ICD-11 proposal: delete the sexual orientation categories, move gender incongruence out of mental disorders
The WHO working group's 2016 paper: ICD-10's "F64 Gender identity disorders" were "reconceptualized as Gender incongruence" and proposed for a sexual health chapter; the sexual orientation categories were "recommended for deletion".
Weak or heavily disputed. Treat as a question, not an answer. how we score evidence
Caveat on this rating: The paper states that its recommendations rest on social attitudes, policy and human rights as well as research. It reports no outcome data of its own. An erratum was published in 2017 and was not read for this row.
This is the paper in which the World Health Organization's working group set out what it wanted changed in the eleventh revision of the international classification, and why. It sits on both the sexual orientation page and the gender identity page because it is the same document doing both things.
Significant findings
The abstract names the ICD-10 groupings under review: "F52 Sexual dysfunctions, not caused by organic disorder or disease; F64 Gender identity disorders; F65 Disorders of sexual preference; and F66 Psychological and behavioural disorders associated with sexual development and orientation."
The basis for change is stated as three things at once: "advances in research and clinical practice, and major shifts in social attitudes and in relevant policies, laws, and human rights standards."
On gender identity: "Gender identity disorders in ICD-10 have been reconceptualized as Gender incongruence, and also proposed to be moved to the new chapter on sexual health." The new chapter is "Conditions Related to Sexual Health", described as "overcoming the mind/body separation that is inherent in ICD-10."
On sexual orientation, the last sentence of the abstract: "ICD-10 categories related to sexual orientation have been recommended for deletion from the ICD-11."
The World Health Assembly adopted ICD-11 in May 2019 and it came into effect on 1 January 2022; those dates are the WHO's, not this paper's.
The other direction
The paper says in its own words that the changes rest partly on "shifts in social attitudes" and "human rights standards", not only on research. A reader who wants a classification to follow evidence alone will notice that. The working group's answer, in the companion Drescher 2012 row, is that the placement of these categories had always reflected social views, and that the question was which ones.
What this does not show
A proposal paper reports no outcome data. It does not measure distress, treatment or anything else; the field study that tested the working group's reasoning is the Robles 2016 row. Deleting a category from a classification does not change what happens to anyone in a clinic.
Worth asking
A classification is a filing system. What changes for a person when their entry moves chapters, and what does not?
Source
Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations — Reed GM, Drescher J, Krueger RB, Atalla E, Cochran SD, First MB, Cohen-Kettenis PT, Arango-de Montis I, Parish SJ, Cottler S, Briken P, Saxena S (2016)
Reputable peer-reviewed journal
Read the source: https://doi.org/10.1002/wps.20354
DOI: 10.1002/wps.20354
How this was scored
- Study design
- Narrative review
- Funding
- Funding not disclosed
- Published in
- Reputable peer-reviewed journal
- Sample size
- not recorded
- Preregistered
- not recorded
- Conflicts disclosed
- not recorded
- Independent of proponent
- not recorded
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published September 29, 2026.
Questions
How strong is the evidence behind this?
veisund rates this source "contested". Weak or heavily disputed. Treat as a question, not an answer. It scores 33 out of 100 on our published rubric. One caveat travels with that badge: The paper states that its recommendations rest on social attitudes, policy and human rights as well as research. It reports no outcome data of its own. An erratum was published in 2017 and was not read for this row. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
Disorders related to sexuality and gender identity in the ICD-11: revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations — Reed GM, Drescher J, Krueger RB, Atalla E, Cochran SD, First MB, Cohen-Kettenis PT, Arango-de Montis I, Parish SJ, Cottler S, Briken P, Saxena S (2016). Published in: Reputable peer-reviewed journal. DOI: 10.1002/wps.20354. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Narrative review. Funding: Funding not disclosed. Independence from the proponent is not recorded. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.