Being transgender: why today the label that puts medicine in question is questioned

In many countries, trans people must have a medical diagnosis of ‘gender dysphoria’ to access body or face modification procedures (Getty)

A trans person has a gender identity that differs from the sex they were assigned at birth. Some of them wish to have access to procedures – such as facial surgeries, the use of hormones or genital operations – to reaffirm their sex. Even in many countries around the world, these people are required to have the diagnostic label of “gender dysphoria” before accessing these procedures. However, not everyone experiences this “angst” nor does they have a pathology for being trans.

A team of researchers from the Center for Transgender Medicine and Surgery and the Icahn School of Medicine at Mount Sinai, New York, USA, published an article a few days ago in the specialized journal Medicine Reports Unit which returns to the conception that medicine has built on trans people in relation to “gender dysphoria” and questions it. because they argue that this conception has become a barrier for trans people to actually access reaffirmation procedures.

It is the researchers Anish Kumar, Uchechukwu Amakiri and Joshua Safer, who consider that healthcare professionals are mistaken when they require a diagnosis of gender dysphoria – which involves anxiety about sex assigned at birth – before offering gender-affirming care. They also wonder when it is assumed that psychological distress defines all people and that procedures will “resolve” it.

Historically, it is considered that
Historically, ‘gender dysphoria’ has been considered an angst experienced by all trans people, but that’s not true, experts say / TED EYTAN / CC BY-SA 2.0

It’s not just about definitions of terms. According to the researchers, psychiatry’s classic textbook, the DSM-5 Diagnostic and Statistical Manual of Mental Disorders, includes a definition of gender dysphoria that helps limit the procedures trans people choose to undergo. A 2021 study found that insurance companies in the United States were increasing requirements for access to medical procedures.

However, The World Health Organization’s International Classification of Diseases (ICD)-11 came into effect this year and no longer classifies transgender health care under the umbrella of mental and behavioral disorders. And the practice of medicine has outstanding challenges.

“The article published in Medicine Reports Unit It’s very interesting because it does a historical review and questions that trans people have psychological anguish that needs to be diagnosed. Today we know that there are trans people who want to exercise their autonomy and access procedures with hormones or surgeries, but not all of them. Some prefer feminization surgeries on the face, but not genital surgeries. There is a wide variety and this must be taken into account”pointed out Inés Aristegui, doctor in psychology and coordinator of the social research area of ​​the Huésped Foundation in Argentina.

For Aristegui, a trans person’s discomfort with their sex assigned at birth is generally not an intrinsic reason that generates a mental disorder. Conversely, “The mental health problems suffered by trans people are developed by the stigma and social rejection they suffer by their relatives, their school or their colleagues, neighbours, security forces and even by health professionals”.

The mental health problems that trans people suffer from are developed by the stigma and social rejection they suffer from health professionals and others, according to Dr. Inés Aristegui (Getty)
The mental health problems that trans people suffer from are developed by the stigma and social rejection they suffer from health professionals and others, according to Dr. Inés Aristegui (Getty)

Based on research conducted with his team, Dr. Aristegui reported that 5 out of 10 trans men avoid going to the doctor and 4 out of 10 trans women also do not go on time because they fear discrimination by the healthcare system. It affects what’s left undermined their fundamental right to health.

“Being a trans person does not mean that a person has a disease or pathology. In the past, the DSM-4 psychiatry manual categorized trans people under gender identity disorder. The next version of the manual, the DSM-5, which was approved in 2012, retained the concept of gender dysphoria as a disorder that refers to the anguish a person experiences because their gender identity does not match to the sex assigned at birth.explained to Infobae Adrián Helién, doctor specializing in clinical sexology and sex education, psychiatrist and coordinator of the care group for transgender people (Gapet) at Durand Hospital in Buenos Aires.

In a way, according to Dr Helién, the American Psychiatric Association’s Handbook for Professionals continues to associate “gender dysphoria” with trans people is one way to further pathologize. For one thing, it forces people diagnosed with the disorder to access procedures involving body modifications. However, it is not true that all trans people suffer from this anxiety. Some may experience bodily discomfort and some may not. Even if they feel discomfort, not all of them feel anxiety.

Thus, according to Helien, “This gives rise to a situation of discrimination and injustice in many countries around the world because trans people must be assessed by a mental health professional to have a diagnosis and then access procedures. Hopefully the American Psychiatric Association and the World Association of Transgender Health Professionals will drop the label of gender dysphoria as a transgender disorder.

For specialist Helién, Argentina is at the forefront of this change in the consideration of trans people because the National Congress has already sanctioned Law No. 26,743 on gender identity in 2012. This rule guarantees everyone the recognition of their perceived gender identity through an administrative procedure and access to comprehensive gender health, without having to submit to a diagnosis or medical expertise. Trans people in Argentina are not required to have a diagnosis of gender dysphoria to access procedures.

In Argentina, the gender identity law applies, but there are still prepaid and social works that resist providing procedures for trans people (Getty)
In Argentina, the gender identity law applies, but there are still prepaid and social works that resist providing procedures for trans people (Getty)

“Gender dysphoria involves a pathologization of trans people and should no longer be considered a mental disorder. In Argentina, the situation has changed since the law passed in 2012 which does not require a psychological or psychiatric diagnosis for a trans person to access gender reaffirmation procedures,” she said. Infobae Cristina Montserrat Hendrickse, lawyer and trans activist.

However, despite the law being regulated and in effect, Hendrickse mentioned that even in the country “there is some resistance from some prepaid and social works to provide procedures for trans people. As this is a group that also faces barriers in accessing legal advice, some people find barriers in accessing facial feminization surgeries. Some social and prepaid works tell them that it is cosmetic surgery and do not allow them. However, several court decisions have already confirmed that this type of surgery and hair implant surgery are included in Law 26,743″.

Regarding treatment in the healthcare system, Hendrickse said the abuse of trans people is less and less. There was training for the health teams. But in some cases they still call them by their old name and not by name according to their perceived identity. We hope that everything continues to change for trans rights.

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