Criteria

International classification of diseases 11th revision (ICD-11)[1]

Published by the World Health Organization, ICD-11 represents a significant shift in the classification of gender identity-related health compared to ICD-10. Outdated diagnostic categories including "gender identity disorder of children" and "transsexualism" have been replaced to reflect modern understanding of sexual health and gender identity. The new diagnostic categories have also been moved out of the "Mental and behavioral disorders" chapter and into the new "Conditions related to sexual health" chapter, as it is stigmatizing to associate gender diversity with mental ill health.

Gender incongruence

  • Characterized by a marked and persistent incongruence between an individual’s experienced gender and the assigned sex.

  • Gender variant behavior and preferences alone are not a basis for assigning the diagnoses in this group.

Gender incongruence of adolescence or adulthood

  • Characterized by a marked and persistent incongruence between an individual´s experienced gender and the assigned sex, which often leads to a desire to "transition", in order to live and be accepted as a person of the experienced gender, through hormonal treatment, surgery or other health care services to make the individual´s body align, as much as desired and to the extent possible, with the experienced gender.

  • The diagnosis cannot be assigned prior the onset of puberty.

  • Gender variant behavior and preferences alone are not a basis for assigning the diagnosis.

Separate ICD-11 criteria exist for the diagnosis of children; however, children with gender dysphoria/incongruence are not covered by this topic.

WHO: International Classification of Diseases 11th Revision Opens in new window

WHO: FAQs Gender incongruence and transgender health in the ICD Opens in new window

Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR)[2]

Gender dysphoria in adolescents and adults

  • A marked incongruence between one's experienced/expressed gender and assigned gender, of at least 6 months' duration, as manifested by at least two of the following:

    • A marked incongruence between one's experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics).

    • A strong desire to be rid of one's primary and/or secondary sex characteristics because of a marked incongruence with one's experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics).

    • A strong desire for the primary and/or secondary sex characteristics of the other gender.

    • A strong desire to be of the other gender (or some alternative gender different from one's assigned gender).

    • A strong desire to be treated as the other gender (or some alternative gender different from one's assigned gender).

    • A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one's assigned gender).

  • The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning.

  • Two specifiers exist:

    • With a disorder of sex development (e.g., congenital adrenal hyperplasiaor androgen insensitivity syndrome).

    • Post-transition: the individual has transitioned to full-time living in the experienced gender (with or without legalization of gender change) and has undergone (or is preparing to have) at least one gender-affirming medical procedure or treatment regimen (e.g., regular gender-affirming hormone treatment or gender reassignment surgery confirming the experienced gender).

  • Separate DSM-5-TR criteria exist for the diagnosis of children; however, children with gender dysphoria/incongruence are not covered by this topic.

"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

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