Being transgender is not a mental health problem, WHO says

Doctors and activists are pleased that the WHO is now classifying transgender under sexual health instead of mental health, but some believe the definition needs to be further broadened.

World Health Organization has changed the classification of transgender in its diagnoses

Some gender diversity experts believe transgender issues transcend sexual health. (Kevin Lamarque/Reuters)

The World Health Organization took what many doctors and advocates believe is a big step this week towards removing the stigma around transgender people.

Their health issues will no longer be classified as mental and behavioural disorders in the WHO global manual of diagnoses. Instead, transgender will soon be under a chapter on sexual health.

Changes to the diagnostic manual were first announced in 2018 and approved at the WHO Assembly on Saturday.

"It was taken out from mental health disorders because we had a better understanding that this was not actually a mental health condition, and leaving it there was causing stigma." said Dr. Lale Say, a WHO reproductive health expert.

The move was meant to create better access to medical care and allow transgender people to speak candidly about their health issues. Human Rights Watch predicted the change would have a "liberating effect worldwide." Graeme Reid, lesbian, gay, bisexual, transgender rights director at for the WHO hailed the move as an important recognition and called for immediate changes.

"Governments should swiftly reform national medical systems and laws that require this now official outdated diagnosis," he said in a statement.

Elizabeth Saewyc, the executive director of the Stigma and Resilience Among Vulnerable Youth Centre at the University of British Columbia, was involved in the consultations. She called the change important, even though it may seem to some as a minor bureaucratic redefinition.

"This helps further to let people know that the leading health authority in the world has looked at the evidence and they're saying this is a normal variation of humankind," Saewyc said in an interview.

Doctors, she said, have traditionally acted as gatekeepers for people who seek to transition. Saewyc, a nursing professor, hoped the new guidelines would clarify the procedure.

"In many parts of the world, and in some parts of Canada, it has been 'We decide whether or not you're really trans, we decide whether or not you fit the mental health diagnosis and therefore eligible for this care,'" such as hormone drugs and surgery. "So it's gatekeeping rather than readiness preparation."

Like Saewyc, Dr. Stephen Feder, co-director of the Gender Diversity Clinic at the Children's Hospital of Eastern Ontario in Ottawa, is pleased with the changes, especially in how it will help parents understand the challenges kids and teens face.

"The parents frequently express concern, concern that there may be a mental health issue that's clouding the diagnosis, clouding their [children's] judgment. I feel the more we validate the normality of this phenomenon, the better able the parents will be to respond to their children's needs and to play the strong supportive role that is so critically important."

Still there are many questions about the practical implications of the change and what it will mean. Nine international organizations working on gender identity said in a joint statement: "Although placement in this chapter is an improvement, it is by no means perfect. For example, it is somewhat reductive to define trans health as related only to sexual health."

Gender diversity experts believe transgender issues transcend sexual health and should include its emotional and educational aspects.

Saewyc added that in parts of the world where transgender people are marginalized and stigmatized, strong opposition remains.

"I think that we don't know yet the widespread potential impact this is going to have in terms of law and policy, as well as health care and access to health care."

Nations have until January 2022 to implement the changes.