Seven years ago, the World Health Organisation did something that should have changed everything. It removed trans identities from the International Classification of Diseases. Being trans was no longer a mental disorder. It was, as it had always been, simply a way of being human. And yet, for most trans people around the world, that decision has changed very little about what actually happens when they try to access healthcare.

ILGA World, alongside Asia Pacific Transgender Network, EATHAN, GATE, and TGEU, published a joint statement on International Day of Action for Trans Depathologisation to mark seven years since that WHO decision, and to ask an uncomfortable question: where are the benefits that depathologisation was supposed to deliver?

It is a question I have been asking for years, from a different vantage point. When I hear from trans people about their experiences of healthcare, what strikes me most is not the complexity of gender medicine. It is the sheer, grinding ordinariness of the discrimination they describe. The clinician who uses the wrong name. The receptionist who makes the appointment into a spectacle. The GP who says they are not sure they can help, and who offers nothing in its place. None of that requires a disease classification to explain it. It requires a culture that still, deep down, treats trans people as a problem to be managed rather than a person to be cared for.

The gap between the declaration and the door

The WHO can set direction, but it cannot walk trans people into clinics. That is governments' job, and most governments have not done it. ICD-11 was adopted in 2019. National health systems were supposed to follow. Most have not, or not meaningfully. Trans communities are still encountering the pathologising framework in practice: the requirement to prove distress, to submit to psychological assessment, to justify their own identity before a doctor will engage with their actual health needs.

There is something particularly galling about a system that removes the diagnosis of being trans from one hand, and then continues to require a psychiatric gatekeeping process with the other. If being trans is not a disorder, what exactly are we assessing? What are we waiting to confirm? The honest answer is that the gatekeeping was never primarily about health. It was about control, and it outlasted the justification for it.

Three things that would actually change lives

The joint statement sets out three concrete demands, and I want to name them plainly, because they are right.

The first is decriminalisation. A person who risks arrest by presenting as themselves cannot safely seek healthcare. Colonial-era laws that criminalise trans communities remain in force in too many countries, and they do not simply limit healthcare access: they make the whole ecosystem of health and safety inaccessible. You cannot pursue well-being when your existence is treated as an offence.

The second is legal gender recognition. Identity documents that match a person's gender identity are not a luxury or an aspiration. They are a precondition for dignified care. Mismatched documents invite discrimination and humiliation at the point of contact, and in some cases lead to outright refusal of services. The statement makes the point that when people face discrimination, they protect themselves by avoiding the situation. Trans people do the same. When healthcare means walking into a space where your documents mark you as other, where the name on the form is not your name, many people will simply stop going. The health consequences of that are serious and entirely preventable.

The third is gender-affirming healthcare, delivered through an informed consent model, affordable and accessible, within universal health coverage. That means care that affirms a person's gender identity in every consultation, not only in transition-related care. It means using the right name and the right pronouns. It means treating a trans patient as a patient, with the same basic respect that any patient is owed. And in transition-related care, it means surgical and non-surgical interventions available to those who need them, without the requirement to prove and re-prove and justify and wait.

The stigma that statistics cannot capture

There is a fourth dimension to this that is harder to quantify, and the statement names it directly: social stigma. Being viewed through a pathologised lens has effects that run far deeper than any single healthcare interaction. It shapes how families respond to trans children. It shapes how employers think about trans colleagues. It shapes the internal experience of trans people themselves, who have grown up in a world that told them their identity was a symptom.

Trans communities are not alone in facing this kind of structural stigma. But what is particular to trans communities right now is the scale and coordination of the hostility being directed at us. The anti-gender movement is not a fringe phenomenon. It is organised, it is well-funded, and its explicit aim is to roll back the progress that trans people and their allies have built over decades. The statement is right that the only counter to it is collective power, and solidarity across communities.

A person just trying to live their life

At the end of its statement, ILGA World returns to something simple. At the heart of all of this is a person who is just trying to live their life to the fullest. Isn't that what we all want?

I have heard versions of that from so many trans people over the years. Not a demand for special treatment. Not an ideological position. Just the ordinary human wish to exist, to be well, to be seen as who they are. The depathologisation of trans identities was supposed to be one step towards that. Seven years on, most of that step remains to be taken. Governments need to implement ICD-11. Health systems need to stop treating trans people as a category requiring special justification. And the rest of us need to keep making the case, loudly and without apology, that a right to health which has to be earned by proving you are ill is not a right at all.

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Dr Helen Webberley is a gender specialist, medical educator, and advocate. She is the founder of GenderGP and writes about gender diversity, trans healthcare, and the lives of trans people and their families.