I recently had a conversation with a Dutch psychiatrist that surprised me, because it seemed to indicate that the narrative around “gender affirmation” was shifting in an important direction.
“Gender dysphoria is not a psychological condition,” he said to me, “it’s just a way of being. It’s not a problem.”
“If it’s not a condition,” I asked, “then why does it need so many medical interventions, and for children of such young ages?”
“Well, it’s just to make them comfortable. To look right,” he answered. “So it’s just cosmetic?” I asked.
“Yes,” he said. “Something like that. It’s just to look good. We are not curing anything. There is nothing to cure.”
Of course I then read the Dutch guidelines for transgender care, and they indeed say that they “do not want to suggest that transgender people have a disease, or suffer from a psychological disorder.” However, these guidelines proceed to describe how to “treat” gender incongruence, and one of the guidelines is that “diagnosis” of gender incongruence should be by a psychologist or psychiatrist. So: there’s no disease, but there is diagnosis and treatment. Curious.
The Dutch guidelines are also very clear that a psychologist or psychiatrist should be involved at every step of the medical treatment: “for somatic treatment, always provide psychological support.” (Somatic means ‘relating to the body, as distinct from the mind’). I have read many medical guidelines for all sorts of disease (it’s part of my job) and I’ve never seen psychological support recommended for other somatic treatments.
A recent Pitt article – “The University Agrees – there are no clinical metrics of gender- affirming care” – confirmed to me that this shift in thinking is taking place worldwide. It’s a shift that we need to pay attention to. Until now, we have been told that children need puberty blockers and cross-sex hormones to alleviate their gender dysphoria and improve their mental health. But there is no solid data to support the idea that medical transition cures gender dysphoria or distress in children—most recently again shown by the re-examination of the Tavistock data. I think it’s precisely because of this lack of evidence that the definitions are shifting—if there is no condition to cure, than one also does not need proof that the treatment provides a cure.
The DSM-5, a guide for mental health providers that is used around the world, still contains gender dysphoria as a mental health condition, and defines it as “psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity.”
The International Classification of Diseases (ICD), which is maintained by the World Health Organisation, was recently updated to its 11th edition. In the process it changed the definitions related to gender. The ICD-10 defined gender identity disorders, but the ICD-11 has changed this to gender incongruence, which is “characterized by a marked and persistent incongruence between an individual’s experienced gender and the assigned sex.” Gender incongruence is no longer classified as a disorder, but falls under the parent category of “conditions related to sexual health.”
These medical definitions contextualise the shift: gender dysphoria used to be seen as a psychiatric disorder that could be cured by gender transition, but there is a move away from that idea. I believe this is largely to do with the fact that homosexuality also used to be classified by the DSM as a mental disorder, until 1973. Health organisations do not want to repeat the mistakes of the past, and they feel pressure to put trans in the same category as gay.
I think as gender-critical parents we should celebrate this shift in position. If gender dysphoria isn’t a medical condition, but just a way of being human, then we can get to the point where it no longer has a diagnostic code (like the ICD-11 code) associated with it. And if there is no diagnostic code, insurance will not pay for procedures. In all health systems I have encountered (including socialised systems), you need a diagnostic code to have a procedure covered. If there is nothing to cure, and the procedures are cosmetic, then saying no to “gender affirming care” for a child becomes as easy as saying no to a boob job or facelift.
I think that you don’t hear any trans activists campaigning to remove these definitions from diagnostic manuals, because they know that the moment the codes are removed, and the procedures become purely cosmetic, they will no longer be covered. So we are currently in this liminal state where the medical world is starting to say that gender dysphoria is not an illness, while also still saying that the treatment for it is life-saving. This makes no sense.
I have never cared about my child’s hairstyle or clothes. I have encouraged any and all hobbies whether society considers those “feminine” or “masculine”. The thing I have cared very deeply about is protecting my young teenager from medical procedures that would impact her body, and her sex life, forever. If “gender incongruence” comes to be seen not as a disease, but just a way of being human, we may not have to fight so hard to protect our children’s bodies from the medical professionals who seek to harm them.
