Depathologising diversity: Trans children and families' experiences of pathologisation in the UK

Abstract

In January 2022 the World Health Organization removed transgender identities from categorisation as a mental illness, marking a significant global shift from the pathologisation of gender diversity. However, a legacy of pathologisation of trans identities continues to impact trans lives, particularly on trans children. Informed by qualitative data from 30 families with trans children, this article examines the continued impacts of pathologisation on trans children and families in the UK, exploring how pathologisation manifests at individual, institutional and societal levels.The article advocates for trans depathologisation as a critical priority for child rights and social justice.

Implementation of Patient-Reported Outcome Measures for Gender-Affirming Care Worldwide

“…Practical considerations for overcoming these barriers include communication between clinicians and patients on how PROM results will be used for research and care purposes and providing patients information on how their data will be handled securely. Due to discrimination experienced by patients in some specialist centers delivering gender-affirming care, 9 patient and public partners emphasized confidentiality as key for PROM sections that evaluate satisfaction with health care professionals so that their care is not negatively impacted. Furthermore, applying techniques in computerized adaptive testing, a form of artificial intelligence that can reduce PROM length, may reduce patient burden of completing lengthy PROMs, resulting in higher engagement.…”

“…However, not all gender identity service delivery is gender affirming due to pathologization, discrimination, and cisnormativity existing in some gender identity centers. 9 Clinical guidance and international standards emphasize that individual patient needs must be comprehensively understood to offer gender-affirming care in line with patient goals. 10 Implementation of PROMs can improve gender-affirming care through regular monitoring of patient satisfaction (through patient-reported experience measures) and facilitate studies of treatment effectiveness and cost-effectiveness, supporting access to gender-affirming care.…”

Respecting the free will, authenticity and autonomy of transgender youth

“…7,18,19,40 Despite World Health Organisation (WHO) policy depathologising the experience of TGD people, very few countries are described as not having prohibitive requirements regarding medical and legal gender change. 12,20,22,24,29,41 Most frequently, these conditions focus on minors and are driven by religious ideologies that influence those people who legislate healthcare. 42 In the United States, more than 146,700 youths aged 13-17 years have had or are in jeopardy of having their access to gender-affirming care restricted with this number ever increasing due to expanding prohibitive laws.…”

“…48,49,50 Often they must have a diagnosis of gender dysphoria even if they do not feel a significant impairment or distress related to their gender incongruence. 8,24 For a TGD adolescent to be provided medical care gender affirmation is subjected to a degree of concretisation. This is due to treatment being guided by the recommendations for children and adolescents in the DSM-5 8 where criteria predominantly mention gender in the binary.…”

“…18,19,20,21 In some countries, there is access to self-determined legal name and gender recognition; however, other governments require medical examinations or a psychiatric diagnosis of gender dysphoria which continue to pathologise TGD as medically or psychologically disordered. 20,22,23,24 Where gender-affirming medical care is permitted for adolescents, this can include puberty blockers, hormone therapy or in some cases top surgery (chest masculinisation or feminisation surgery). 14,25 Bottom surgery or gender reconfiguration surgery is not usually considered for adolescents who have not reached the age of adulthood or 18 years of age.…”