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A History of
Transgender Medicine
In the United States
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The classification of gender nonconformity as described in the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) reflects a persistent resistance to incorporate changing views around our understanding of gender diversity. In 1980, the diagnosis of transsexualism was included for the first time in the DSM-3, under the heading of gender identity disorders (GID). Providers hoped that inclusion in the DSM would legitimize transgender identities, and facilitate access to medical care, including insurance coverage. This occurred to some extent, but diagnostic inclusion also reinforced the popular notion of transsexualism as a mental illness, which led to further marginalization, and discrimination. Ironically, in 1980, the diagnosis of Ego Dystonic-Homosexuality was removed from the DSM-3 on the grounds that it was not a disorder. In 2014, GID was removed from the DSM for similar reasons and replaced with the term gender dysphoria, which refers to the distress caused by a discrepancy between assigned sex at birth and gender identity. There is ongoing discussion about the diagnostic and coding terms used to describe gender variance—a constant battle to balance the need for medical treatment against language that implies pathology and leads to stigmatization.
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