The American Psychiatric Association has removed the term "gender identity disorder" from the Diagnostic Statistical Manual (DSM), a much-anticipated move that has been met with mixed reactions among transgender people.
The DSM, which sets the standard for classifying mental disorders in the U.S., had previously classified transgender identity as "gender identity disorder," a term that many transgender people found offensive.
In its latest edition, the DSM-V, the manual has introduced the term "gender dysphoria," a phrase intended to highlight the experiences of gender-variant people whose identity or experiences fall out of step with their birth-assigned gender.
Some have remarked that the new classification is the most significant DSM rewrite concerning LGBT people since homosexuality was removed from the DSM in 1973. But the new term has been met with mixed responses.
Some worry that without a diagnosis of "gender identity disorder," health insurance companies will be less likely to cover gender-affirming surgeries and other medical interventions. Others have advocated for the removal of transgender identity altogether, stating that inclusion of gender identity in the DSM pathologizes transgender people.
Randi Ettner is an Illinois-based clinical forensic psychiatrist, specializing in gender conditions. She called the new classification a double-edged sword.
"I think it's a very evolved position that they've come to, but it isn't a perfect resolution," said Ettner.
Ettner worries about what the change will mean for transgender people in institutionalized settings, like prisons, where a diagnosis of "gender identity disorder" has sometimes forced officials to provide hormones to people behind bars.
Others have suggested that gender-variance be removed from the DSM and placed in the International Classification of Diseases, the standard manual used for diagnosing health conditions.
Still, the change in classifications in the DSM will have serious practical benefits for many transgender people, Ettner noted.
Perhaps most significantly, transgender people will no longer need to seek therapy before accessing hormones and transition-related medical care. In the past, transgender people had to convince therapists of the veracity of their identities, sometimes attending counseling for more than a year before being allowed to transition.
Therapists and medical providers have been moving away from that model for years, especially at LGBT health clinics like Howard Brown Health Center in Chicago, where transgender people are not required to attend therapy to receive hormones.
But for people without access to those newer programs, the removal of "gender identity disorder" from the DSM will likely mean that more people can get transition-related healthcare directly from their doctors, without first receiving a therapist's diagnosis.
That model looks more like approaches doctors use when agreeing to perform cosmetic surgeries, say experts. It could also mean that gender-variant people who do not identify strictly as male or female can still access medical interventions they may want or need.
But transgender advocates are also quick to point out that gender-affirming healthcare is not cosmetic. And some worry that efforts to empower transgender people to make those decisions, gives insurance companies the impression that such medical interventions are not necessary.
Part of the challenge, said Laura Goring, therapist at River Rock Psychotherapy & Consulting, is that Western medicine sees gender-variant people as the problem, when it should be looking at gender rules themselves.
Goring uses the example of women wearing pants, an act that would have been deemed gender non-conforming in the past but has been normalized today.
"I tell people all the time, 'You don't need therapy because you're trans,'" said Goring. She tells clients they need therapy because the world does not know how to deal with transgender people.
Given that reality, Goring said, she believes the DSM change is a good thing.
