The clinical diagnostic criteria for gender dysphoria, a condition defined by incongruence between biological sex and gender identity, is a continually evolving one with frequent updates to help standardize care of transgender individuals amongst healthcare personnel around the world.
The International Classification of Diseases (ICD) of the World Health Organization (WHO) describes gender dysphoria in several different ways. The 10th revision, ICD-10, called this clinical condition "transsexualism"1 and describes it as an individual’s desire to live and gain social acceptance as a member of the opposite sex, including a desire to undertake interventions such as hormonal therapy or surgery to gain anatomical congruence with the desired sex. To ensure the common understanding, The Royal College of Psychiatrists of Thailand defined “transsexualism” as the desire for gender reassignment
ICD-11 (the 11th revision), is projected to come into effect in 2022. It replaces the term “transsexualism” with "gender incongruence of adolescence or adulthood."3 This is defined as marked and persistent incongruence between an individual's experienced gender and assigned sex. The incongruence leads to a need to be treated and accepted as the other, desired gender, with usage of hormone treatment or gender reassignment surgery or other healthcare services to change one’s primary and secondary sexual characteristics to match the desired gender. The condition cannot be diagnosed before puberty and diagnosis cannot be based solely on gender behavior or sexual orientation alone.
Another widely used guideline for the clinical diagnosis of gender dysphoria is the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), by the American Psychiatric Association.4 It consists of the following diagnostic criteria:
A marked incongruence between the experienced
A marked incongruence between the experienced or expressed gender and assigned gender, of at least six months’ duration with at least two of the following:
- A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics
- A strong desire to be rid of one’s primary and/or secondary sex characteristics
- A strong desire for the primary and/or secondary sex characteristics of the other gender
- A strong desire to be of the other gender
- A strong desire to be treated as the other gender
- A strong conviction that one has the typical feelings and reactions of the other gender
Such condition causes significant distress or impairs function, such as in a social, occupational, or other setting. The abovementioned criteria are used for transgender adults and adolescents only. The American Psychiatric Association provides a different specific diagnostic criterion for transgender children
Refer: Diagnosis of Gender Dysphoria - The Thai Handbook of Transgender Healthcare Services, Center of Excellence in Transgender Health, Chulalongkorn University
Sources and further reading
Primary and authoritative sources used for context and fact-checking.
- Frequently asked questions on sexual and gender diversity, health and human rights World Health Organization (WHO)
- The Thai Handbook of Transgender Healthcare Services IHRI & Center of Excellence in Transgender Health, Chulalongkorn University
- Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 World Professional Association for Transgender Health (WPATH)
- Consolidated guidelines on HIV, viral hepatitis and STI for key populations (2022) World Health Organization (WHO)
- STI Treatment Guidelines: Transgender and Gender Diverse Persons U.S. Centers for Disease Control and Prevention (CDC)