Psychological health
Being trans is not a mental illness, it is an integral part of being human.
In the latest edition of the WHO International Compendium of Diseases (ICD-11), the diagnostic term HA 60.0 Gender Incongruence replaces F.64 Transsexualism (ICD-10) and has been moved out of the chapter on Mental and Behavioural Disorders. This has been welcomed by those campaigning for de-stigmatisation.
Not all trans people present with more mental health problems than cisgender people but may well experience minority stress. This is the additional burden of stress faced by minority groups and includes stigmatisation and marginalisation.8 Most studies have particularly included clinical populations (i.e., those seeking medical intervention), and show that mental health problems are higher in those who have not had any gender affirming medical treatments.9-12 Withdrawing hormone therapy in the event of a mental health crisis and against a patient’s wishes is rarely advised.
Autistic traits are common among trans people, so it is important to be mindful of the ways in which we communicate and adopt a holistic approach to consulting that is tailored to individual needs. 13,14
‘Deadnaming’ is when a person who has changed their name to reflect their gender is referred to by their previous name. It can potentially cause significant psychological distress and alienation.
Practical Tip
While it is important to be aware of co-morbid mental health difficulties, particularly suicide risk, it is vital not to pathologize gender identity, as this is part of human diversity.
Treating a mental health condition will not make gender incongruence go away, but the reverse could well be true. Support your patient in accessing a gender identity service waiting list rather than delaying or postponing a referral unnecessarily.