WHO and the ICD-11 Revision

Q: When did the ICD-11 take effect?

The World Health Assembly adopted the ICD-11 on 25 May 2019, and the classification has applied since 1 January 2022. Since then, gender incongruence has no longer been included in the chapter on mental and behavioural disorders, but in a new chapter on conditions related to sexual health, with separate codes for childhood and for adolescence and adulthood.

Q: What do the ICD-11 codes HA60 and HA61 mean?

HA60 is the code for gender incongruence in adolescence and adulthood, while HA61 is the code for gender incongruence in childhood. Both are included in the chapter Conditions related to sexual health. They replace the ICD-10 categories transsexualism and gender identity disorder in childhood and were retained to enable access to care and reimbursement.

Q: According to the WHO, is being transgender still a mental disorder?

No. Since the ICD-11, gender incongruence has no longer been classified as a mental disorder. According to the WHO, this reflects current knowledge that transgender and gender-diverse identities are not a mental disorder. A diagnosis remains possible, however, so that people can retain access to care and reimbursement by insurers.

Q: Does the ICD-11 recommend a treatment for gender incongruence?

No. The ICD is a classification of diseases and health conditions and does not prescribe which treatment is appropriate. Relocating gender incongruence to a different chapter says nothing about the effectiveness or safety of puberty blockers, hormones or surgeries. Nor is the code for childhood a recommendation to provide medical treatment to children.

The headquarters of the World Health Organization in Geneva — Photo: Yann Forget, CC BY-SA 3.0, via Wikimedia Commons

The World Health Organization published the eleventh revision of the International Classification of Diseases (ICD-11) in 2019, with the classification taking effect in January 2022.

ICD-11 (2019/2022)

The World Health Organization published the eleventh revision of the International Classification of Diseases (ICD-11) in 2019, with the classification taking effect in January 2022. An important change was the relocation of 'gender incongruence' from the chapter on mental and behavioural disorders to a new chapter on conditions related to sexual health.

Depathologisation

This relocation is internationally regarded as depathologisation: gender incongruence is no longer classified as a mental disorder. However, a diagnosis remains possible to support access to care.

Discussion

The change was welcomed by advocacy organisations. Critics have pointed to the tension between depathologisation and retaining a medical diagnosis for access to care and insurance coverage. The DSM-5 still refers to gender dysphoria. transgemeenschap.nl discusses how the two classifications relate to each other in its article on the DSM versus ICD debate.

What exactly changed

The World Health Assembly adopted the ICD-11 on 25 May 2019. The classification has applied since 1 January 2022. In the ICD-10, the categories transsexualism and gender identity disorder in childhood were included in the chapter on mental and behavioural disorders. In the ICD-11, they were replaced by two codes in the new chapter Conditions related to sexual health: HA60 for gender incongruence in adolescence and adulthood, and HA61 for gender incongruence in childhood. According to the WHO, the change reflects current knowledge that transgender and gender-diverse identities are not a mental disorder. The codes were retained to enable access to care and reimbursement by insurers.

Classification is not a treatment guideline

The ICD is a classification of diseases and health conditions. It does not prescribe which treatment is appropriate. That distinction is sometimes lost in the debate. Relocating gender incongruence to a different chapter says nothing about the effectiveness or safety of puberty blockers, hormones or surgeries. Nor is the code for childhood a recommendation to provide medical treatment to children.

WHO guideline for adults only

In December 2023, the WHO announced that it would develop a guideline on the health of transgender and gender-diverse people. In January 2024, it clarified that the guideline would cover adults only. The WHO stated that the evidence on the long-term outcomes of gender-affirming care for children and adolescents is limited and mixed. In June 2024, it added that it had not itself published a review or recommendation concerning minors. The guideline covers topics including hormones for adults, training for healthcare providers and legal recognition of adults' self-identified gender. SEGM and The BMJ pointed to ties between members of the guideline committee and WPATH. See also ICD-11 and gender variation, gender dysphoria in the DSM-5 and the criticism of SOC-8.

Frequently asked questions

When did the ICD-11 take effect?

What do the ICD-11 codes HA60 and HA61 mean?

According to the WHO, is being transgender still a mental disorder?

Sources

World Health Organization (2019/2022). ICD-11: HA60 Gender incongruence of adolescence or adulthood. icd.who.int

Coleman, E., Radix, A.E., Bouman, W.P., et al. (2022). Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health, 23(sup1), S1–S259. doi:10.1080/26895269.2022.2100644