Kunzel is among those who look at homosexuality’s decadeslong evolution in the DSM and see at least a partial parallel to the more recent effort to depathologize transgender identities.
“Transsexualism†first entered the manual in 1980, enraging many trans activists for, they argued, turning their identity into a sickness. This was replaced in 1994 by “gender identity disorder† an effort by the APA to mitigate stigma that nevertheless left many trans people unappeased. Then, in 2013, that diagnosis was
replaced by the current “gender dysphoria,†which distances the source of distress from the core sense of self and attributes it more to society’s stigma toward gender nonconformity.
Today, there is sustained pressure on the APA to discard the gender dysphoria diagnosis and, just as with gay and lesbian people, totally depathologize trans people in the eyes of psychiatry. However, because receiving hormones and transition-related surgeries is key for many trans people to fully realize their identities, and given that insurance companies require a diagnosis to cover such treatment, a tension remains that may prove irreconcilable.
Levounis, the current APA president, declined to take a position on what should become of the gender dysphoria diagnosis.
“It’s a very active debate within our field,†Levounis said. “Unlike other discussions within the APA of yesteryear, we do involve a lot of lived experience in our work  people who are transgender,†including psychiatrists and nonpsychiatrists alike, “who do help inform us in these discussions.â€Â
Hartmann said the effort to depathologize homosexuality has “a mixed relevance to the present, very lively and argumentative field†of gender identity  one in which he hopes to see further research that will yield clearer insights.