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ICD evolution
In 2019, the WHO moved transsexualism from the psychiatric F-codes to a new chapter, "conditions related to sexual health" (HA60). A depathologization without any new empirical evidence — purely the result of a small working group staffed by WPATH-affiliated experts. Institutional capture at the WHO level.
ICD-9 and ICD-10 (1990): F64.0 Transsexualism
In ICD-10, "transsexualism" was coded as F64.0, within the chapter "personality and behavioural disorders." A psychiatric diagnosis requiring differential diagnosis for autism, dissociation, and personality disorder. That clinical framework compelled carefulness — precisely what the affirmative lobby wanted to get rid of decades later.
ICD-11 (2019): HA60 Gender Incongruence
The WHO published the final version of ICD-11 in 2018; it entered into force in 2019. Transsexualism was replaced by "Gender Incongruence" (HA60) and moved to a new chapter, "Conditions related to sexual health." Consequently, gender incongruence is formally no longer a psychiatric disorder, while care continues to be reimbursed — a political compromise that combines the best of both worlds: no mandatory psychiatric evaluation, but reimbursement. See also the parallel DSM evolution .
Who drove the change?
The WHO Working Group on Sexual Disorders and Sexual Health was led by Geoffrey Reed and consisted largely of gender-affirmative clinicians with direct ties to WPATH . Conflict of interest: the same group that wrote SOC now also rewrote the WHO classification. Sander Breiner and others pointed out at the time that the WG was not representative of clinical sexology worldwide. The criticism was silenced under the label "transphobia" — the standard repertoire of the lobby.
The Cass Review (2024) points out that depathologization undermines clinical quality: without a psychiatric diagnosis, there is no mandatory differential diagnosis, and thus no filter against misdiagnosing ROGD patients as trans. The WPATH Files (2024) confirm that WPATH-related experts deliberately pursued this choice to broaden access to surgery and hormones — not for medical reasons.
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. In use since 2019.
No. It was a political change by a WHO Working Group with WPATH bands, not based on new biological evidence.
No more mandatory psychiatric evaluation. Differential diagnosis for autism, dissociation, and trauma disappeared. Affirmation became the default.
Cass (2024): depathologization undermines clinical quality and facilitates the current medicalization of ROGD.
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.