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Critique and Alternative Proposal to the “Gender Incongruence of Childhood” Category in the ICD-11

A report from the GATE Civil Society Expert Working Group: Buenos Aires, 4-6 April 2013

  • Published
  • 1 May 2013
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In November 2011, GATE organized a civil society meeting of experts on trans issues in The Hague with the purpose of opening a vital space for sharing, analyzing, and discussing viewpoints on the process of ICD reform. The outcome of that meeting was a report titled “It’s time for reform: Trans Health Issues in the International Classification of Diseases.” This report was submitted to WHO in January 2012.

In the context of the DSM revision, the WPATH meeting, and the upcoming ICD-11 field tests at the country level, GATE decided to convene a second meeting on trans issues, which took place in Buenos Aires at the beginning of April 2013. This meeting, titled “The Time Has Come: An International Conversation on Health Reform and Human Rights,” was attended by experts on trans health and human rights:

One of the key goals of the meeting was to analyze current processes of health reform in relation to trans health care, including the process of reviewing ICD-10 and producing ICD-11 that is currently underway at WHO, and their implications for the health and human rights of trans people worldwide. This report is a summary of that meeting.

Purpose of report

Access to legal recognition and transition-related health care are two key interrelated issues that affect trans people around the world. These two issues are very often combined into a third major issue for trans people: How can we ensure that trans people can change their gender markers and access transition-related health care services without pathologizing trans experiences of embodiment, identity, and expression? The answer to this question has become a central human rights question posed by trans movements and their allies worldwide. In this context, the process of reviewing the tenth version of the International Classification of Diseases (ICD-10) and producing a new version (ICD-11) at the World Health Organization (WHO) constitutes a historical opportunity to secure trans people’s full access to both legal recognition and transition-related health care in circumstances compatible with the full enjoyment of their human rights.


On the basis of this analysis, the Expert Working Group is submitting the following recommendations to WHO concerning the proposed category of “Gender Incongruence of Childhood”:

  • To consider the complete deletion of the proposed category of Gender Incongruence of Childhood.
  • To consider field-testing a combination of existing Chapter XXI codes and newly developed Z codes for the ability to facilitate access to appropriate counseling and adaptive environments for gender-variant children and their families.
  • If WHO moves forward with field-testing the proposed GIC category, the Expert Working Group strongly recommends that the proposed category be further analyzed and modified. We further recommend that this modified GID category be tested against the Z code alternatives and a “no specific children’s diagnosis” option.