People who develop a gender identity that does not correspond to their biological sex have historically been exposed to difficulties derived mainly from the structure that society adopts at different times. One of the answers that was tried to give to this reality was through its medicalization.
In this sense, transsexuality appeared as a diagnostic category in the 1950s. Hormone treatment and sexual reassignment surgeries were the options that transsexual people had to follow to “correct” what was considered a pathology. In this way, it was intended that trans people occupy a position of “normality” in the binary system, but the negative consequences that this intervention could have on their personal development and well-being were made invisible.
Hormone treatment was not accepted by all health professionals, which led to the inclusion of transsexualism as a psychiatric category in the DSM-III in 1980, the most influential classification manual for mental disorders worldwide. The objective of this inclusion was to socially and scientifically legitimize the hormonal-surgical treatment of transsexual people. Obtaining a psychiatric diagnosis of the transsexual condition opened the way to officially access hormone therapy or surgery (Garaizabal et al., 2015).
In its 1994 update, the DSM-IV replaces the term transsexualism with the category “disorder of sexual identity” and in the latest version of the manual, in 2013, it is categorized as “gender dysphoria”.
Although it sounds old-fashioned, today many centers work with this vision of the 80s. The diagnostic criteria of these psychiatric categories are like wearing a reflective badge: since only people who “wear it” can access treatment, they are forced to live with a diagnosis of psychiatric abnormality and are seen from discrimination and stigma.
Fortunately, in recent decades we are going through the rise of a depathologizing model, which implies eliminating the diagnosis of mental pathology and replacing it with a dialogue where the person is informed about their options and has full decision-making capacity about their transit process (Garaizabal et al., 2015). In this process, which leads to “informed consent”, the health professional provides information and accompanies, but does not oblige or prohibit.
Garaizabal, C., Mas, J., Almirall, R., Vega, S. (2015). Informe de model d’acompanyament i assistència a persones Trans a la ciutat de Barcelona. Ajuntament de Barcelona: Barcelona.