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ICD evolution
In ICD-11, adopted by the World Health Assembly in 2019 and in force since 1 January 2022, the WHO moved gender incongruence (HA60) out of the chapter on mental and behavioural disorders into the new chapter "Conditions related to sexual health". The WHO gives as its reason that classifying trans-related identities as mental ill-health 'can cause enormous stigma' (source).
ICD-9 and ICD-10 (1990): F64.0 Transsexualism
In ICD-10, "transsexualism" was coded F64.0 in the chapter on mental and behavioural disorders, in the block on disorders of adult personality and behaviour. It was therefore formally a psychiatric diagnosis.
ICD-11 (2019): HA60 Gender Incongruence
ICD-11 came into effect on 1 January 2022 (source). Transsexualism was replaced by "Gender Incongruence" (HA60) and moved to the new chapter "Conditions related to sexual health". According to the Cass Review, the ICD-11 definition does not include distress (dysphoria) as a diagnostic requirement (para. 10.66). Gender incongruence did stay in the classification: according to the WHO, this should ensure access to gender-affirming care and adequate insurance coverage for it (source). See also the parallel DSM evolution.
Who drove the change?
The proposals were drawn up by the WHO Working Group on the Classification of Sexual Disorders and Sexual Health. Reed et al. (2016), among them Jack Drescher and Peggy Cohen-Kettenis, described them in World Psychiatry as a revision based on current scientific evidence, best clinical practices and human rights considerations (source). The Cass Review calls care for young people with gender dysphoria 'an area of remarkably weak evidence' (source).
According to the Cass Review (2024), ICD-11 attempted to de-pathologise gender diversity. The review stresses that clinicians should consider and record all possibly relevant diagnoses for these children and young people, because other diagnoses were not consistently documented in the studies reviewed (paras 10.64-10.66) (source).
Relationship to DSM and Yogyakarta
ICD-11 goes further than DSM-5. Whereas DSM-5 retained "Gender Dysphoria" as a psychological condition, ICD-11 completely abolishes its psychiatric character. Together with the Yogyakarta Principles (2006/+10), this forms the legal-medical triptych with which the ideological belief in gender identity was anchored as an international norm — without any evidence base , without a measurable marker , and without falsifiability .
Frequently Asked Questions
The ICD-11 code for "Gender Incongruence", outside the psychiatric chapter. ICD-11 has been in force since 1 January 2022.
The WHO justified the move by the stigma of classification as a mental disorder. Reed et al. (2016) describe the revision as based on scientific evidence, clinical practice and human rights considerations.
ICD-11 does not require distress for the diagnosis. The Cass Review stresses that clinicians should consider and record all possibly relevant diagnoses.
Cass (2024): ICD-11 attempted to de-pathologise gender diversity; the international guidelines reviewed show no clear consensus on whether the DSM-5 or the ICD-11 diagnosis is preferred (paras 10.66-10.68).
Sources
- World Health Organization (2018). ICD-11 .
- Reed GM et al. (2016). Disorders related to sexuality and gender identity in the ICD-11. World Psychiatry .
- Cass, H. (2024). Independent Review . NHS England.
- WPATH Files (2024). Environmental Progress.