"Transgender" is not rocket science. The underlying concepts are simple: we are all assigned a sex or gender at birth, usually when a doctor or parent looks at our genitals and declares us "boy" or "girl." As we grow and our bodies, minds, and personalities develop, we may identify in ways that do not match our assigned sex.
Transgender human rights activists around the world are fighting a tide of stigma and discrimination, with roots deeply entwined in a system that has historically diagnosed this very desire to change as mental pathology -- currently as "gender dysphoria" in the DSM-5 (the American Psychiatric Association's diagnostic manual) and as "gender identity disorders" in the ICD-10 (the World Health Organization's International Classification of Diseases).
Multiple studies have shown that stigma and discrimination, bullying, harassment -- and not anything inherent in gender transition -- cause the major mental health problems for transgender people. There is an important global moment approaching when this view of transgender people as mentally disordered could become a thing of the past. But there is also a risk that the interests of younger children could be lost in the process.
In 2017 or 2018 the WHO will release a revised ICD: ICD-11. This will be an important document: one worldwide survey showed that around 70 percent of psychiatrists currently use ICD to code their diagnoses.
WHO proposes to re-frame "gender identity disorders" as "gender incongruence" and to move the diagnosis from the chapter on mental disorders to one on sexual health. This is an important step and a big gain for transgender adolescents and adults, who may soon be able to seek medical support without being viewed as mentally disordered.
But WHO is also proposing a diagnosis called "gender incongruence of childhood" (GIC), which would apply to pre-adolescent children--that is before the age of puberty.
Young kids who are exploring their gender identity need the personal and social space to do it, as well as support and information to become comfortable expressing that identity, and to learn to handle other people's reactions. Some of these pre-pubescent children may also need access to health services. They may be depressed or anxious, or need documentation to ensure that their gender issues are accommodated at school.
However kids below puberty are too young for puberty blockers, cross-sex hormones, surgery, or any of the other body-modifying healthcare services often sought by transgender people later in life. So why the GIC diagnosis?
To employ a diagnosis of "gender incongruence of childhood" would place a stigmatizing burden on transgender pre-pubescent kids. Would WHO propose a disease diagnosis for young people exploring their sexual orientation, or learning to accept and express who they are sexually? Certainly not. Indeed WHO is proposing to remove diagnoses currently in ICD that might be used for those purposes.
The European Parliament's 2015 Fundamental Rights report has criticized the GIC proposal, and the potential it represents for continuing a disease stigma. A 2014 survey of members of the World Professional Association for Transgender Health reveals that, outside the US, about two thirds of experts in the field oppose the GIC diagnosis.
Young children exploring and learning to express their gender need space, support, and information (regardless of whether they turn out to be transgender adults). They don't need their experiences to be turned into a disease. True, transgender children may experience distress, and they (and their parents or teachers for that matter) may benefit from professional support. But the ICD already provides ways in which these needs can be documented without disease diagnoses. Non-disease codes -- called "Z-Codes" -- allow practitioners to record the circumstances in which a person accesses health services, can provide the basis for documentation for schools, and (when puberty finally hits) can be used to expedite the provision of hormone suppressants.
Under international law, children have a right to an identity, and a right to be heard. All decisions made about children must take into consideration their best interests. As children develop, not only do their bodies and brains grow, but so do their roles as citizens: they develop into decision-makers -- crucially about their own lives.
If drafters of ICD-11 take into consideration the rights of all children -- specifically to information, education, and health -- as they move toward this much-anticipated revision to a global guide for health providers, then they too should come to the conclusion that GIC has no place in the ICD.
In 2014, 35 transgender children were murdered. Today, on Trans Day of Remembrance, they are among those we mourn and remember -- people around the world should refuse to forget the young lives lost to prejudice and brutality.
And we must also not forget the world has a long way to go in protecting the fundamental rights of all transgender children -- including by remembering that they are kids like any others, who have rights enshrined in international law.
Dr. Sam Winter is professor of public health at Curtin University in Perth, Australia, and a board member of the World Professional Association of Transgender Health. Kyle Knight is a researcher in the lesbian, gay, bisexual, and transgender rights program at Human Rights Watch based in Berlin.
