What is the ICD?

The International Classification serves to record and report health and health-related conditions globally. ICD ensures interoperability of digital health data, and their comparability. The ICD contains diseases, disorders, health conditions and much more. The inclusion of a specific category into ICD depends on utility to the different uses of ICD and sufficient evidence that a health condition exists.  

ICD-11 and Gender Incongruence

The 11^th edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-11). The newly revised ICD-11 codes includes new changes to reflect modern understanding of sexual health and gender identity.

What does the ICD revision aim to do for transgender health?

ICD-11 has redefined gender identity-related health, replacing outdated diagnostic categories like ICD-10’s “transsexualism” and “gender identity disorder of children” with “gender incongruence of adolescence and adulthood” and “gender incongruence of childhood” respectively. Gender incongruence has been moved out of the “Mental and behavioural disorders” chapter and into the new “Conditions related to sexual health” chapter. This reflects current knowledge that trans-related and gender diverse identities are not conditions of mental ill-health, and that classifying them as such can cause enormous stigma. 

Inclusion of gender incongruence in the ICD-11 should ensure transgender people’s access to gender-affirming health care, as well as adequate health insurance coverage for such services. Recognition in the ICD also acknowledges the links between gender identity, sexual behaviour, exposure to violence and sexually transmitted infections.

What is Gender Incongruence?

Gender incongruence of adolescence or adulthood : Gender Incongruence of Adolescence and Adulthood is characterised by a marked and persistent incongruence between an individual´s experienced gender and the assigned sex, which often leads to a desire to ‘transition’, in order to live and be accepted as a person of the experienced gender, through hormonal treatment, surgery or other health care services to make the individual´s body align, as much as desired and to the extent possible, with the experienced gender. The diagnosis cannot be assigned prior the onset of puberty. Gender variant behaviour and preferences alone are not a basis for assigning the diagnosis.

Gender incongruence of childhood : Gender incongruence of childhood is characterised by a marked incongruence between an individual’s experienced/expressed gender and the assigned sex in pre-pubertal children. It includes a strong desire to be a different gender than the assigned sex; a strong dislike on the child’s part of his or her sexual anatomy or anticipated secondary sex characteristics and/or a strong desire for the primary and/or anticipated secondary sex characteristics that match the experienced gender; and make-believe or fantasy play, toys, games, or activities and playmates that are typical of the experienced gender rather than the assigned sex. The incongruence must have persisted for about 2 years. Gender variant behaviour and preferences alone are not a basis for assigning the diagnosis.

What is transgender and what are the main health concerns of transgender people?

Transgender people share many of the same health needs as the general population, but may have other specialist health-care needs, such as gender-affirming hormone therapy and surgery. However, evidence suggests that transgender people often experience a disproportionately high burden of disease, including in the domains of mental, sexual and reproductive health. Some transgender people seek medical or surgical transition, others do not.

What is gender-affirmative health care?

Gender-affirmative health care can include any single or combination of a number of social, psychological, behavioural or medical (including hormonal treatment or surgery) interventions designed to support and affirm an individual’s gender identity.