Vivek Ramaswamy got it wrong; being trans isn’t a mental health disorder.

Onstage at the second Republican presidential primary debate, entrepreneur Vivek Ramaswamy said he wanted to be "very clear": "Transgenderism, especially in kids, is a mental health disorder."

Ramaswamy has said this before, but the medical community disagrees. Being transgender is not classified as a mental illness. 

If people are transgender, that means their sex — the biological category they were assigned at birth —  does not match their gender identity, which is someone’s internal sense of being a man, woman, something in between or neither. Most major medical organizations agree that sex and gender are separate and distinct things. 

Historically, the experience of being transgender carried the term "disorder," but experts no longer view it that way and are working to destigmatize the diagnosis while continuing to ensure access to gender-affirming health care.

In 2019, in the latest edition of the World Health Organization’s International Classification of Diseases, the WHO renamed the diagnosis from "transsexualism" to "gender incongruence" and moved it from the chapter on mental health disorders to a new section titled "conditions related to sexual health."  

Similarly, in 2013, when the Diagnostic and Statistical Manual of Mental Disorders, or DSM, was revised, the term "gender identity disorder" was changed to "gender dysphoria" to clarify that being transgender is not an illness. 

Some advocates argued the diagnosis should be removed from the manual, but that change would jeopardize access to gender-affirming care. Without a diagnostic code, most insurance plans wouldn’t cover it, and incarcerated trans people could be denied gender-affirming health care. 

When revising the DSM, "the challenge … was how to reduce the stigma of having a diagnosis while maintaining access to care," said Dr. Jack Drescher, a distinguished life fellow of the American Psychiatric Association and past president of the Group for Advancement of Psychiatry. 

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But not all trans people experience gender dysphoria. Gender dysphoria is the experience of distress as a result of your sex not matching your gender identity. It’s an "emotional response to being trans," said Michael Hendricks, a Washington, D.C.-based clinical psychologist focused on gender diversity. "Being trans is who you are." 

The distress of gender dysphoria can be treated by affirming a person’s gender identity through social support and sometimes medical or surgical treatment, experts say. 

Although persistent gender dysphoria can cause other mental health issues, it is not itself a mental health disorder, according to experts. 

Research suggests that higher rates of mental health struggles among trans people can be attributed to the social stigma and discrimination they experience. But Hendricks said these secondary mental health problems can sometimes be resolved when people receive gender-affirming care. 

All of the following professional medical associations affirm that being trans is not a mental health disorder: American Medical Association, American Academy of Pediatrics, Endocrine Society, Pediatric Endocrine Society, American Psychological Association, American College of Obstetricians and Gynecologists, American Psychiatric Association, and the World Professional Association for Transgender Health. 

Ramaswamy said that being transgender is a "mental health disorder." 

But that runs contrary to the widespread medical community consensus. In the past, the medical community considered this incongruence to be a disorder. But medical experts today widely agree that being transgender is not a mental health disorder.

Leading medical organizations have taken steps in recent years to revise diagnostic manuals and standards of care to clarify that being transgender is not a mental illness.

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