WHO/Europe brief – transgender health in the context of ICD-11

What is ICD-11?

The 11th edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-11), is a document that provides standardized data and vocabulary to help diagnose and monitor health problems around the world. It includes revised “codes”. The international system of codes is used by health professionals to classify a disease or health condition for multiple use. These newly revised ICD-11 codes will impact provisions of care and health financing, with new changes to reflect modern understandings of sexual health and gender identity.

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What does the ICD revision aim to do for transgender health?

ICD-11 has redefined gender identity-related health, replacing diagnostic categories like ICD-10’s “transsexualism” and “gender identity disorder of children” with “gender incongruence of adolescence and adulthood” and “gender incongruence of childhood”, respectively. Gender incongruence has thus broadly been moved out of the “Mental and behavioural disorders” chapter and into the new “Conditions related to sexual health” chapter. This reflects evidence that trans-related and gender diverse identities are not conditions of mental ill health, and classifying them as such can cause enormous stigma.

Inclusion of gender incongruence in the ICD should ensure transgender people’s access to gender-affirming health care, as well as adequate health insurance coverage for such services. Recognition in the ICD also acknowledges the links between gender identity, sexual behaviour, exposure to violence and sexually transmitted infections.

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What is transgender and what are the main health concerns of transgender people?

There is a growing commitment in public health to understand and improve the health and well-being of transgender people and other gender minorities, who comprise an estimated 0.3–0.5% (25 million) of the global population. The adoption of the 2030 Agenda for Sustainable Development and its pledge to “leave no one behind” has given renewed impetus to this movement.

Transgender is an umbrella term that describes a diverse group of people whose internal sense of gender is different than that which they were assigned at birth. Transgender refers to gender identity and gender expression, and has nothing to do with sexual orientation. The term is increasing in familiarity globally, although other culturally specific terms may be used to describe people who have non-binary gender identities.

Transgender people share many of the same health needs as the general population, but may have other specialist health-care needs, such as gender-affirming hormone therapy and surgery. However, evidence suggests that transgender people often experience a disproportionately high burden of disease, including in the domains of mental, sexual and reproductive health. Some transgender people seek medical or surgical transition, others do not.

Similar to other lesbian, gay, bisexual, transgender, queer or intersex (LGBTQI) populations, the trans community is at an increased risk of mental ill health related to transphobia, discrimination and violence. Transphobia and discrimination are major barriers to health-care access, and can result in increased risk of health concerns unrelated to gender or sexuality. Evidence also suggests that young transgender people are at an increased risk of HIV and sexually transmitted infections, compared to their age peers.

Legal gender recognition, represented through documents reflecting a person’s gender identity, is important for protection, dignity and health. Many countries in the WHO European Region impose a number of conditions on changing documents, including the requirement to undergo sterilization. Human rights bodies conclude that these sterilization requirements run counter to respect for bodily integrity, self-determination and human dignity, and can cause and perpetuate discrimination against transgender people.

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What is gender-affirmative health care?

Gender-affirmative health care can include any single or combination of a number of social, psychological, behavioural or medical (including hormonal treatment or surgery) interventions designed to support and affirm an individual’s gender identity.

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