First update: Gender-critical comments on WHO’s proposed faulty new definitions of transgenderism in ICD-11

As you know, the World Health Organization has hooked up with a bunch of obsessed tranny activists/narcissists and their ethically-challenged gaggle of “scientist” admirers in order to re-define transgenderism. The goal of this re-definition is to de-pathologize transgenderism (i.e. removing the idea that there could possibly be something mentally a bit “off” with crazed transgenderist cravings for drastic unnecessary surgeries in their otherwise healthy bodies) but also to ensure that tranny surgeries to create these fuck-holes to nowhere and other abominations are fully covered by medical insurance. The new catch-all term is “gender incongruence.” It is placed under “Sexual health” for some reason, not “Mental health.” Even “gender incongruence of childhood” is disturbingly filed under “Sexual health.” You can see where that will lead.

Since I posted my appeal to gender-critical folks last week, to please comment on WHO’s proposed new definitions of transgenderism, many brilliant women have posted excellent and inspiring comments on WHO’s site. (I am nearly certain that all have been women, except myself.) Several obsessed trannies and their enablers have also posted there, but their comments are feeble, & sometimes obviously crazy.

I feel it’s important to preserve the excellent gender-critical comments. Here are a few of them. Although many commenters provided their names on WHO’s site, I will give only their initials here (out of concern for safety).

Under “Conditions related to sexual health”:

MC said:

WPATH is a crooked, opportunistic attempt by for-profit interests to manipulate public opinion and WHO digagnosis codes that serve the pharmaceutical and cosmetic surgery business and its clientele NOT the global health community.

Furthermore, the mental disorder of dysmorphia in children and adults (whether it be anorexia, bulimia, or gender obsession) is deserving of psychological treatment and social health support such as anti-bullying policies and safe spaces for all. To medicalize personal expression of identity (including gender obsession) and call it a sexual health problem is to deny its psychosocial etiologies. It is also to deny its negative sequelae which include longterm physical health damage from hormonal manipulation, risk of death due to a high number of cosmetic surgeries per transgender patient, and absolutely unsustainable environmental realities.

LC said:

Gender is a social construct, not biological and not related to sexual preference.

The WHO’s Commission on Women emphasizes that gendering is a hierarchy of social injustice & stereotypes towards women, perpetuated towards children.

“Gender Incongruence” is a fabricated diagnosis promoted by the “World Professional Association for Transgender Health” (WPATH) which has a strong desire to validate the adult surgical transsexual trend at the expense of children, and to collude with unethical profiteering by pharmaceutiful companies and cosmetic surgeons.

The lobbyists of the non-evidence based WPATH (World Professional Association for Transgender Health) as well as others who seek to profit through pharmaceutical prescribing and surgical alteration need to be thoroughly examined by the World Health Organization – from the perspective of Children’s Rights and Human Rights.

Lesbian and Gay are sexual preference categories – Transgender people are a gender performance category. These two categories should not be lumped together when addressing conditions related to sexual health.

In response to a trans apologist saying that WPATH’s recommendations are “heavily evidence-based,” AC (that’s me) said:

Actually, it’s not. It’s based on various small case series, small retrospective cohorts, case reports, qualitative research and above all “expert opinion.” Sure, this is “evidence,” but it’s not “evidence-based,” in the sense of WHO’s usual practice in using systematic reviews to inform policy. WPATH is being pulled by the nose by transgender activists who are determined to have things their way. The quality of the “evidence” informing WPATH’s input on these “gender incongruence” definitions is approximately nil. Meanwhile, because it is inconveniently discordant with the transgender activist agenda, most research concerned with transgenderism’s psychosocial etiologies (as well as its objectively-measured negative sequelae) is ignored, when it is published at all.

Under “Gender incongruence”:

MC said:

Gender incongruence is a misleading term and a failure in reasoning, considering that gender is a socially constructed and behavioral category that privileges men over women and children worldwide. The United Nations Commission on Women has well explained that sex is biological and gender is social.

That being said, any correct terminology for the transsexual lobby (in both its commercial and non-profit guises) must address the mental disorder of dysmorphia and the dissociation that drives hormonal manipulation & surgical altering to create a costume out of the physical body – rather than to address the psychological disorder at the root of rejection of the physical body and reliance on lifelong artificial means of sustaining it.

Therefore correct terminology must be considered. Dysmorphia and Gender-Obsessive-Compulsive Disorders should be addressed with cognitive therapies and trauma resolution therapy that addresses mind-body reconnection. The meta analyses of neuropsychiatrists such as Bessel van der Kolk (founder and medical director of the Trauma Center in Brookline, Massachusetts, and director of the National Complex Trauma Treatment Network) and Paul R. McHugh (Distinguished Professor of Psychiatry at the Johns Hopkins University School of Medicine) would indicate that this WHO category is a fallacious marketing attempt by those who profit from the medicalization of gender without regard for the psychosocial realities of gender as a brutal socio-behavioral construct that must itself be abolished.

The international community should be focusing on ways to combat gender. As international security scholar Nafeez Ahmed PhD has robustly reported, the social class system of gender is brutal for women, children, and the natural world. Climate change is gendered. Poverty is gendered. Food & water is gendered. Violence is gendered. Power is gendered. Rape is good for business.

Gender incongruence is good for business, but it is neither ethical nor medically sound. Gender OCD on the other hand, would be a condition treatable with psychosocial support and therapies.

TA said:

Thank you for the opportunity to share our thoughts with you.

As a young female raised by unconventional parents, I was never taught gender stereotypes. As a child I was allowed to play with all sorts of games and toys, but mostly I wanted to be athletic and have fun playing outside. When it came time for school, I was teased mercilessly until about the age of 14, for being a tomboy, constantly being missexed, constantly taunted for not having the right hairdo, not having the right clothing, no having a boyfriend, not being submissive and compliant to boys wishes. What changed at 14, is that I made a pact with myself: what others thought did not matter one iota. While all the other girls were being coerced by boys into having unprotected sex, my parents put me on the pill at 14, but I waited until high school was over for my first intercourse. So many young women are coerced into having sex, because they are raised with sexist “feminine” stereotypes, and they end up pregnant, raped, beaten, disappeared. My refusal to perform gender stereotypes has ensured my safety as a female in this world dominated by males.

Stereotypes are just that. I am so glad I was born in 1966 and grew up in the unisex 70s. I think that was probably the best time to grow up in within the past century, on the issue of combating sexism.

So, when I see males saying that wearing a dress is female: wrong

So, when I see males saying that having long hair is female: wrong

So, when I see males saying that playing with dolls and clothing is female: wrong

So, when I see males saying that playing with girls is female: wrong

So, when I see males saying that submitting and pleasing males is female: wrong

So, when I see males saying that wearing pink if female: wrong

So, when I see males saying that “feeling like a girl/woman” is female: wrong

I have known so many males and so many females in my life that did not perform the gender stereotypes that our patriarchal society expects and am appalled at this fashion in psycho-medical treatment.

I am very much reminded of the decades where lobotomies and electroshock therapy were the norm. We stopped because we came to realise that one does not fix the brain by traumatising it.

One does not fix anorexia by doing liposuction

One does not fix BIID by performing amputations

One does not prevent cutting by providing a knife

People with body dysphoria have experienced trauma, and the important thing is to recognise the trauma (usually religious mandatory behaviours, or over-stereotyped parents) and deal with that trauma, just like all other forms of trauma.

Giving males the authority to self determine their gender, and have those individuals’ self declaration override protections instated for the protection of females from males, is a catastrophe waiting to happen.

Mental health practitioners must stop selling the lie that one can “change sex”, and stop selling the concept of “brain gender”, it is all simply stereotypes, and nobody is born a stereotype.

Beyond protective female spaces, I am most concerned by two consequences regarding “gender incongruence” in the real world.

1-On youth. The transgender lobby would like parents to believe that puberty can be artificially delayed without consequence. This is a medical falsity which is well documented. Delaying puberty should be considered abuse. There are young girls in sports who grow up to suffer tremendously from having their puberty delayed by excessive athleticism and insufficient fat percentages. One does not ever fully catch up after delayed puberty.

2-Sport. Males are on average 10% stronger/faster than females. If there were only one category in the world of sports (excluding locomotion provided by other means like horses and motorised vehicles) females would have no access to medals. That is why we create a female category. Down the road, we realised that we also needed Special Olympics and Paralympics. When it comes to males passing themselves off as females, in the world of sports, even after surgery and hormone conversion therapy, they are still stronger/faster than females, as has been demonstrated in gold, MMA, swimming, and running, that we know of. In the other direction, those few females who long to be males, and who get all the suggested body modifications, still have no chance at medalling in sports. Doctors and the IOC have sold the illusion that one can truly change their sex and become the other sex (2 years). This is one of the biggest lies the medical industry has ever told us and females in sports are already paying the price.

Now, beyond mislabelled “sex change” operations, transgender lobbies are not pushing (and succeeding) in letting people self-diagnose. On one hand, transgender people are requesting this be an entirely personal path and should be de-medicalised, on the other hand they are wanting it considered a serious maladie and demand healthcare coverage. It would seem that one should have to decide, is it a medical condition or not, and if it is a medical condition warranting the time of psychiatrists and doctors, then it CAN NOT be a matter of self-diagnosis.

To finish, there is the issue of people getting “sex changes” (medically or “self-identified”) in order to escape their criminal pasts, to escape father child support payments, etc. The most cautionary approach is that people with a criminal record or those under legal/court surveillance should not be able to access identity changes. There are too many cases of wife murdering males who once in jail are requesting public financing and endorsement of their sex change requests, in order to be free of the harshness of incarceration with other males.

The international community should be much more careful with this topic. Women around the globe are only just starting to be able to escape the shackles of patriarchal stereotypes. To have males reinforce those stereotypes via the side door will set woman’s equality back decades.

Under “Gender incongruence of adolescence and adulthood”:

CB said:

Gender is a social construct that has been around for so long that we just assume that it is the natural state of things. There are prescriptions for each sex as soon as they are born, female is subservient, care-giver, gentle, mothers, home-keepers, wives, supports for men…etc. Male are prescribed to be aggressive, conquerors, leaders, fathers, bosses, explorers, warriors. What gender does not do is accept that in each sex (male and female) there are different ways of expressing oneself. This has led to many who are uncomfortable with their prescriptions. Men and women are not accepting their gender roles. For those who have experienced gender bending (mostly in the gay community) this has given an outlet for being non-conforming, even rebellious. For some, the implications of their gender is so agonizing that they choose to have SRS (sexual reassignment surgery) and become the other gender.

What this does however, is blur the lines for sex, it doesn’t account for the difference in bodies. This has led to men invading women’s spaces (they are aggressive, the bosses, the leaders and the conquerors after all)and traumatizing women who were born female.

This CANNOT be allowed to continue. There is biology which is undeniable and there is gender, which is manmade. We can undo manmade constructs and be happier and healthier people. What we cannot do is change our sex. This comes in a time when women are fighting transgender people with transsexual gender critical people along their side.

We need some common sense in the approach to gender. Let it be known that gender roles are often what leads to mental health problems and gender disphoria, which is a man made problem to begin with.

We need leadership in showing people that there are as many ways of expressing oneself as there are people. We need to lose the stereotypes and we will all be a lot happier, women will feel safer and men can be who they want to be.

LP said:

While not discounting the difficulties experienced by individuals who are profoundly at odds with their social conditioning, we need to recognize that gender dysphoria is this generation’s “Problem That Has No Name” (- B. Friedan).

Feminists, before they could even attempt to dismantle Patriarchy, had to name it. As a result we gained a valuable insight into how structures that buttress existing power relations elude being named – while naming those who elude them as pathological. We are now in the process of dismantling gender presumptions, and actively naming gender constructions as societal mechanisms responsible for so much conflict within and between individuals. We are also in the middle of a gender reifying backlash.

The proposed WHO language for Gender incongruence, by eliding social mechanisms, risks locating “dislike and discomfort” (which arise from an individual’s experience of ascribed gender meanings) in the “primary or secondary sex characteristics” themselves. Biological sex, clearly exists without such meaning.

“[I]ncongruence” with our “experienced gender” applies to all of us. That more people are finally feeling capable of modifying, rejecting, and brilliantly side-stepping our gender indoctrinations is a sign of an overall increase in societal mental health. Ironically, this pivotal time could see gender non-conforming youth in particular, become more constrained by existing gender expectations, and/or pathologicalized and treated with medical interventions (apart from necessary psychological support for both the children and their families).

Women and men, as WHO currently recognizes, are socially constructed groups applied along the lines of sexed bodies, subject to different societal expectations, teachings, and constrained by external forces in ways that can be traumatizing and deadly. Moving the site of gender from the societal to the personal risks making WHO’s existing frameworks for dealing with gendered exploitation, economic inequities, and violence without meaning.

LW said:

Gender, sex and sexuality should not be conflated. Sex and sexuality are based upon biology whereas gender is an abstract and socially constructed concept.

Human beings, like the majority of other mammals, are sexually dimorphic ie there are two distinct sexes, Female and Male, with each having particular primary and secondary sex characteristics that allow us to make such a distinction between the two. Sex is entirely natural, biological and objectively factual and it is important to recognise for several reasons:

  1. The root of female oppression is derived from biology. The existence of intersexed people does not negate this and is also based upon the biology of the body and not of an abstract identity adopted by any particular individual.
  2. Females have a right to bodily autonomy and to speak about their bodies and lives without have to crouch it in language which suits the agenda of others.
  3. Male violence is the number one risk to female health and life. Females therefore have a right to safe and private spaces which are not obligated to include males, regardless of how they “identify.”
  4. Failing to recognise biological sex can have severe health implications for all, regardless of “identity.” Serious, even life-threatening conditions may be misdiagnosed or missed altogether if attachment to biological sex and family history is severed.
  5. Suggests “gender” is an innate quality and not a socially enforced phenomena. Disallows objective and sociological analysis of the harms of “gender” and of SRS/hormone treatments.
  6. Priorities the agenda of a minority over the safety and well-being of the majority, in a “cult of the individual” fashion.

To remove “female” as a biological reality and obfuscate what it means to be a female human, is to rob women of the right to question, challenge or resist the patriarchal structures which control their lives and of the right to full bodily autonomy. It leaves them unable to oppose male supremacy and name men as their oppressors because the objective categories of male(man) and female(woman) no longer exist in any useful capacity. The lived reality of females – the life-long socialisation, the beliefs and various types of violence (both threatened and enacted) against them – is now silenced and crouched in placid language that makes it near impossible for women to address these concerns and speak candidly about them.

It is important to recognise sex as independent of gender because the crimes and discriminatory beliefs levelled against women such as rape, FGM, forced pregnancy and exclusion from social discourse due to reproductive capacity (to name but a few) are a result of being biologically female not through a result of “identifying” as such. Women do not identify with the prejudice and violence forced upon them and they also cannot identify out of it either. Gender can therefore be characterised as a contributory factor in the oppression of women by linking an abstract identity which is characterised by weakness and inferiority to the natural biology of the female. And vice versa attaching one of superiority and dominance to that of the male.

Gender is not innate, it’s social and it changes across time and culture but one aspect of it that has remained constant is it’s use as a tool to enforce a hierarchical dominance of males over females. This has been primarily through placing limitations and conditions upon the behaviours, beliefs, social roles and appearances that are considered “appropriate” depending on sex, not identity. Nobody identifies fully with gender, they are socialised into it and obviously some protest this more strongly than others. However stretching the definition of gender does not solve the issue if the oppressive and restrictive framework is still left intact. The abolishment of gender altogether and merely identifying oneself via their sex – as in no predetermined characteristics, just a male or female person – would be a significant step in liberating females and allowing for a happier and more expressive, accepting society overall. But until such a time it is incredibly vital that sex and gender not be conflated and twisted into completely subjective and individualised concepts with no acknowledgement of scientific reality, and for females an oppressive reality.

AC said:

You need to define “gender.” It is not an objective reality, based on biology. As defined by WHO, it is “…the socially constructed roles, behaviours, activities, and attributes that a given society considers appropriate for men and women.” http://www.who.int/gender/whatisgender/en/

So, an “individual’s experienced gender,” as you put it, really means a male’s or female’s intense desire to conform to socially-constructed stereotypes of appearance, mannerisms, roles etc. that are normally manifested by the other sex (as a result of psychosocial conditioning).

MC said:

Unfortunately you are pushing a non evidence-based, WPATH agenda. The evidence is that 80% of children with your so-called “gender incongruence” if not interfered with by adults (and industrial interests) would identify as Gay or Lesbian by age 18. The evidence is that when you hormonally manipulate children, a significant number of them are sterilized.

This poses enormous children’s rights and human rights issues, particularly for people from communities already suffering from genocide: people of color and indigenous peoples.

MC said:

There is a huge difference between “evidence” and “evidence-based.”

Furthermore, this stealthy attempt to project “informed consent” upon those under the age of 18 for medical transgendering is absurd to those who understand the sea changes of child development through early childhood to completion of adolescence. Proposing hormonal manipulation to match a media-driven trend of gendering is not only unethical, it is harmful. First, do no harm (the Hippocratic Oath, to which all medical professionals are ethically bound).

ET said:

Confusing gender as an innate trait instead of a socially imposed power arrangement that subjugates females is a gross misstep. Females do not identify with their oppression and encouraging children to sterilize themselves to escape societal pressure is nothing short of abuse.

In response to a tranny attempting to co-opt intersex conditions and claiming to be “a girl with masculinized body parts,” GC said:

Please let us not conflate biological conditions with transsexuality or transgenderism (these two terms are often used interchangeably or to clarify the surgical state of the person), both of which have been unable to establish a biological link. Strangely enough, it appears there is quite a conflict among activists: a desire to be removed as a pathology while simulatenously establishing medical coverage as a necessity. Simply impossible.

Under “Gender incongruence of childhood”:

AC said:

This should not be listed under “sexual health.” Why would you put childrens’ non-compliance with socially-constructed “gender” stereotypes under a “sexual” category? You are promoting an idea that “children” and “sexuality” can be categorized together.

 MC said:

What is incongruent here is that A: Gender is a social construct, not biological and not related to sexual preference. And B: The WHO’s Commission on Women well identifies that gendering is a brutal hierarchy of social injustice & stereotypes towards women, perpetuated towards children.

“Gender Incongruence” is a fabricated diagnosis promoted by the crooked and non-evidence-based “World Professional Association for Transgender Health” (WPATH) which has a strong desire to validate the adult surgical transsexual trend at the expense of children, and to collude with unethical profiteering by pharmaceutiful companies and cosmetic surgeons. The work of Paul McHugh (Distinguished Professor of Psychiatry at the Johns Hopkins University School of Medicine) urges that children who suffer from dysmorphia should be treated for a mental health disorder NOT sterilized via hormones and surgery!

The Children’s Rights issues on this are twofold. First, children must be protected from unscrupulous commercial interests in the medical and pharmaceutical industries who are seeking financial gain. And second, being that children’s identities fluctuate enormously throughout the pre-adolescent and adolescent yeart – the legal age of consent (18) for non lifesaving (cosmetic) hormonal manipulation & life-altering surgery must be respected.

The Human Rights aspect is found in the elimination of children who, if supported to continue to develop as individuals, would otherwise identify as LGB by age 18. Homophobia is very bound to this new diagnosis of Gender Incongruence of Adolescence. In addition, such a diagnosis and its so-called “treatement” carries serious, longterm, and unknown health impacts and forces young people to rely on external solutions to internal crises.

Please protect children from the unethical political rhetoric of the WPATH lobbyists who have positioned themselves in the WHO’s ICD revisions.

CB said:

Children are learning a lot of things, about the world, their familes, the human race and people who are different than they are. They are not capable of assigning themselves to a way of being, a way of expressing themselves in the world until they have figured out who they are and that takes decades really. Allowing children to have SRS and HRT is criminal and will lead to criminal charges against whomever is involved in counseling, surgery and advocacy their having this done. Children need to be happy and explore the world, NOT be defined by how they ‘feel’ at the time. Many of us are very angry about this and we know that in the future, those who have advocated for youth sexual reassignment surgery and hormone replacement therapy, will be looked at with serious disfavor and possible criminality.

SM said:

It is natural for children to try various roles and identities. Allowing children to choose their preferred toys and clothing is fine. Children do not have to fit into rigid gender-role boxes.

Allowing or encouraging children to take experimental puberty blocking drugs is cruel, and will cause damage to their developing bodies. This is criminal, and many children will grow up to regret what their misguided elders put them through.

Children should not be the subjects of drug experimentation.

People who put children through this should be charged with criminal behavior.

TT said:

Children love to play with fantasy and try different things. Because toys are highly segregated into “boy toys” and “girl toys” it’s understandable that children sometimes feel confused when they have preferences for toys not assigned to their gender. De-segregating toys would help enormously with this. Any child should be able to play with balls or dolls.

Giving children puberty-blocking drugs, sets them on the road to sex reassignment surgery and hormone replacement therapy. These things are not very well studied, and children are being used as guinea pigs for dangerous drugs.

Young children do not know the impact these procedures will have on their lives. Already some teens are regretting this.

This trend is going to have a devastating impact on today’s youth about 10 years down the road. Many of them are going to have regrets, and there will be lawsuits.

Under “Body Site: Brain” (i.e. where “gender incongruence” is supposedly located):

YS said:

Gender, being a social construct, has nothing to do with brain or any other part of the body.

THANKS to ALL for making great comments. Please continue, if desired!  “Agree” with (vote up) the gender-critical comments. The site is a bit confusing and you can make comments in several areas. You can even put together a “proposal” to make major changes. If you are logged in to the site (after registering), the best way to see new comments is to go here: http://apps.who.int/classifications/icd11/browse/Contributions/RecentComments

If you haven’t registered, and would like to make comments, start here:

http://www.who.int/classifications/icd/revision/en/

After you register, look to the left panel: “06 Conditions related to sexual health”

PLEASE COMMENT on WHO’s NEW DEFINITIONS of TRANSGENDERISM!

This is your opportunity to comment on transgenderism (“gender incongruence”) in the 11th revision of the draft International Classification of Diseases (ICD-11).

transgender-bullshitThe ICD system (currently ICD-10), developed and published by the World Health Organization (WHO), is the international standard diagnostic tool for epidemiology, health management and clinical purposes. It is used worldwide for morbidity and mortality statistics, reimbursement systems, and automated decision support in health care.

In developing its draft definitions for transgenderist conditions, WHO consulted with “researchers” and activists from the crooked and non-evidence-based “World Professional Association for Transgender Health” (WPATH). In February 2013, WHO and WPATH convened a “consensus meeting” to decide which conditions and definitions hurt trans-folks’ feelings too much, and should thus be thrown out or at least defined as vaguely as possible.

Not surprisingly, WPATH wanted to have it both ways, so that transgenderist conditions were simultaneously de-pathologized and made eligible for health care insurance coverage.

Anyway, the process is pretty far along by now, but it is not too late for people to weigh in on the draft definitions. In fact, WHO is HOPING that people will weigh in. You can do it online, in the draft “beta” version of ICD-11. So far, only one other person besides myself has provided input in this way.

We have until late 2015 to make comments. [edit May 2017: comments still accepted; opportunity will likely end soon.] ICD-11 will be released in 2017 2018. It is crucial that WHO receive comments from people who are critical of “gender,” to counter the self-serving definitions written by transgender activists, as well as to refute their foolish comments.

Please go here, register and make comments on the definitions. The web site is a bit “pokey” and confusing, but I’m sure you can figure it out.

http://apps.who.int/classifications/icd11/browse/f/en

After you register, look to the left panel: “Conditions related to sexual health”

Within that framework are the “gender incongruence” definitions. Open those, so you can comment separately on the ones for adults and children.

Look for a little flag where it says “Definition.” Click on that, and you can make comments. In addition to making comments, please “Agree” with posts made by gender-critical folks.

You can also propose drastic changes or even make whole new proposals.

You won’t be able to see other people’s comments until you register.

Of note: In an effort to pretend autogynephilia doesn’t exist, the WPATH/WHO consensus meeting voted to delete the whole category of “fetishistic transvestism.”

Also, “gender” is not defined anywhere. It is naturalized, just sort of “understood” that transgenderist cravings to mimic stereotypes of the other sex have some biological basis. This “lack” of definition conflicts with WHO’s own definition of gender, elsewhere on their site.

Here is the report of what the transgenderist lobby decided: From a document called “WPATH Consensus Process regarding transgender and transsexual-related diagnoses in the ICD-11”:

The Working Group’s initial recommendations, which were reviewed at the meeting, include the following:

  • A reconceptualization of ICD-10 category F64.0 Transsexualism as ‘Gender Incongruence of Adolescence and Adulthood’, characterized by ‘a marked and persistent incongruence between an individual’s experienced gender and the assigned sex’.
  • A reconceptualization of ICD-10 category F64.2 Gender Identity Disorder of Childhood as ‘Gender Incongruence of Childhood’ characterized by ‘a marked incongruence between an individual’s experienced/expressed gender and the assigned sex in pre-pubertal children’.
  • Deletion of the ICD-10 category of F64.1 Dual Role Transvestism.
  • Moving the Gender Incongruence categories out of the ICD-11 chapter on Mental and Behavioural Disorders. There are various options for the placement of this category; the option with the broadest support across the ICD revision is to create a new chapter on conditions related to sexuality, of which Gender Incongruence would be a part.
  • Elimination of many existing F65 categories, specifically those that involve consensual or solitary activity that is not distressing to the individual, including F65.1 Fetishistic Transvestism.
  • Elimination of all existing categories under “Psychological and Behavioural Disorders associated with Sexual Development and Orientation” (F66), including F66.0 Sexual Maturation Disorder; F66.1 Egodystonic Sexual Orientation, and F66.2 Sexual Relationship Disorder. ICD-10 indicates that all of these categories may be assigned based on sexual orientation or gender identity.

FIELD TESTING OF THE PROPOSALS
As a next step, WHO will subject the Working Group’s initial recommendations to field testing in a variety of relevant health care settings in different WHO regions, particularly in low- and middle-income countries. The purpose of field testing is to assess:

  • The acceptability of the proposals to health professionals and to the affected communities;
  • The reliability and the coherence of the constructs;
  • The global clinical utility of the proposed categories, definitions, and diagnostic guidelines;
  • The validity of the categories as predictors of health care needs; and
  • The usefulness of the categories in accessing health care services.

Based on the peer review process and comments received so far from professional groups and civil society, WHO has indicated that the greatest question about the above proposals concerns the need for a category of Gender Incongruence of Childhood. There appear to be different, valid perspectives on this issue. Therefore, the clinical utility and need for this category, as well as the potential consequences of its use, will be a particular focus of field testing. If such a category is retained in ICD-11, it will be placed in the same chapter as ‘Gender Incongruence of Adolescence and Adulthood’.

The field tests will involve internet-based methodologies to assess acceptability and feasibility, and subsequently clinic-based methodologies to assess the use of the classification by health professionals and clients in real-life settings. Country based field tests will be conducted within a multi-stakeholder process including the involvement of academic institutions, government ministries with special attention to the ministry of health, civil society, professional associations and other relevant actors.

The field study process will also include review and analysis of legal and policy issues that affect the utilization of health services by the affected populations. WHO has invited WPATH to collaborate actively in the field testing process.