Depathologizing gender diversity in ICD-11

The new 11th release of International Classification of Diseases (ICD) is coming soon. Diagnoses related to gender variance are those that are likely to be altered in this version. Despite wide acceptance among trans* community that these diagnoses must be changed, there’s a big diversity in opinions on how exactly this should be done. So, I’ll start by mentioning the options currently under discussion.

If speaking of what now is called “transvestic fetishism”, this diagnosis should be eliminated completely. But when we move to those states that are ascribed by “transsexualism” diagnosis, there’s a great deal of opinions. Unlike “transvestism” (or earlier depathologised “homosexuality”), people now diagnosed with “transsexualism” sometimes want some kind of body modifications, either by hormones or by surgery. This fact discourages many trans* activists from requesting the complete removal of the diagnosis and makes them argue for its preservation in some form or another. The suggested options include moving the diagnosis from psychiatric disorders (F codes) to a different existing or specially created class in ICD. The less pathologizing option is class Z (“Factors influencing health status and contact with health services”), the others include moving to nervous or endocrine diseases.

When speaking about the new name for the category, “gender dysphoria” (as in DSM-V), “gender incongruence”, “gender/body divergence”, “gender non-conformity” and several other were proposed. While “gender dysphoria” is not suitable for access to medical interventions by trans* people who do not have any dysphoria, “gender incongruence” and “gender/body divergence” are still pathologizing whatever class they are put in, as they follow pathology/treatment model. Within this model the “incongruence” is the problem, which is “corrected” using hormone therapy or surgery in order to “align”. But what is most worrying to me as a transfeminist in all these titles is that they all fail to separate gender from sex. They assume that there’s some problem with our gender and that’s why we need to do something with our sex.

Another pitfall is that this way of thinking supports the idea that we need some reason to modify our bodies. A question arises: who do our bodies belong to? Do they belong to the state, to the society or to ourselves? If we answer with the last option, then why do we need an excuse, be it “dysphoria”, “incongruence” or whatever you call it, to modify our bodies that solely belong to our own? Given these considerations, I do support moving to Z codes, however, I’m against any mentioning of gender in the name of the code. If this is a modification of genitals, call things by their names, don’t mix it with gender! In my opinion, under Z codes there must be a subcategory on body modifications, whether they affect sex or not.

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