This site is intended for health professionals only

At the heart of general practice since 1960

Transgender identity shouldn’t be classed as mental disorder say researchers

Transgender identity should be removed from the ICD classification of mental disorders to increase ‘access to appropriate services’ and reduce 'the victimisation of transgender people’ according to a study published in Lancet Psychiatry.

Researchers in Mexico found that transgender people largely experience distress as a result of social rejection, rather than as a result of their gender identity. 

WHO’s classification of diseases, the latest of which is ICD-10, currently lists ‘transgender identity disorders’ as a mental illness, under the category ‘disorders of adult personality and behaviour’. ICD-10 is what most clinicians in the UK use to diagnose mental disorders.

However, the researchers suggest that gender identity categories should be removed from the ICD classification of mental disorders, as ‘distress and dysfunction, considered to be defining features of mental disorders, were not universal and were found to be more strongly related to experiences of stigmatisation and violence than to gender incongruence’.

This would be ‘a useful instrument in the discussion of public health policies aimed at increasing access to appropriate services and reducing the victimisation of transgender people.’ 

This is in line with the proposed guidelines for the upcoming ICD-11, which - if implemented - would remove gender incongruence from the classification of mental disorders and put it into a different category on conditions related to sexual health.

The study participants, who were 250 transgender adults receiving healthcare at a specialist centre, often had distress and dysfunction, but this was by no means universal and this was ‘more strongly predicted by experiences of social rejection and violence than by gender incongruence’. This suggests that this distress was caused by ‘stigmatisation and maltreatment rather than integral aspects of transgender identity.’

Lead investigator, Dr Rebeca Robles from Mexican National Institute of Psychiatry said: ’Our findings support the idea that distress and dysfunction may be the result of stigmatization and maltreatment, rather than integral aspects of transgender identity… The next step is to confirm this in further studies in different countries, ahead of the approval of the WHO revision to International Classification of Diseases in 2018.”

This comes after the GMC advised GPs to initiate hormones in patients with gender dysphoria in specific circumstances, which the GPC has argued would lead to GPs prescribing outside their competence.


Readers' comments (6)

  • QUite: it's not a disease so let's not get involved as doctors at all?

    Unsuitable or offensive? Report this comment

  • @5:52 - management of transition involves administration of hormonal treatments with complex monitoring and risk profiles, so I don't know how you propose to do this without doctors.
    They're also high risk patients for anxiety/depression/suicide, so close contact and good relationships w. health professionals crucial to avoid preventable harm.

    Unsuitable or offensive? Report this comment

  • not a disease, not a Dr problem.
    Want hormones, no problem. Buy them off the internet and do your own monitoring.
    If you want me as a GP in the NHS to be involved it needs shared care with a specialist or nothing at all

    Unsuitable or offensive? Report this comment

  • It's a shame you've buried a sensible point (re: shared care) amongst callous and compassion-less rejection of an entire patient group. I take it you tell menopausal women to buy their HRT online? Gender dysphoria is still a condition, and should be managed by doctors - the point here is that the label it has as a mental health condition is outdated. That doesn't remove it's status as a manageable condition, and it doesn't let you wash your hands of a patient group you seem so keen to disregard.

    I genuinely would like to see a consultation where you implement your last statement - CAMHS and eating disorder services are equally problematic, but I doubt you would simply refuse to get involved in their care.

    Unsuitable or offensive? Report this comment

  • CAMHS and eating disorders. There is a problematic area.
    Should we GPs pick up all the work that should be done by specialists because the NHS fails to provide sufficient levels of clinical care?
    My view is that we should not.
    In the same way that patients suffer because their hernia surgery is delayed patients suffer because their psychotherapy is delayed.
    I do not provide hernia surgery or psychotherapy.
    (I actually have qualifications in both of the above but that is not what a GP provides)

    Unsuitable or offensive? Report this comment

  • But you would provide symptom control and conservative management advice about interim measures while awaiting secondary care, which is what is required for gender dysphoria patients. If someone came in with abdominal pain as a result of their hernia, you'd not just refuse to see them.

    The 'It's not part of our job' mentality is quite rigid, the prevalence of conditions varies and new conditions emerge, and we can't just wash our hands of learning how to manage these newer issues. But I appreciate my knowledge of funding work for these conditions is restricted and beyond my current level of understanding.

    The principles of managing dysphoric symptoms aren't that complicated, and at least fall in line with some other similar prescribing fields (eg. GnRH antagonists, HRT etc) and can be learnt in about a half hour of CPD.

    Unsuitable or offensive? Report this comment

Have your say