WHO Abstains From “Transgender” Guidelines For Minors

This is a quick update about WHO’s plan for creating a “transgender” health guidelines. It was announced in late December and the consultations were supposed to begin on February. We outlined some major problems about the plan in an editorial early January. We thank all of our readers who took action either by signing petitions or by sending emails to WHO highlighting those problems.

As a result of actions from people across the world, WHO published a FAQ regarding the “transgender” health guideline. WHO has now announced that the guideline is only for adults who suffer from gender dysphoria. They have completely excluded children and adolescents because of a lack of research findings of the effect of gender affirmative care on children and adolescents. You can find the full document here.

While exclusion of children and adolescents from the guidelines is definitely progress, it was by far not the only problem with WHO’s stance on the issue. In this article, we’ll highlight how the WHO has attempted to change its conceptualization of gender dysphoria from a mental illness to a condition that is not so serious to be classified as a mental disorder, yet serious enough to absolutely require a specialized form of treatment: gender affirmative care, lack of which would be terribly hurtful to them. This piece is a short critique of this step. This article does not deal with many other problems on this proposition, which we have already discussed in our original editorial.

ICD Classification

The International Statistical Classification of Diseases and Related Health Problems (ICD) is an official taxonomy of disorders published by the WHO. It consists of a list of physical and mental disorders along with systemized sets of criteria for classification into any of the disorders. ICD is widely used by physicians across the world for diagnosis. One chapter of ICD is dedicated for mental disorders, and serves as the primary system of classification outside US (which uses DSM system prepared by American Psychiatric Organizaiton).

The WHO periodically updates ICD to keep up to date with the latest research findings. The ICD is currently in its 11th edition, which was recently published in 2022. In the 10th edition, the “transgender” behavior was categorized as “transsexualism” and “gender identity disorder of children”. They have now been replaced by “gender incongruence of adolescence and adulthood” and “gender incongruence of childhood” respectively. They have also been moved from “Mental and behavioral disorders” into the new “Conditions related to sexual health” category. In other words, it has been removed from the chapter that deals with mental disorders, indicating that WHO does not believe gender incongruence to be a mental illness.

There are some obvious flaws in this reasoning. The obvious one being that if gender dysphoria is not a mental illness, why place it in ICD at all? Why not remove it altogether just like homosexuality was completely removed? Other “conditions” that fall under the same heading include sexual dysfunctions, sexual pain disorders, changes in female/male genital anatomy, paraphilic disorders, adrenogenital disorders and predominantly sexually transmitted infections. With an exception of paraphilic disorders, all other disorders are primarily physical in nature. Even if they are psychogenic (i.e. have psychological causes), the physical symptoms are way more intense than psychological ones. The same cannot be said for gender “incongruence” or paraphilia. A discussion of why paraphilia is listed under the same heading would be out of scope of this article.

Gender dysphoria has primarily psychological manifestations with little or no physical symptoms. The psychological distress a dysphoric suffers from is not merely rooted in stigma and lack of acceptance of their condition by the society, as the WHO FAQ document would have you believe. Their distress is rooted in their own personal dissatisfaction with their bodies. That is something that no amount of gender affirmative services can cure. High rates of comorbidity with other mental disorders (e.g. childhood trauma, depression, autism spectrum disorder, personality disorders) and high suicide rates even after sex reassignment surgeries further strengthens this point.

Another interesting point is that all of the other disorders listed in the category of “conditions related to sexual health” are related to sexual behavior. “Transgender”, on the other hand, is not related to sexual behavior at all. Even by the definition put forward in ICD;

[g]ender incongruence is characterised by a marked and persistent incongruence between an individual’s experienced gender and the assigned sex.

It is merely a dissatisfaction one feels with one’s biological sex, or the gender roles assigned with one’s sex. It does not have anything to do with sexual behavior at all. So, why was it included in this particular chapter at all?

Why is WHO pushing for a reconceptualization and gender affirming care?

The renaming and shifting of categories begs the questions of why WHO, despite no reliable empirical support, is so inclined to recreate the entire concept of “transgenderism”: and a contradictory concept at that. According to WHO, “transgenderism” is not a serious issue, therefore it was removed from the list of “Mental and behavioral disorders.” Yet, it is so serious that it should still be included in ICD, albeit in a category that does not make sense at all. Also, it should be dealt with a very specialized form of treatment, lacking which the person suffers with all sort of consequences: stigma, inability to access health care, etc.

The FAQ document makes it perfectly clear that WHO is pushing only for gender-affirming care (with no substantial evidence and flawed logic). They have made this clear before the actual consultations. Consultations are supposed to guide conclusions. Yet, it seems that WHO already has its conclusion ready. All they had to do was to direct the consultations accordingly. Now, it seems less confusing why the panel was filled with people who have been vocally pushing for gender-affirming care.

Graphic by Benja Weller