Controversies in Gender Diagnoses.

Area of Science:

• Psychiatry and Psychology
• Medical Diagnostics and Classification
• Gender Studies

Background:

• The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-11) have undergone revisions concerning gender identity and sexual disorders.
• Significant controversies arose during these revision processes, particularly regarding gender diagnosis, stigma, and treatment approaches.

Purpose of the Study:

• To present the author's insights from participation in the DSM-5 and ICD-11 working groups.
• To summarize key conclusions on controversies surrounding gender diagnosis, focusing on stigma vs. access, child gender diagnosis, and prepubescent transgender child treatment.

Main Methods:

• Review and synthesis of published conclusions from the DSM-5 and ICD-11 revision processes.
• Analysis of three specific controversies: stigma vs. access to care, retention of child gender diagnosis, and treatment of prepubescent transgender children.

Main Results:

• Both DSM-5 and ICD-11 working groups retained adolescent and adult gender diagnoses to ensure access to care, despite associated stigma.
• A child diagnosis for Gender Dysphoria (DSM) and Gender Incongruence (ICD) was retained to facilitate ongoing evaluation and management in childhood, acknowledging outcome uncertainty.
• The treatment of extremely gender-variant prepubescent children remains contentious, with some clinical assumptions lacking empirical support.

Conclusions:

• Retaining gender diagnoses is crucial for maintaining access to necessary medical and psychological care.
• Child gender diagnoses serve an important role in early evaluation and management, despite the high likelihood of desistance.
• Further empirical research is needed to address the controversies surrounding the treatment of prepubescent transgender children.