ICD-11 represents major shift in the classification of gender identity-related health
The World Health Organization’s International Classification of Diseases 11th revision (ICD-11) came into effect in February 2022 and includes significant updates to the classification of gender identity-related health compared with ICD 10th revision (ICD-10).
Gender identity disorder' and ‘transsexualism’ have been replaced with ‘gender incongruence’.
New diagnostic categories have been moved out of the ‘Mental and behavioural disorders’ chapter and into the new ‘Conditions related to sexual health’ chapter.
Minor changes have also been made to terminology used in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR), published in March 2022.
Use of ‘experienced gender’ rather than ‘desired gender’.
Use of ‘gender-affirming’ rather than ‘cross-sex’ in relation to treatment and medical procedures.
It is hoped that the updates to language used in ICD-11 and DSM-5-TR will help remove stigma associated with gender diversity.
Gender dysphoria, also known as gender incongruence, is present when there is a distressing dissonance between a person's biological sex and associated social gender role, as assigned at birth, and that person's sense of their own gender.
Many adults with gender dysphoria will not seek specialist medical intervention, and prevalence is likely underestimated.
In children and adolescents, gender dysphoria is particularly complicated, may have higher comorbidity, and may change form as patients mature, making specialist assessment particularly important. This topic covers the management of gender dysphoria in adults only.
Subspecialty consultation is required for any patient with suspected or confirmed gender dysphoria (gender incongruence). Treatment is complex and should only be undertaken as part of a package of care provided by a multidisciplinary team with extensive experience in this area.
Gender non-conformity is when a person’s gender identity, role, or expression differs from the cultural norms prescribed for people of a particular sex.
Gender dysphoria, also known as gender incongruence, is present when there is a distressing dissonance between a person's biological sex and associated social gender role, as assigned at birth, and that person's sense of their own gender. 'Gender identity disorder' and related terms should be avoided due to their connotations with mental ill health and the associated stigma. APA: gender dysphoria Opens in new window WHO: FAQs Gender incongruence and transgender health in the ICD Opens in new window
People with gender dysphoria express the desire to live and be accepted in a social gender role other than that assigned at birth. Gender dysphoria is usually accompanied by a sense of discomfort with one's own body, particularly those primary and secondary sexual characteristics others use to assign social gender role, such as genitals, breasts, or facial hair.
Only some gender non-conforming people experience gender dysphoria at some point in their lives.
The historical terms ‘transvestite’ and ‘transsexual’ are considered pejorative, and their use should be avoided.
History and exam
Key diagnostic factors
- incongruence between birth-assigned gender and experienced gender
- altered appearance or affect
- congenital adrenal hyperplasia
- partial androgen insensitivity syndromes
- Klinefelter's syndrome
1st investigations to order
- serum testosterone
- serum dihydrotestosterone
- serum follicle-stimulating hormone (FSH) and luteinising hormone (LH)
- serum prolactin
- serum liver function tests
- serum lipid screen
James Barrett, FRCPsych, BSc, MSc
Consultant Psychiatrist and Lead Clinician
Charing Cross Gender Identity Clinic
JB has produced educational material for the Royal College of Physicians Gender Healthcare course and is a tutor on the course. He has occasionally received payment for speaking engagements on the subject and usually gets paid expenses. JB is an author of a number of references cited in this topic.
Roy Goldberg, MD
Kings Harbor Multicare Center
RG declares that he has no competing interests.
Craig N. Sawchuk, PhD
Affiliate Assistant Professor
Department of Psychiatry and Behavioral Sciences
University of Washington Medical Center
CNS declares that he has no competing interests.
- Body dysmorphic disorder
- Ego-dystonic sexual orientation
- Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR)
- International Classification of Diseases 11th revision (ICD-11)
Gender dysphoria in adults: what is it?
Gender dysphoria in adults: surgeryMore Patient leaflets
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