The Problem of Gender Identity Disorder

I recently sat down with Jess Guerriero, a genderqueer activist and trans ally with an MA in Gender and Cultural Studies and a candidate for MSW from Simmons College. For her thesis, Jess examined the diagnosis of Gender Identity Disorder in the DSM IV-TR and how the current treatment model does not include folks who identify beyond the gender binary.

Gender Identity Disorder (GID) is the diagnosis currently given to transgender and transexual people. This gives providers a diagnosis they can use for reimbursement from insurance companies. The problem is that GID is very binary based and doesn’t recognize people who do not identify as trans but are gender non-conforming.

The current standards of care for someone who has been diagnosed with GID are that they must meet with a therapist to get a letter in order to get hormones. They must then be on those hormones for 9 months to a year and pass the “real life test” – which is “successfully” living as the opposite gender for one full year before they can get a second letter to approve surgery. There is also a “treatment narrative” that therapists are often looking for – a long standing history of “gender troubles”. For example, “I always knew I was a boy, I liked to play with trucks instead of dolls…” etc. These requirements are becoming a little more fluid, especially here in Massachusetts, but still don’t leave much room for people who may not want to fully transition.

The thing is, there’s really no room for folks who don’t want to play the binary game. While the system works for some, for those who don’t want to fully transition or may not have the narrative that therapists are looking for, providers are not given any kind of system care. The hard thing is that therapists need to be able to get paid for their work. That money needs to either come from out of pocket or from an insurance company, and those insurance companies want a diagnosis. However, being transgender or genderqueer or not fitting on the gender binary is not something that should be diagnosed, much like being gay isn’t something that should be diagnosed.

Before setting out to write her thesis, Jess really hoped that she could create a recommended plan of action. What she found is that there’s no clear fix. The systems are broken – the systems of diagnosis, insurance, and communication between the mental health and medical world. What became clear, though, is that there should not be one uniform treatment path and that the client needs to be involved in creating that path.

So what can professionals do now?

  • Start where the person is. Have them define and describe their gender identity to you.
  • Don’t act as a gate keeper. Be honest about the diagnosis process and allow the client to decide if they would like to use the GID diagnosis for the insurance company. Work within the system, but don’t necessarily follow the system perfectly.
  • Increase communication between the mental health world and the medical world.
  • Increase education on gender identity for yourself and other professionals.
  • Provide services for after any body modification.
  • Pay attention to social policy and advocate for your clients. Help create a world that better includes them.

We’ve got a long way to go, but we’re making small steps. For example, as of yesterday, a huge advancement took place, thanks to the Department of State. In the past, some states required passport applicants to show proof of gender reassignment surgery before they could change the gender on their passport. This is no longer a requirement! The requirement now is to show “certification from an attending medical physician that the applicant has undergone appropriate clinical treatment for gender transition.” This is a step in the right direction. Thanks to the World Professional Association for Transgender Health!

For more information, check out and World Professional Association for Transgender Health. If you’re interested in reading Jess’s amazing thesis, give me a shout out and I can connect you with her!


5 responses to “The Problem of Gender Identity Disorder

  1. It’s actually even a lot more fluid than that. Providers can choose how to administer hormones and a lot of clinics are working on new models. My favorite is allowing patients the most autonomy by firstly making sure they know the full effects of whatever hormone they want and then signing a consent waver that they are making an informed decision to start hormones. No therapist, no GID diagnosis (something that can have long term negative affects on your life due to the stigma of psychological disorders, and something I would argue trans-ness is definitely NOT), no waiting months and months to start your life.

    The clinic I went to had me get three people vouch for the fact that I’ve been out for more than 3 months. It was a good compromise, in my opinion.

  2. The DSM-V supposedly gets rid of the gender binary for GID…or so I’ve heard. I’m waiting with bated breath.

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