ (from Latin trans-, "across, over" and vestitus, "dressed"), but recognised that the term did not account for the internal lives of many of his patients. Hirschfeld went on to found the Institut für Sexualwissenschaft (Institute of Sexual Research), which became a haven for trans people of the day, and performed several of the first genital reconfiguration surgeries.
  • 1933
    Dr. Magnus Hirschfeld’s library was looted and burned by Nazis in Berlin, and his Institute of Sexual Research was firebombed. These events arguably set trans health research back by decades.
  • 1953
    Dr. Harry Benjamin, a cisgender man who worked with Hirschfeld, is claimed to have used the term ‘transsexual’ for the first time during a lecture, and goes on to use the term in his 1966 book ‘The Transsexual Phenomenon’.
  • 1965
    The term ‘transgender’ was coined by Dr. John Oliven, and popularised by trans people around the world.
  • 1970s
    The term 'tranny’ was used by trans women in Australia and America as a term that didn’t have medical origins. Though this term is now used most often as a slur, it was used to describe community and pride at the time.
  • 1973 - APA
    American Psychiatric Association (who publish the Diagnostic Statistical Manual (DSM)) issued a resolution stating that homosexuality was not a mental illness or sickness.
  • 1974
    First Transvestite and Transsexual Conference at University of Leeds, that brought activists, social workers, and physicians together to discuss healthcare, language and relationships between all parties.
  • 1979-1998 - ICD-9
    Inclusion of Sexual and Gender Identity Disorders (302) including, transsexualism and gender identity disorder in children, alongside transvestic fetishism, exhibitionism, ego-dystonic sexual orientation, and pedophilia.
  • 1980 - DSM 3
    Gender Identity Disorder was included in the DSM for the first time, to describe "transsexualism". The specified categories were: "GID/Children Transsexualism"; "GID/Adolescent and Adult, Non-transsexual type" and "GID/Not Otherwise Specified".
  • 1980s - Autogynephilia
    Coined by researcher Dr Ray Blanchard, to describe what was seen as sexual arousal by a person “at the thought of ... themselves as a woman.” There is no credible research that supports this theory.
  • 1981
    Sydney-based Australian Transsexual Association established, with activist, academic and author Roberta Perkins as a member.
  • 1987
    Estelle Asmodelle became possibly Australia's first person to have her gender legally recognised by the Births, Deaths and Marriages Department of New South Wales.
  • 1994 - DSM 4
    'Gender Identity Disorder in Adolescents and Adults' replaced the term transsexualism in the DSM IV.
  • 1999 - ICD-10
    Inclusion of Gender Identity Disorders (F64) including, transsexualism, dual-role transvestism, and gender identity disorder.
  • 2013 - DSM 5
    Gender dysphoria replaces Gender Identity Disorder in the DSM V, placing the emphasis on distress rather than a disordered identity.
  • 2018 - ICD-11
    The codes F64 Gender identity disorders and F65.1 Fetishistic Transvestism are removed from the newly updated ICD.
  • 2019 - ICD-11
    Gender Incongruence in Adults and Adolescents, and Gender Incongruence in Childhood endorsed. The code states "Gender variant behavior and preferences alone are not a basis for assigning the diagnosis."