Minister for Women and Equalities Kemi Badenoch has announced plans that mean in England and Wales the Government will only recognise the legal genders of trans people with a medical diagnosis of gender dysphoria. This decision flies in the face of medical best practice and is ignorant of current guidelines for transgender care. Medical best practice now recognises that dysphoria is not a necessary component of being trans.
Gender Recognition Certificates allow trans people to change their legal gender, allowing them to update their birth certificates and have their gender recognised on marriage and death certificates. Badenoch’s statement says for the Government to recognise international Gender Recognition Certificates, the countries of origin must have “equivalently rigorous systems”. She wrote “It should not be possible for a person who would not satisfy the criteria to obtain UK legal gender recognition to use the overseas recognition route to obtain a UK Gender Recognition Certificate.”
The move is widely seen as a reaction to the passage of Gender Recognition Reform in Scotland. According to The Times, “UK government sources said that unless the Scottish government amended the legislation to require a medical diagnosis of gender dysphoria, Scotland would be added to the list of countries that the rest of the UK would no longer recognise as having a rigorous process for changing gender.”
The timing of this shows the Government’s ignorance about transgender care, because in 2022 leading global medical organisations updated their guidelines to recognise that gender dysphoria is not a necessary part of being trans. Trans people face incongruence between their sex assigned at birth and their experienced gender. Dysphoria is psychological distress caused by this incongruence. The international medical community now recognises that not all trans people experience clinical distress.
In January 2022, the World Health Organisation (WHO) released the International Classification of Disease 11th Edition (ICD-11). This removed the old diagnoses of “transsexualism” and “gender identity disorder of childhood”, replacing them with “gender incongruence” of adolescence and adulthood and of children respectively. Where the ICD-10 spoke of “intense distress about assigned sex” (ie dysphoria), this language is no longer included. The difference reflects the medical community’s acceptance is not pathological and dysphoria is not universal. In September 2022, the World Professional Association for Transgender Health (WPATH), released its own updated Standards of Care, which also removed the dysphoria requirement. The WPATH Standards represent the consensus view of medical experts who work with trans people.
The American Psychiatric Assocation (APA) is also influential on the practice of UK doctors. Its Diagnostic and Statistical Manual (DSM-V) does still list gender dysphoria as a medical condition. The DSM, however, has not been revised since 2013 and is outdated compared with the standards from the WHO and WPATH. In 2019, the APA published “Expert Q&A: Gender Dysphoria”, which affirms “Not all transgender people suffer from gender dysphoria and that distinction is important to keep in mind.” In August 2022, the APA reviewed its “What is Gender Dysphoria?” article, clarifying that only “Some people who are transgender will experience gender dysphoria.” These more recent articles on the official APA website reflect the current consensus in the field.
Given that leading experts are clear that gender dysphoria is not a requirement of a valid trans identity, the Government has no business insisting otherwise. The Women and Equalities Select Committee recommended in its reports in 2016 and 2021 that the requirement for a medical diagnosis of gender dysphoria be removed from the process of acquiring a Gender Recognition Certificate. There are no reasonable grounds for de-recognising Certificates from countries with fairer gender recognition systems. The latest medical evidence demonstrates that the requirement is outdated and unethical. Requiring a medical diagnosis is discriminatory, and the Government’s position is unjustifiable.
Corrections: An earlier version of this article referred to the ICD-10 as including a diagnosis of "gender dysphoria". This was incorrect and the article has been updated to reflect that.