Promoting and Protecting Human Rights in relation to Sexual Orientation, Gender Identity and Sex Characteristics A Manual for National Human Rights Institutions 1.6.2. Being transgender is not an illness Transgender people who medically transition have specific health needs that are related to their gender identity. However, this does not mean that gender diversity is a medical condition or that it requires medical treatment. Traditional concepts of gender diversity existed long before the introduction of medical terms. Medical terms describing transgender people only emerged in the twentieth century after the development of hormone treatment and gender-affirming surgeries that have enabled transgender people to medically transition. Specifically, some forms of gender diversity have been defined as a mental health condition in the World Health Organisation’s ICD series and in the DSM series of the American Psychiatric Association. These classifications are used by public health systems around the world to code, and thus fund, health services that enable transgender people to access gender-affirming hormone treatment and surgeries. As part of its current revision of ICD-10, the World Health Organisation has proposed removing such diagnoses so they are no longer classed as mental health diagnoses. A remaining challenge is to ensure the continuation of diagnostic codes for the gender-affirming health services that are medically necessary for some transgender people. The World Professional Association for Transgender Health publishes Standards of Care on the health of transsexual, transgender and gender non-conforming people. In May 2010, its Board of Directors issued a ‘de-psychopathologisation’ statement emphasising that gender diversity is common across many cultures. It recommended that gender diversity should not be defined by a mental health diagnosis, as part of broader steps needed to eliminate stigma against transgender and gender-variant people.63 Participants from 19 countries, attending the Trans* Pre-conference at the 2015 ILGA Asia Conference in Taiwan, unanimously passed a declaration supporting this approach and opposing World Health Organisation proposals to define gender diversity in children as a disease. This declaration was endorsed by the Asia Pacific Transgender Network and the ILGA Asia conference.64 In some parts of the region, the perception that gender diversity is an illness is the only mitigating factor reducing violence and discrimination against transgender people. In these circumstances, it is understandable if transgender people argue that they should not be criminalised for a mental health condition and that being transgender is not their choice. NHRIs can play an important role by emphasising that transgender people have the right to freedom from discrimination, whether or not they have a mental health diagnosis such as gender dysphoria. 1.6.3. Being intersex is not an illness Being intersex is about body diversity. It is not inevitably about having a physical illness. Most intersex variations have no impacts on an intersex person’s health, yet medical terms are used frequently to describe all intersex variations as ‘disorders of sex development’. This contributes to the level of stigma attached to intersex traits and the pressure for medical interventions to ‘correct’ such disorders. There is emerging evidence that, when parents have access to information describing the lived experiences of intersex people, they are more likely to delay or refuse medical interventions.65 Parents may not realise that they are consenting to experimental treatments and later parental regret can be high.66 22 63 See www.wpath.org/uploaded_files/140/files/de-psychopathologisation%205-26-10%20on%20letterhead.pdf. 64 The ILGA Trans* Secretariat and the Asia Pacific Transgender Network, Statement on Gender Incongruence in Childhood, Trans* Pre-conference, 6th ILGA Asia Conference, Taipei, Taiwan, 27 October 2015. 65 G. Davis, Contesting Intersex, the Dubious Diagnosis, 2015. 66 L. Liao, D. Wood and S.M. Creighton, ‘Parental Choice on Normalising Cosmetic Genital Surgery’, BMJ, 28 September 2015. .