World Health Organisation ICD 11 on trans people

[Wakame]

The World Health Organisation produces a document called the "International Classification of Diseases" (the "ICD").

Version 11 is out and you'll all be delighted to know that they have moved "gender incongruence" (their term for being trans) out of the section for mental illness and into the section for sexual health.

Here is section HA61 on "Gender incongruence of childhood" for example:

icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f344733949

And note the last line:

"Gender variant behaviour and preferences alone are not a basis for assigning the diagnosis."

That's right - gendered behaviour and gender identity are not the same thing.

Same, of course, for HA60 "Gender incongruence of adolescence or adulthood":

icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f90875286

You may be interested in this Wakame

Christime Burns MBE was involved with the 2004 act and so I am sure she is very well informed.

Guardian article on background and work done by 'Press for Change'
(extract)
"Much of their campaigning remained on the quiet. The passage of the 2004 law to give trans people legal status was "remarkable," says Burns, because "the government was able to pass an entire act in parliament without anyone throwing a fit in the press"." (continues)
www.theguardian.com/society/2013/jan/22/voices-from-trans-community-prejudice

"I thought that scientific progress was forged on challenging convention."

It is sometimes. In this case, by challenging the convention that being trans is a mental illness.

I think the angels dancing on a pin head argument about what trans isn't or is makes no odds to the existence of female humans.

Female humans are not male humans, male humans are not female humans.

S'not complicated.

Of course, and there always will be, but medical science moves by broad consensus, and that is currently against you.

I’d just like to say, as an active, working scientist, that this is, in fact, not true

Trans people also have genetic anomalies, but again, although it is fairly clear that they are relevant, it is not yet clear which of those anomalies informs gender identity and in what way.

Genetic anomalies? Where? In what gene/s? Please explain this statement as this, again, is not true

Ray Blanchard's opinion

Also defining gender identity would be lovely but let's concentrate on the genetic anomalies

I am all ears.

That tweet was interesting wasn't it R0wantrees?

They are treading a fine line here between wanting it de-listed but needing health classifications to get treatment paid for in the strict US insured health system

Means nothing has changed in reality, absolutely zero.

"I’d just like to say, as an active, working scientist, that this is, in fact, not true"

If only the WHO had asked you instead.

"Genetic anomalies? Where? In what gene/s?"

Do your research.

cf
NHS England and NHS Scotland
Analysis of public consultation on proposed service specifications for specialised Gender Identity Services for Adults (published March 2018)
www.engage.england.nhs.uk/survey/gender-identity-services-for-adults/user_uploads/report-independent-analysis-consultation-responses-gender-identity-service-specifications.pdf

"Ray Blanchard's opinion"

Ah - the scientist who says either your test results support his theory, or you must be lying.

"Also defining gender identity would be lovely"

"gender identity" is person's innate sense of their own sex. You should know that by now. Not everyone has one of course, or at least, not everyone is aware of it. They are called "agender" and are actually part of the non-binary trans spectrum.

The answer to that is complex and nuanced

That will be a no, then.

Human sex differences are not a simple binary

Human sex is based on reproductive role, which is a binary.

Ray Blanchard career
(Wikipedia)
"He received his A.B. in psychology from the University of Pennsylvania in 1967 and his Ph.D. from the University of Illinois in 1973. He conducted postdoctoral research at Dalhousie University until 1976, when he accepted a position as a clinical psychologist at the Ontario Correctional Institute in Brampton, Ontario, Canada (a suburb of Toronto). There, Blanchard met Kurt Freund, who became his mentor. Freund was conducting research in chemical castration for sex offenders.[1] In 1980, he joined the Clarke Institute of Psychiatry (now part of the Centre for Addiction and Mental Health).[2] In 1995 Blanchard was named Head of Clinical Sexology Services in the Law and Mental Health Programme of the CAMH, where he served until 2010. He is an adjunct Professor of Psychiatry at the University of Toronto.[3] He served on the American Psychiatric Association DSM-IV Subcommittee on Gender Identity Disorders[4] and was named to the DSM-5 committee. According to the Web of Science, Blanchard's scientific articles have been cited more than 1800 times, with an h-index of 27.[5]"

"Genetic anomalies? Where? In what gene/s?"Do your research

I’ve done twenty plus years of it. If you make a statement like that the onus is on YOU to provide evidence.

The paper you posted on the other thread has no controls, a tiny sample group and they’ve picked out genes in sex steroid metabolism without stating if the people they arrayed are on hormones.

It’s laughable.

What are these genetic anomalies you mean?

"gender identity" is person's innate sense of their own sex. You should know that by now. Not everyone has one of course, or at least, not everyone is aware of it. They are called "agender" and are actually part of the non-binary trans spectrum.

Fine, wakame. Do you think there are any circumstances where a person's innate sense of their own sex is actually of secondary importance to their actual sex? For instance, in sport, where a male with an innate sense of being female is 2 stone heavier with significantly more muscle than his competitors? Or where administering a particular drug would cause health complications in a female body, but not a male one? Could you explain how an innate sense of sex is of any relevance there?

Do trans folk get referred to the genetic scientists then? I’ve found my personal journey into discovering our familial gene fault (BRCA2) to be fascinating (and terrifying). I’d love to learn about the trans experience - for instance, our fault line comes from the X chromosome, so it’s literally 50/50 as whether I have it, dependent on which X of my mother’s 2 XX’s I inherited.

I thought trans being genetic in origin had been ruled out via studies of identical twins though?

No Betty they don’t.

The BRCA2 gene variant you may or may not have is something you can counsel patients on. There are multiple studies, large bodies of work on it etc.

There is no current evidence that there’s ‘a trans gene’ at all. The current drive to get some sort of scientific ‘proof’ there is goes back to validation - there’s a need to say ‘look, it’s real! There’s a gene for it.’

It’s also very muddled because atcthe same time of course if you could identify a genetic signal associated with being trans you might be able to objectively say who was and who wasn’t and that idea is viciously rejected by activists. They also want descriptions of it in the medical literature changed to remove any reference to fetishism, transvestism and AGP (autogynephilia.) but again they do t want it totally demedicalised because then there’s no way to access treatment.

So the use and abuse of science is misguided and muddled.

I hope you get the all clear - if not, you will be able to access treatment and monitoring to reduce your chances of becoming ill in the future.

Where in the WHO guidelines does it refer to genetic anomalies?

Do your research.

wakame As you have obviously been convinced by this research, can you point us in the direction of the most compelling studies so that we can all be as well informed as you?

It doesn’t orchid
There aren’t any.

That paper is a fishing excercise. I’ve done loads of array work and it fails all the usual statistical checks.

An array is effectively a chip, with cut up bits of dna on. You get the RNA readout from a sample (which is all the actively genes that are being read and used) and turn it into DNA. Then you wash that over the chip and examine it. So a gene which is being highly expressed will have a stronger signal.
Obviously you can look at different gene variants too - there are thousands of these variants between any two random people though so what you can’t do is just say look at ‘anything that comes up.’ Because if you fling enough spaghetti at the wall some will stick.

21000 genes, and a confidence level of 95% gives you roughly a thousand genes that will pop up as positive for chance just by chance. Ooops.

So you have to be careful with arrays. There are very sophisticated analysis programs that allow you to reduce the false positives but by its nature an array is a fishing expedition. And that’s fine, as long as you then go into the source material and verify those gene changes and what they mean. So I’d then get actual tissue samples and look at whthervthat gene really was being expressed at a higher level. That paper didn't do that either - they stopped at the fishing.

They also looked a sex steroid metabolism genes in a population that could be treated with sex steroids. It’s a bit like saying that body builders on anabolic asteroids have changes and conveniently ignoring the facts the drugs they are taking cause them...

Thanks Babel!

I assumed that trans folk didn’t get referred to the genetic scientists, but I was prepared to be wrong (and would’ve loved to have looked at the research if it was a gene thing - I’ve been beyond impressed by both the staff at my local clinic and the worldwide body of work they are contributing to).

Regarding my outcome - I am trying to be stoic - I still have the exact same body as I had before we knew about the gene fault. The only thing that’s changed is we now have an option for additional knowledge and active risk management. I’m incredibly thankful for the NHS.

Knowledge about one’s own condition can be so useful for coming to terms with it. The TRA argument for non medicalisation must be very frustrating for trans people who’d like to see more scientific research, not less of it. I feel for them.

"gender identity" is person's innate sense of their own sex.

So presumably you know what it is by looking in your underwear.