Call to Action to Urge Trans-Affirming Position Statements by the APA

Kelley Winters, Ph.D.
GID Reform Advocates

On May 18, I presented a paper to the Annual Meeting of the American Psychiatric Association on the diagnostic categories of Gender Identity Disorder (GID) and Transvestic Fetishism (TF) in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Coauthored by San Francisco psychologist and community advocate Dr. Randall Ehrbar, our presentation stressed the need to address two issues in the upcoming Fifth Edition of the DSM. First, the GID and TF diagnoses inflict harmful stigma of mental illness and sexual deviance on all trans, gender variant and queer identified individuals who do not conform to their assigned birth-sex, either by inner identity or outer social expression. Second, the GID diagnosis fails to support the medical necessity of hormonal or surgical transition care for those transsexual individuals who need them. In fact, the current GID diagnostic criteria and supporting text contradict both medical and social transition.

In addition to the case for reforming GID and removing the defamatory TF diagnosis in the DSM-V, we also urged the elected leadership of the APA to issue three public position statements in support of human dignity and medical care for trans and gender variant people.

We would like to ask the trans-community, our LGB and straight allies and especially our supportive medical and mental health providers to join us in calling for position statements that gender difference is not disorder, affirming the medical necessity of transition care, and recognizing social gender transition. The American Psychiatric Association has an opportunity today to reclaim its compassion for human dignity and its mandate to do no harm.

In 1973, the American Psychiatric Association made a historic step toward the ultimate declassification of same sex orientation as mental illness in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Although the actual removal of the homosexuality diagnosis from the DSM occurred in incremental revisions over the following fourteen years, the elected leadership of the APA issued a Position Statement on “Homosexuality and Civil Rights” that had a profound impact on public opinion and defamatory stereotypes. Tragically, the APA has never issued a similar position statement in support of trans and gender variant people.

How can you help?

Please send letters to the President and Board of Trustees of the APA and the President of the Association of Gay and Lesbian Psychiatrists with the following requests:1

1– We ask the elected leadership and Board of Trustees of the American Psychiatric Association to affirm in a position statement that gender identity and expression which differ from assigned birth sex do not, in themselves, constitute mental disorder and imply no impairment in judgment or competence.

2– We also ask the APA to follow the example of the American Medical Association, the American Psychological Association, and the World Professional Association for Transgender Health (WPATH) by issuing a statement clarifying the medical necessity of hormonal and/or surgical transition treatments for those who suffer distress caused by deprivation of physical characteristics congruent with their gender identity. We call on the APA to urge insurance and healthcare coverage for medically prescribed transition treatment as well as ongoing and ordinary medical and mental health care. 2

3– Finally, we ask the American Psychiatric Association to follow the example of the American Psychological Association, the National Association of Social Workers and WPATH in opposing discrimination on the basis of gender identity or expression and encouraging legal recognition of all people that is consistent with their gender identity and expression. We ask the APA to affirm in a position statement the dignity and legitimacy of individuals who have transitioned their social gender roles, regardless of their physical anatomy or assigned birth sex.

Contact Information:

Alan F. Schatzberg, President, American Psychiatric Association
Carol A. Bernstein, M.D., President-elect, American Psychiatric Association

American Psychiatric Association
1000 Wilson Boulevard
Suite 1825
Arlington, VA 22209
email in care of:

Board of Trustees, American Psychiatric Association
in care of: Thomas Graham
Senior Governance Specialist – Board of Trustees

Copy to Ubaldo Leli, M.D., President, Association of Gay and Lesbian Psychiatrists

Please send copies of your letters to me at Include the phrase “APA Gender Position Statements” in your email header.

Update: My letter of June 22, 2009, to APA officials, with names of over 400 online endorsements and copies of letters received by GID Reform advocates, is available at

Finally, if you are a Facebook member, please consider adding your name to this Facebook Group to Urge the American Psychiatric Association to Publicly Affirm Human Dignity and Access to Medical Care for Trans and Gender Variant People. See

1. Statement text updated May 31 and June 2, 2009 to clarify the distress of anatomic gender dysphoria, acknowledge organizations that previously issued similar statements and call for a statement to oppose discrimination. My deep thanks to Randall Ehrbar, Becky Allison, Jamison Green, Dan Karasic, Arlene Lev and Anne Vitale for their insight and input.

2. Based on input from clinicians and friends in the community, “and mental health” care was added to the second position statement request. At issue: those transpeople who do suffer depression or anxiety face unusual barriers to care that result from the stereotype that our gender identities are defective or “disordered.” All too often, care givers may ignore these conditions because they are preoccupied with “fixing” our gender identities; or insurers may deny claims altogether once they are aware that transition has started. For a thoughtful discussion of some of these issues, see the sent(a)mental project, founded by author Dylan Scholinski, at

Copyright © 2009 Kelley Winters, GID Reform Advocates

About gidreform
Kelley Winters, a writer on issues of transgender medical policy, founder of GID Reform Advocates and an Advisory Board Member for TransYouth Family Advocates. She has presented papers on the psychiatric classification of gender diversity at the annual conventions of the American Psychiatric Association, the American Counseling Association and the Association of Women in Psychology.

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