The World Health Organization (WHO) has made an historic change, ending the era in which being transgender was considered a mental illness. In doing so, it has significantly undermined the Trump administration’s purported rationale for banning transgender people from military service.
In a new revision to the International Classification of Diseases (ICD-11) — the first since 1992 — the language to describe transgender identities has been changed and moved. Instead of using the term “transsexualism,” the manual now refers to “gender incongruence,” and it is now listed among sexual health conditions — not mental disorders.
The WHO explained in a press statement that the “evidence is now clear that it is not a mental disorder” and listing it as such “can cause enormous stigma for people who are transgender.” It remains listed elsewhere in the manual because the WHO recognizes that “there remain significant health care needs that can best be met if the condition is coded under the ICD.”
Dr. Lale Say, coordinator for the WHO’s Department of Reproductive Health and Research, explained in an accompanying video that by reducing stigma, the change may increase access to care for transgender people. She also preemptively countered a common talking point about conservatives that this was just a political decision. “In this case, the decision was not only based on the advocacy or feedback from the concerned communities,” she explained. “All available evidence was reviewed and discussed by an external advisory group, and [that evidence] — together with the scientific basis of this condition and the feedback from the professional community and concerned communities — formed the basis of this decision.”
The ICD is used worldwide, offering a universal model for comparing health systems country to country, meaning the implications could be far-reaching. It is even the official system for the United States, despite the prominence of the Diagnostics and Statistics Manual (DSM) developed by the American Psychiatric Association, which means it has implications here as well.
These changes were forecasted by the medical experts who consulted on President Trump’s ban on transgender people serving in the military last fall. This is how the minutes from the November 9th committee meeting describe the conversation they had:
When asked if Gender Incongruence was in the current Diagnostic and Statistical Manual of Mental Disorders, the medical experts stated that it was not. It will, however, be included in the next update to the International Classification of Diseases (ICD) codes when ICD version 11 is released. Gender incongruence is, however, currently included in the latest version of the Endocrine Society Guidelines.
When asked why the military medical specialists previously stated that transgenderism is not a medical condition, none of the medical experts could explain why that would be true. Transgenderism is the incongruence between one’s body and how that person sees themselves. There is no need to have a mental health concern in order to have medical procedures to facilitate a transition. The evolution to ICD 11 will make gender incongruence a sexual health issue.
In the rationale issued in March, the Trump administration explained that transgender people could not serve because of doubts about their mental health outcomes. But the doubts are not substantiated by the research, as evidenced by the WHO’s change to the ICD.
As a result, the trans ban is now flagrantly out of sync with even the diagnostic health manual the U.S. government uses. The administration is using its rationale to defend the ban in four different court battles, and the ICD change makes their case all the weaker.