In order to have access to necessary, often life-saving care options, transgender people whose bodies are incongruent with their gender identity, must accept the label of having severe mental distress (Gender Dysphoria) or worse yet, a mental disorder (Gender Identity Disorder—older terminology, but still used). This reinforces the delusive belief that just being a transgender person inherently means that the person must have a mental issue.

As a professional, accomplished woman that happens to be transgender, I was shocked when upon seeking needed medical care, I was initially assessed as having a Gender Identity Disorder (GID), and later reassessed with Gender Dysphoria—both references from the Diagnostic and Statistical Manual of Mental Disorders (DSM). Knowing that the healthcare treatment I required was physically focused, I challenged the conclusion of several doctors. I quickly learned that accepting a diagnosis of having a mental disorder and securing multiple, costly mental health recommendations was the only medical means of unlocking access to critical care. Once care was technically accessible, though monetarily very prohibitive, available physical treatments were exactly what I needed to regain basic health, but the mechanism to get there was and is all wrong.

Unfortunately there are several harmful factors that continue to fuel the mischaracterization of transgender people as inherently having a mental disorder:

1. “Gender” is assigned based on external physicality, at or before birth.

A quick, visual check while having a pregnancy ultrasound or upon birth, and then a life-altering binary sex/gender blended declaration from a physician is made: Boy or girl? Penis or not? That’s it—just a visual check. From that casual birth proclamation, children are immediately prescribed a narrow girl or boy gender binary path of cultural appropriateness. This sets the filter through which society continually passes judgment from childhood through adulthood, and prescribed gender roles and expectations pervade everything from allowed activities, permitted behaviors, expressed emotions, preferences, appearance, and even legal rights.

For some, where the birth declaration and the personal gender identity match, predefined gender judgment paths may even provide some sense of comfort. However, for transgender people whose gender identity does not match the blended assignment of sex and gender declared at birth, this is the foundation for a long and arduous three-way struggle between self, society, and the medical community.

2. Anything contrary to a person’s assigned gender, must be a mental issue.

“Nature loves diversity; society hates it,” said Dr. Milton Diamond, Professor Emeritus of anatomy and reproductive biology at the University of Hawaii at Mānoa.

Broad and continual natural variation has resulted in evolutionary advancement over millions of years, but conformity and simplification offer societies the illusion of greater comfort and stability. Relative to gender, this translates into overly simplified and immediately assigned categories of male or female (blended sex/gender), but any variation or complexity beyond those simple definitions, often incites fear and sometimes violence. After all, the assigned sex/gender at birth was likely made by a medical professional with society-granted powers of authority and purported medical experience. This assumption of authority and expertise implies a false sense of accuracy. So what is easier to accept: that a highly trained medical professional’s external physical examination of a newly born baby and resulting gender declaration is potentially inaccurate or that a baby’s gender is yet unknown at birth and that it will likely take several years to fully recognize that individual’s gender and detect potential incongruence? The former option is clearly the simplest explanation. Therefore, concluding that natural variation is a mental disorder is society’s means of dismissing variation and reinforcing gender role conformance.

Additionally, the argument that being a transgender person inherently results in mental dysphoria, is also incorrect. Dysphoria is not created from simply being transgender rather society creates dysphoria through years of denial of transgender existence, fear, violence, stigmatization and marginalization. Prolonged exposure to these conditions is toxic and dangerous for anyone. Transgender children, just like all children, aren’t born with preconceptions as to societal rules and judgments regarding gender expression or roles. Rather, children are born with a sense of personal identity, but the binary societal gender rules have to be taught, enforced, and learned. For transgender children, as the disconnect grows between personal gender identity and imposed societal gender rules, internal conflicts proliferate and are manifested externally: society reacts to those manifestations with fear and judgment and the circumstances escalate over time.

3. Basic medical terminology used to describe a transgender person is at best judgmental, and at worse abusive.

Inaccurate and polarizing terminology such as disorder, deviation, abnormality or defect, all further community stigmatization, fuel societal discomfort and fears, and often accumulate into discrimination, ostracization, and even violence. A simple shift to using the term variation, as in “sex variation” or “gender variation,” is medically more accurate and has a completely different connotation, void of negative judgment.

Also, at a really basic level, consider the definition of the prefix “trans” itself. The definition of trans is “beyond,” so transgender is essentially “beyond-gender.” But of course that is not true for all. Many transgender people have a very strong gender identity. Their identity just doesn’t always fit neatly into the rigid, traditional male/female binary. Gender must evolve like everything else. Why is this evolution threatening? The concept of an oversimplified categorization evolving past initial societal resistance is not shocking, nor uncommon. Consider that the greatest scientific minds in the world once described the earth as flat. Later it was recognized as round, then recognized again as an oblate ellipsoid (bulging at the center), and later it evolved yet again, as we know now even the oblate ellipsoid categorization is less than accurate, as the earth’s center mass is not evenly dispersed.

Since being transgender is not a mental issue, why can’t a transgender person simply be determined to have a physical issue (as appropriate to the individual)?

Consider any number of non-life threatening physical birth variations (unfortunately referred to as “birth defects”). According to the CDC, birth defects affect 1 in every 33 U.S. births and can be structural, functional or both, and most often occur in early pregnancy. Detection often occurs early (e.g., cleft lip or palate) but can also be discovered much later in life (e.g., heart or hearing defects). For these physical conditions, upon discovery modern medical science recognizes the condition, and doctor’s quickly collaborate with guardians (in the case of minors) and/or the individual to define healthy accommodations or correction paths. Prescribed care and associated health insurance coverage often spans a broad range inclusive of surgical options, medication treatments, and counseling. A birth variation condition is therefore relatively accepted by society and optional care processes are fairly simple—detect/recognize, understand options, optionally treat, and support as necessary.

So how are birth variations different than a transgender person detecting that their body doesn’t align with their gender?

Physical/structural issues and variation are readily accepted within the 3 percent of the U.S. population that is born with physical birth variations, but a physical issue of “wrong parts” is somehow not accepted by society or large groups within the medical community as being possible. Yet the process and need is the same. The individual (or their guardian) first recognizes the physical issue, understands options, makes appropriate and timely decisions as to how to proceed, and then based on the decided path, accompanying support is sought. At a high-level, there is little practical difference.

Why not just consider being transgender as a basic natural variation with no diagnosis required for care?

A “no diagnosis” approach has large negative implications for transgender people with physical variation. Medical care and coverage is generally activated as preventative or as the result of a specific diagnosis. Although requiring that a transgender person be categorized as having a mental disorder is inaccurate and pejorative, at a basic level it does unlock some level of access to medically necessary care (assuming all pre-qualifications are met). Without a basic medical diagnosis, hormones, surgical corrections, and rudimentary support needs are all potentially out of reach. Coupled with society-induced dysphoria, a lack of access to medical options is life threatening.

Making the world a safer and healthier place.

Society needs to recognize that biological, physical, and gender variation are absolutely a natural part of the human condition and that labeling variation as a disorder only furthers division and fuels fears. Being transgender is not a mental disorder, but denying people their identity and the care they need in a timely manner, can result in creating extreme distress.

An important first step is to enable a physical variation diagnosis for transgender people needing physical care and treatment, rather than forcing a mental disorder label prior to allowing access to necessary care. This reduces potential medical miscategorization and negative connotations associated with being labeled as a disorder.

Lastly, communities need to acknowledge that collectively, our current rigid binary gender system is actually creating and exacerbating gender dysphoria. The long-term cost (to society, families and individuals) of marginalizing and stigmatizing transgender people is immeasurably higher, than recognizing normal physical variation, eschewing gender judgments and enabling full access to care as appropriate to individual needs.