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What Men Should Know


Today is International Day Against Homophobia, Transphobia and Biphobia and this year’s theme is ‘Mental Health and Wellbeing’.

The topic of mental health and wellbeing is central to the healthcare treatment we as transgender people receive. According to the World Health Organization (WHO), which provides the worldwide standards of healthcare, transgender people are classified as mentally ill, as we are included in the mental illness chapter in the International Classification of Diseases (ICD) healthcare guidelines. Transgender identity is currently classified in the same chapter as paedophilia and bestiality, which, together with religious, cultural and societal prejudice, further serves to demonise the transgender community, exacerbating the oppression and discrimination we face on a daily basis.

Just as homosexuality was classified as a mental illness in previous versions of the ICD and gay and lesbian people were subject to horrific psychological and medical interventions and criminalisation, this means that transgender people are pathologised and seen as unhealthy, unnatural, immoral and abnormal. In less progressive countries, transgender people are subject to medical and psychological interventions that seek to cure us of our ‘illness’. In countries that are more progressive, we are forced to agree to the diagnosis of “gender identity disorder” or “gender dysphoria” in order to access gender-affirming healthcare such as therapy, hormones and life-saving surgical procedures.

Transgender activists around the world are currently trying to have our voices heard in the upcoming amendment to the ICD (which will be updated after 20 years in 2018), so that our identities are no longer pathologised. Instead, we are lobbying for our healthcare needs to be treated in a sensitive and affirming way in order for us to access healthcare services that are basic human rights, not special rights. The likelihood of the WHO listening to trans voices in the prescription of our own treatment is slim, and the probability is that their proposal to include transgender treatment in the chapter on sexual disorders is high. This would lead to further entrenching of the misunderstanding by society at large that being transgender is a sexual orientation issue and disease, rather than a common and legitimate gender identity.

The reality for transgender people in South Africa is that we are treated as mentally ill, and those seeking basic healthcare unrelated to their gender identity are subject to humiliating and invasive treatment from healthcare providers. For example, transgender men needing to undergo appendix removal surgery, are put in wards with women and misgendered by staff, leading many trans people to avoid doctors and medical staff, putting themselves at physical risk. When seeking gender-affirming healthcare in both public and private hospitals, transgender people are on the receiving end of incredibly offensive and stigmatising attitudes, and have their healthcare needs delayed by months and even years until they have jumped through all of the hoops needed to ‘prove’ that they are indeed transgender and ‘deserving’ of medical care. 

This affects not only medical care, but daily life as well, as we need two doctors’ letters proving that we are transgender before we can update our identity documents to reflect our gender and our names. Even then, the process of receiving these documents takes months, and sometimes years, placing transgender people in the embarrassing and often life-threatening positions of having an identity document that reflects a gender and a name very different to the way we look.

The effect this has on the mental wellbeing of transgender people is serious and life threatening. The depression and suicide rate among transgender people is significantly higher than the general population, as our lives, jobs, family lives and general day to day interactions are severely impacted by the stigma of being mis-classified as mentally ill and the resulting societal prejudice and violence. The stigma of this mis-classification also means that transgender people are less likely to seek psychological and medical intervention when they experience depression, because the medical fraternity links the depression to our gender identity. But it is not our being trans that causes our depression. It is society’s inability to accept our being transgender that causes our depression. 

Sadly, the incorrect classification of being transgender as a mental illness severely affects the wellbeing of the trans community, and in framing our existence as a mental disorder, a pathology and an illness, the medical industry creates a healthcare system that does not have the wellbeing of the transgender community at heart.


Germaine de Larch is a non-binary trans guy living in Johannesburg, South Africa. He is a writer, artist and activist focusing on gender and transgender visibility.