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

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.

I agree. The research community is being pressured to find ‘a gene for trans’ when they should be investigating dysphoria as a concept so that transpeople can access evidence based treatments that will benefit them. It worries me greatly that pressure is being on science this way and as we keep seeing, the genuinely vulnerable patient population with gender dysphoria will suffer for it.

Best of luck with the counselling. The NHS is amazing with it (disclaimer: I’m not a genetic counsellor as that has its own training pathway, I am a geneticist and scientist.)

Betty - I've had genetic counselling for a different inherited gene and the NHS were brilliant

And Thanks Bowl. I love your posts

"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."

If you want to take that up with John G. Theisen, MD, Mary S. Filchak1, Viji Sundaram, MD, Lynn P. Chorich, MS, Megan E. Sullivan, BS, Michael J. Friez, PhD, Hyung-Goo Kim, PhD, Lawrence C. Layman, MD, then I am sure they will be happy to hear your argument. But for now, I'm with them rather than an anonymous person on Mumsnet.

You haven't answered my question wakame.

"so that transpeople can access evidence based treatments that will benefit them."

We do - it's called transition.

whatweknow.inequality.cornell.edu/topics/lgbt-equality/%20what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people%20/

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

Your gender identity isn't between your legs, it's between your ears - you're looking in wring place.

Do you not see, wakame that the demedicalisation of the trans ideology will result in defunding? Because if it’s no longer classed as an illness there will be no rationale to treat? That if you push for the idea of being able to define who is trans on brain scans, those will be used as a gatekeeping device?

What the trans lobby is trying to do with the science is contradictory. You can’t have it as a disorder but not a disorder, that you want an objective scan for but no you can self identify in to. It doesn’t work

Transition is not always an appropriate treatment. For minors for example itvis grossly unethical to use blockers and then go from there. Affirmative treatment is unethical when 80% of your patient population group won’t need it.

"You haven't answered my question wakame."

Do you mean "Where in the WHO guidelines does it refer to genetic anomalies?" It doesn't - you can verify that by looking at the ICD - I can't answer every question for everyone who can't be bothered to look it up themselves.

I have no need to take it up with them unless I’m a peer reviewer for their paper. In which case it’d have gone back to them with rather a lot of comments and queries.

There are no ‘genetic anomalies’ associated with being trans. None.

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.

If I had a condition where I thought my body was totally 'wrong', and the only 'solutions' being offered were major surgery and a reliance on medication for life, I would be hoping that research would be done to try to find less invasive solution: preferably one which would make me content with the body I have. When I have suggested that before, I have been told that that is either like trying to 'cure' homosexuality or that people tried this 50 years ago and it didn't work. As if science has not moved on at all in that time.

STBXH was once such a happy and brilliant man, but is now so reduced. How can his anger and his shouting at me, because he has to have the pink toothbrush, how can this be can be considered an expression of his gender identity, and not a bit worrying.

Right. I'm unclear why you're talking about it then.

Stay safe, Birdbandit. Thinking of you.

Yes, if there were even the smallest hope for a non-surgical, non pharmaceutical-dependency-for-life option, surely it’s irresponsible to not ensure research is pursuing that possibility?

I worry that the best interests of transfolk aren’t the driving factor here. After all, there is much money to be made from all those prescriptions and surgical procedures - especially outside of the UK.

I can’t help but wonder if some gender therapists and surgeons have financial agreements over referrals :/

Finding an observable cause (as opposed to the felt-but-not-seen concept of gender identity) could actually safeguard vulnerable dysphoric people?

There are a couple of Twitter screenshots from a leading gender clinic in London and Spain boasting about how much money he was making. I don't think altruism is at the root of most private clinics

BowlofBabelFish
While I agree with most of your posts, I have to pick you up on your response to the abstract Wakame posted in support of genetic evidence for 'transness' (for want of a better word)

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

It's not an array, it was exome sequencing, and as it's only an abstract (presumably for a talk or poster) I don't see how you can pass judgement on the statistical methodology without seeing more details.

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.

Exome analysis, which is what is described in that abstract, looks for variants or mutations in the germline and has nothing to do with RNA. The first grant I was principal investigator on did something similar.

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.

Obviously don't disagree with this.

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.

One person's fishing expedition is another's unbiased, agnostic approach...
Yes, the data would need to be confirmed, but I don't think anyone is claiming it's anything but preliminary.

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.

Again, there are not enough details in the abstract to criticise the methodology. Yes, it's a potential problem, but it may or may not have been addressed.

As a geneticist (as I am also) I would be interested in your opinion on this paper www.ncbi.nlm.nih.gov/pubmed/22146048. I can only see the abstract (as I am no longer in academia and don’t have institutional access), but it seems fairly convincing to me that there is a genetic component to gender dysphoria. Maybe you can get the whole paper?

Just had another thought re. this..

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.

Actually, it isn't a potential problem for exome analysis. It would be if you were analysing RNA, but not for germline coding sequence. That's not going to be altered by taking sex steroids.

Started reading and skipped to the end to post

"Actually, had a look at ICD 11; ‘gender incongruence’ is still listed under “mental, behavioural and neurodevelopmental disorders”"

then

"Gender incongruence of childhood is characterized by a marked incongruence between an individual’s experienced/expressed gender and the assigned sex in pre-pubertal children"

EXPRESSED gender we all know what that means - adhering to the prevalent norms in society for a child of that sex aka gender role aka stereotype.

So these statements to me are bizarre and worrying.

I think it means it can be an illness if you feel shit about it, but not if you don’t? Which sounds about right.

"fully masculine or feminine brains"

????

The statement that brains are "masculine" or "feminine" is grotesque to post on a feminism board. I mean, seriously.

Loads of poeple think women are fucking stupid / subhuman / incapable of rational thought so ra ra ra to the trans crew for pushing the idea of innate differences in how men and women think, right to the fore again.

I'm obviously a bit thick because I don't understand what's so worrying. It also says: "Gender variant behaviour and preferences alone are not a basis for assigning the diagnosis." And in the adolescent and adult section (immediately prior to that line): "The diagnosis cannot be assigned prior the onset of puberty."

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

This is always the crux of the difference between the trans idea what it means and the feminist idea of what it means.

The feminist idea says it's impossible to feel like a woman unless you are one. Because stereotypical behaviour does not determine sex.

So @Wakame can you describe what a man feels when he has the innate gender identity of a woman?

""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."

So most gender critical feminists / and women are trans then? So why aren't our voices and opinions lifted up by our fellow trans people?

I know the answer to that - it's the same reason trans women who are GC are called "truscum" etc.

OR what actually happens when women report this, that they do not have this feeling, is they are told that they are so at home in their sexed bodies and the sexed brains that they don't even notice it. Which is:
a. Extremely offensive given the massive rates of dysphoria and distress around being female in a sexist society. "Comfortable" is something many women only hit when they are much older, and lots never do
b. Assumes that women don't know their own minds which is super-progressive (although maybe our "feminine" brains just can't handle the concept. Deep / abstract thinking is beyond us)

Agree with PP that says all this internal gender stuff is interesting but beside the point

What you have in your head has no relevance at all when divisions are made between groups based on their bodies - their sex.

I am totally baffled by the idea that any divisions should be made based on how people report that they feel.

(And with most people ending up in a separate room with "dont' know what you're on about" posted on the door).

How would that work in sports?

One race for those who feel female
One race for those who feel male
One race for everyone else

Penis-people win all three hurrah for diversity and progress.