Controversies in Gender Diagnoses

Abstract

This article presents the author's thoughts on gender diagnosis controversies during his tenure at the DSM-5 Workgroup on Sexual and Gender Identity Disorders and the ICD-11 Working Group on the Classification of Sexual Disorders and Sexual Health. The work summarizes some of the published conclusions of the DSM-5 and ICD-11 revision processes regarding three particular controversies: (1) stigma versus access to care; (2) the retention of a child gender diagnosis; and (3) the treatment of prepubescent transgender children. Both the DSM and ICD work groups decided that despite the stigma associated with a diagnosis, retaining an adolescent and adult gender diagnosis is necessary to maintain access to care. As for the child gender diagnosis, given the heterogeneity of this clinical population and that gender dysphoria does not persist in most children, a child diagnosis of Gender Dysphoria (DSM) and Gender Incongruence (ICD) should be retained to facilitate ongoing evaluation and management in childhood while acknowledging the uncertainty of the outcome. The treatment of extremely gender variant prepubescent children remains a controversial subject since some underlying assumptions of the treating clinicians are a matter of opinion rather than of empirical data.