Gender incongruence

Gender incongruence is the term used by the WHO’s International Classification of Diseases, 11th revision (ICD-11, adopted by the World Health Assembly in 2019, in effect since 2022) for a marked and persistent mismatch between a person’s gender identity and their assigned sex.

What matters most about this term is where it sits. ICD-11 moved it out of the “mental and behavioural disorders” chapter and into a new chapter on “conditions related to sexual health.” That placement was a careful balancing act: keeping a diagnostic code means trans people still have a recognized basis for accessing hormones, surgery, and — in many countries — insurance coverage; moving the code out of psychiatry declares that gender diversity is not a mental illness (see the myth page). It is the trans counterpart to the WHO’s 1990 removal of homosexuality from its disease classification.

It differs in emphasis from the DSM-5’s gender dysphoria: dysphoria centers on significant distress, while incongruence describes the mismatch itself without presuming the person is suffering. Whether medical support is wanted is for the person and their clinicians to work out.

In Chinese, the standard rendering is xingbie buyizhi (性别不一致).

Register note: the standard term in academic, public-health, and policy writing. In everyday speech it also works as a neutral descriptive phrase, with no diagnostic overtone.

Common misuse: “it’s still in the ICD, so it’s still a disease.” The opposite — it was deliberately placed in the sexual-health chapter, not the psychiatric one, precisely to keep care accessible while making clear it is not an illness.