Transgender people already navigate a difficult path through life. Some feel their gender doesn't fit with 'male' and 'female' stereotypes at all while others feel they are born into the wrong bodies.
Some decide to undergo invasive painful surgery while others decide on hormone replacement therapy. Even after transitioning, many still experience a lifetime of being seen as something they are not.
This pain is compounded by the World Health Organisation's classification of transsexualism as a mental illness.
This classification fuels discrimination and abuse and makes it difficult for transgender people to get access to the right sort of healthcare according to campaigners.
Comparing its outmoded definition with the once institutionalised belief that being gay was an illness, transgender campaigners are backing a petition to change the system.
Sarah Savage is in her 20s and from Jersey and went through transition last year. She is lobbying for a change to the classification along with 26-year-old Max Zachs from North West London.
Both took part in Channel 4’s My Transsexual Summer and are keen to increase the public’s understanding about what it means to be transgender.
“I really don’t need a psychiatrist to tell me who I am,” Sarah told The Huffington Post UK.
“Gender identity is about identity it's not about being ill, it’s about who you are,” she added.
Sarah claims the latest research shows gender dysphoria begins in the womb.
“The idea that being trans is a mental illness is not based on fact. The latest research into transsexualism shows that it may be caused by a hormonal imbalance in the womb. The WHO needs to reclassify being transgender as a birth defect.
Max Zachs: 'It's irrelevant what causes people to be trans'
“Being trans is something you are born with but at the moment there’s a huge social stigma attached to it.
“That’s in a large part to do with it being classified as a mental illness.
“People say we are thick and deluded because people don’t understand what it is.”
Max stressed what causes people to be trans is "totally irrelevant" and that repathologizing trans people as physically ill misses the point.
"The whole point is we are perfectly healthy, there is nothing wrong with us, and we dont need to be treated like nutters or pitied as physically afflicted.
"What causes people to be trans is totally irrelevant because everyone is different. I don't believe in biological determinism (i.e. born this way) I chose to be like this because I like it"
Jane Fae , 55, from Lincolnshire, is a writer on issues of political and sexual liberty. She said one of the reasons the classification is so damaging is because it cements accusations of “madness” already levelled against the trans community.
“For those who don't like trans folk, its an easy jibe: 'you're mad, really: so we don't have to listen to you.'
“And of course, the mental health tag does make it easier for some to suggest that instead of providing treatment aligned with what the 'patient' needs, it is respectable to advocate reparative therapies to 'cure' transness - a view increasingly recognised as abusive in respect of gay people and increasingly outlawed (most recently in California).”
The classification of transsexualism in the International Classification of Diseases, adopted by the WHO not only impacts on the social perception of transgender people, but also how healthcare is provided.
Health services around the world base their treatment on the International Classification of Diseases. Though the NHS recognises that gender dysforia is not a mental illness, the WHO’s classification of the illness has significant influence.
Sarah explained how the attitude filters through, despite the NHS classification.
“Every part of the NHS that deals with gender identity is held under the mental health department.
“You have to have a referral from a psychiatrist to prove you are sane to get the help you need transitioning.
"Only Nottingham has its only gender identity clinic, where you don’t need a referral from a psychiatrist but can be referred from a GP instead."
Sarah Savage: 'Being trans is something you are born with'
Max is even more damning in his description of doctors and health provision for transgendered people.
“Because transgender people are still seen by doctors as mentally ill the relationship we have with them is skewed,” he told The Huffington Post UK
“Currently the onus is on trans people to somehow 'prove' they are a genuine transsexual before they will be given any assistance to medically transition.
“The problem is that there is no such thing as a 'genuine transsexual' there are as many different ways of doing gender as there are people in the world.”
Sarah, Max and Jane all use the same words to relate their experiences with medical professionals, calling the doctors “gatekeepers” and describing how they needed to “jump through hoops” to get the help they needed.
Jane said it was so difficult to get the healthcare she needed on the NHS she had to pay privately.
“Getting treatment of any kind is a constant struggle, leading people to give up or opt out. I opted out of the NHS.
“A single interview with a supposed gender specialist, which began with the pompous assertion that ‘for the purposes of this interview we shall refer to you as Jane - left me shaken, in tears and for perhaps the only time in my life, briefly suicidal.”
Her experience shows that even though formal reclassification of gender dysphoria might take place, some people’s attitudes still need to catch up.
The WHO is already revising its classification of transsexualism, but the reclassification is unlikely to take place until 2015 and even then there is no guarantee the reclassification will be approved by all 196 member states.
The senior project officer managing the revision, Geoffrey Reed told The Huffington Post UK:
"At the moment theres a double stigmatisation going on at the moment, both the stigma of mental illness and the stigma of being transgender.
"There is no definitive base for saying that being transgender is a mental disorder, but neither is there a base for classifying it as anything else.
"We just don’t know enough about it. It’s an issue about identity and the how people see themselves."
He explained it was important to classify transsexualism in a way that still allowed people to access healthcare and stressed the importance of lobbying politicians at home.
"It’s no good just coming to the ICD with a petition, " he said, "that’s not going to change anything, it just doesn't work that way.
"I would encourage people to lobby their government to change the way transsexualism is viewed.
"If a politician is very strongly backing something, when it gets the stage of being voted on it is much more likely to go through
"Also it is the health system you belong to that dictates how they will respond to ICO classification. For example in some countries transgender people are required to have sterilisation before they go through gender reassignment. That is nothing to do with the ICD, that is their policy."
ICD sexual health and disorder experts have currently made a series of recommendations for the forthcoming review, one of which is to stop transsexualism from being classified under mental illnesses. Their recommendations will go up online on the ICD for public review by the end of the year. Mr Reed encourages the public to read and report on the changes.
October 20 marks the International Day of Action for Trans Despathologization. You can sign the change.org petition here.
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