Transition

« I see transition as a type of rebirth, a reincarnation within our lives. It can be painful, and we need to let go of the past which weighs us down. But we can still carry the positive with us, value everything we can, regardless of gender. » — Cora, 37 (Nonbinary)

Transition is a term that is used to describe the process that individuals typically experiencing gender dysphoria go through to reach their desired social role, and/or physicality; there is no single definition of transition as the term is based on the unique requirements of each individual.

Healthcare services

A diagnosis of gender dysphoria that is congruent with the diagnostic criteria of a recognised 'gender identity disorder' is the typical prerequisite for the treatment of persistent gender dysphoria in those countries which offer such services. Healthcare professionals typically reference either the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases (ICD) in order to confirm a diagnosis of gender dysphoria.

Before the 1960s few countries offered safe, legal medical options for people experiencing gender dysphoria and many criminalized gender-nonconforming behaviours or mandated unproven psychiatric treatments. In response to this problem, the Harry Benjamin International Gender Dysphoria Association now known as the World Professional Association for Transgender Healthcare (WPATH) authored one of the earliest sets of clinical guidelines for the express purpose of ensuring "lasting personal comfort with the gendered self in order to maximize overall psychological well-being and self-fulfilment". The WPATH 'Standards of Care' are the most widespread clinical guidelines used by professionals working with transsexual, transgender, or gender variant people, and have undergone several revisions since its initial publication. Traditionally these guidelines have been structured in relation to the Transsexualism diagnosis and as such have presented a dilemma for non-transsexual individuals who have been unable to meet the eligibility criteria for medical treatment.

In 'Archives of Sexual Behaviour (Volume 16), "Heterosexual and homosexual gender dysphoria"' (1987), Dr Ray Blanchard (who served on the DSM-IV Subcommittee on Gender Identity Disorders) wrote, "(there is a) well-recognized tendency of applicants for sex reassignment surgery to distort their histories in the direction of 'classic' transsexualism in an effort to gain approval for such surgery".

Gender dysphoria Vs. Gender Identity Disorder

Main article: Gender dysphoria

The diagnosis of 'Transsexualism' was introduced in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) compiled by the American Psychiatric Association (APA) in 1980 for individuals who had experienced a minimum of two years of continuous interest in reconstructing their sex-physicality and assigned gendered identity. The criteria of the diagnosis focused on individuals whose identities resembled a male-to-female (MTF) or female-to-male (FTM) paradigm. Others experiencing gender dysphoria, but whose identities did not fit the MTF/FTM paradigms could be diagnosed with 'Adulthood Nontranssexual Type', or 'Gender Identity Disorder: Not Otherwise Specified' (GIDNOS). In 1994 the DSM-IV committee replaced the transsexual diagnosis; for individuals with MTF/FTM type identities a diagnosis of 'Gender Identity Disorder' (GID) would be applied instead. The diagnostic criteria of GIDNOS was left undefined, bar that the diagnosis be given to those whose 'gender identity disorder' cannot be defined within a MTF or FTM paradigm. Though a gender dysphoric nonbinary individual may use the term 'transsexual' to describe themselves, they are not considered to be transsexual within a clinical context.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in May 2013 which replaced the gender identity disorders with Gender Dysphoria[1]. "The new revisions for the Gender Dysphoria diagnosis in the DSM-5 are mostly positive. However they do not go nearly far enough. The change in title from Gender Identity Disorder (intended by its authors to mean “disordered” gender identity) to Gender Dysphoria (from a Greek root for distress) is a significant step forward. It represents a historic shift from gender identities that differ from birth assignment to distress with gender assignment and associated sex characteristics as the focus of the problem to be treated... In another positive change, the Gender Dysphoria category has been moved from the Sexual Disorders chapter of the DSM to a new chapter of its own. Non-binary queer-spectrum identities and expression are now acknowledged in the diagnostic criteria... However, the fundamental problem remains that the need for medical transition treatment is still classed as a mental disorder. In the diagnostic criteria, desire for transition care is itself cast as symptomatic of mental illness, unfortunately reinforcing gender-reparative psychotherapies which suppress expression of this “desire” into the closet. The diagnostic criteria still contradict transition and still describe transition itself as symptomatic of mental illness. The criteria for children retain much of the archaic sexist language of the DSM-IV-TR that psychopathologizes gender nonconformity. Moreover, children who have happily socially transitioned are maligned by misgendering language in the new diagnosis. More troubling is false-positive diagnosis for those who have happily completed transition. Thus, the GD diagnosis, and its controversial post-transition specifier, continue to contradict the proven efficacy of medical transition treatments. This contradiction may be used to support gender conversion/reparative psychotherapies – practices described as no longer ethical in the current WPATH Standards of Care"[2].

U.K.

Main article: Nonbinary healthcare (UK)

Historically, eligibility criteria for medical treatment has presented a barrier for nonbinary individuals, specifically the 'real life test' (RLT) component