Transgender
Transgender (Transgender identity) – an umbrella term used to describe people whose gender identity differs from the sex assigned to them at birth. It encompasses a broad range of identities and experiences and is not, in itself, a medical or psychiatric diagnosis (World Health Organization, 2016, 2024).
Since the 1990s, transgender has become increasingly common as a general designation for people whose gender identity (their internal sense and experience of gender) or gender expression (the outward expression of gender through appearance, behaviour, clothing, and other characteristics) does not correspond to conventional expectations associated with their sex assigned at birth. However, gender identity and gender expression are distinct dimensions of personal experience, and not everyone whose appearance or behaviour departs from established gender norms identifies as transgender (American Psychological Association, 2015).
Some transgender people identify as men or women, while others do not consider themselves part of a strictly binary gender system based on an exclusive division into male and female categories. Various terms are used to describe identities beyond this division, including nonbinary, genderqueer, bigender, agender, multigender, and gender-nonconforming. These terms differ in meaning and are not necessarily interchangeable. Moreover, not all people who identify as nonbinary, genderqueer, or gender-nonconforming consider themselves transgender.
The term transsexual originated in medical and sexological discourse and has historically been associated with people who seek or undergo medical interventions to bring their bodies into closer alignment with their gender identity. It is now generally regarded as a historically specific term, although some individuals continue to use it to describe themselves. Unlike earlier medical definitions, contemporary understandings do not make transgender or transsexual identity dependent on undergoing hormonal treatment or surgery. Some people who identify as transsexual also describe themselves as transgender, while others prefer to identify simply as men or women (American Psychological Association, 2015).
Gender transition refers to the processes through which individuals begin to live in accordance with their gender identity. Transition may involve changes in name, pronouns, clothing, appearance, social relationships, or legal documents. Some individuals also seek gender-affirming medical care, including hormonal treatment or surgery, while others do not. The forms, sequence, and extent of transition vary considerably and depend on personal circumstances, needs, and preferences.
People assigned female at birth who identify and live as men may describe themselves as trans men, while those assigned male at birth who identify and live as women may use the term trans women. Earlier medical and sexological literature frequently employed the expressions female-to-male (FTM) and male-to-female (MTF). Although these designations remain in use in some contexts, trans man and trans woman are generally more appropriate when referring to gender identity rather than a presumed movement between two fixed sex categories. Not everyone who has transitioned wishes to be identified by a transgender designation; some prefer simply to be recognized as men or women.
Genderqueer describes identities that do not fit exclusively within conventional categories of masculinity and femininity. A genderqueer person may experience their gender as situated between these categories, combining elements of both, extending beyond them, or belonging to neither. Some genderqueer people prefer gender-neutral pronouns, such as they/them, or alternative forms, including ze/hir. Pronoun preferences are individual, however, and cannot be inferred solely from a person’s gender identity.
Other terms used in discussions of gender diversity include androgynous, multigender, third gender, and Two-Spirit. These concepts should not automatically be treated as synonymous with transgender identity. In particular, Two-Spirit is a culturally specific term used by some Indigenous peoples of North America to describe identities, experiences, and social or spiritual roles that may involve gender and sexuality. Its meanings vary across communities and cannot be adequately reduced to Western classifications of gender identity or sexual orientation (Carrier et al., 2020).
Understandings of transgender identities in popular culture, academic research, medicine, and public discourse continue to evolve as knowledge of gender diversity and transgender people’s experiences expands. This development has also involved a reconsideration of earlier medical classifications, the relationship between gender identity and psychological well-being, and the effects of social exclusion and discrimination.
Is being transgender a mental disorder?
Transgender identity is not a mental disorder. Being transgender does not inherently cause psychological distress or impair a person’s ability to function in everyday life. Nevertheless, transgender people may encounter difficulties associated with social rejection, discrimination, violence, inadequate institutional recognition, and limited access to appropriate healthcare and social support. Such circumstances can contribute to psychological distress and increase vulnerability to anxiety, depression, and other mental health problems (American Psychological Association, 2015).
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), published by the American Psychiatric Association, retains the diagnosis of gender dysphoria. This diagnosis concerns clinically significant distress or impairment associated with a marked incongruence between an individual’s experienced gender and assigned gender. It does not define transgender identity itself as a mental disorder. Not all transgender people experience gender dysphoria or meet the relevant diagnostic criteria (American Psychiatric Association, 2022).
The continued use of this diagnostic category remains a subject of clinical and scholarly discussion. Some researchers and advocates argue that retaining a psychiatric diagnosis risks pathologizing gender diversity, while others emphasize its role in facilitating access to healthcare and insurance coverage. These debates concern the classification of clinically significant distress rather than the legitimacy of transgender identities.
The World Health Organization’s International Classification of Diseases, Eleventh Revision (ICD-11) introduced a different classification approach. It replaced the earlier category of transsexualism with gender incongruence, which is included in the chapter Conditions Related to Sexual Health, rather than among mental and behavioural disorders. This change reflects the recognition that transgender and gender-diverse identities are not, in themselves, mental health conditions, while retaining a classification intended to support access to appropriate gender-affirming healthcare (World Health Organization, 2024).
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Association Publishing.
American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 70(9), 832–864. https://doi.org/10.1037/a0039906
Carrier, L., Dame, J., & Lane, J. (2020). Two-Spirit identity and Indigenous conceptualization of gender and sexuality: Implications for nursing practice. Creative Nursing, 26(2), 96–100. https://doi.org/10.1891/CRNR-D-19-00091
World Health Organization. (2016). Frequently asked questions on health and sexual diversity: An introduction to key concepts. https://www.who.int/publications/i/item/WHO-FWC-GER-16.2
World Health Organization. (2024). Frequently asked questions on sexual and gender diversity, health and human rights: An introduction to key concepts (2nd ed.). https://www.who.int/publications/m/item/frequently-asked-questions-on-sexual-and-gender-diversity–health-and-human-rights–an-introduction-to-key-concepts
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