An identifier, not a diagnosis

The parliament of Denmark, on New Year's Day voted in favor of removing the stigma from being transgender..."separating them from association with words such as 'problem,' 'disorder,' or dysphoria.'"

Words matter. It was very important that terms like “incongruence,” “disturbance” and “problem” were left out of the code title used by the country’s medical community to track care.

The change makes it a code instead of a diagnosis.

--Linda Thor Pederson, LGBT Denmark

The old system made indirect discrimination possible, she explains; job applications were sometimes rejected because of a “diagnosis.”

The change, although currently limited to Denmark, represents a new phase in the evolution of views on being transgender. An earlier change occurred in 2013, when “gender identity disorder” was renamed “gender dysphoria” in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), U.S. psychiatry’s bible for diagnosing mental illness. The reclassification recognized that a mismatch between one’s birth gender and identity was not necessarily pathological, notes pediatric endocrinologist Norman Spack, a founder of the gender clinic at Boston Children’s Hospital. It shifted the emphasis in treatment from fixing a disorder to resolving distress over the mismatch.

Spack compares the DSM-5’s new definition as similar in effect to its 1973 declassification of homosexuality as a mental illness. University of San Francisco human rights scholar Richard Johnson agrees. Although gay people certainly knew they were not sick, he says, the move did have an effect.

It has allowed the gay population in the U.S. an opportunity to pursue life on their own terms. This will also be the same situation for the transgender population living in Denmark.


As the brand-new measure takes effect, experts are speculating about its political, medical and financial ramifications in Denmark and around the world. Danish politicians had announced last year that they hoped to spur the World Health Organization (WHO) to remove transgender from a category of mental illnesses in its globally used International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10), whose codes are used to mark health records, track epidemiological trends and inform insurance reimbursement. If WHO did not act by January 1, 2017, Denmark had promised to act unilaterally.

As of January 5, WHO had made no comment on the Danish move. In the past the organization had told questioners the transgender redefinition will be part of the ICD-11, an immense and time-consuming project that is expected to be released this year or next.

The concern of some, even me in the past, has been the ability of trans people to access medical treatment like hormone therapy or gender confirmation surgery.

Psychologist Laura Edwards-Leeper of Pacific University in Oregon notes Denmark will still require that psychological evaluation be conducted before any medical intervention. “I’m wondering if Denmark plans to make the diagnosis a medical one,” she says. “Perhaps they are approaching it similarly to what I recommend, which is to involve health care providers in offering support through the process and with readiness assessments, much like we do for patients seeking other life-changing, body-altering surgeries, such as bariatric surgery or organ transplants.”

We expect that transgender health care will move more toward informed consent instead of psychiatric evaluations. In Denmark it can take from a couple of years to more than a decade to get permission for genital reassignment surgery.

The public attitude to transgender people have been improved over the last couple of years and there is generally an acceptance of us.


The difference [between the U.S. and Denmark] is only [that] they have a national health system, and they wanted to make a statement that could not be made here by those who insure the care of transgender people. Because it’s conceivable, pending litigation, that insurance companies could persist in not covering the medical and surgical care needed because they don’t buy into the necessity of these treatments. But that is all changing, more bit by bit because we are a hodgepodge of care providers and insurers. Different states have different policies.


it is sending the message that an increasing number of people across the globe do not perceive transgender people as ‘crazy,’ but as valuable members of society worthy of respect and human rights like everyone else.


This very encouraging move from Denmark sets a strong example internationally towards destigmatizing transgender people and paving the way for quick and transparent processes for legal gender recognition.

This label means that transgender people are forced to undergo traumatizing and humiliating psychiatric evaluations in order to legally change their gender or even to be able to access gender reassignment treatment.

--Leda Avgousti, Amnesty International

Denmark's action will increase the opinion of being transgender is a natural variation in humanity. While there is still a long way to go to achieve full depathologization of trans people; every positive change in law by a government, every statement of support by institutions is an affirmation of the hard work being carried out behind the scenes by activists and organizations alike.

--Julia Ehrt, Transgender Europe




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