Trans Diagnosis 101: Leeds GIC show how not to do it

It seems that Leeds GIC may be having a bit of an identity crisis of their own, given that in response to an FOI request by Emma Brownbill they make it clear they do not really know what they’re diagnosing people with.

First, lets look at the background to the request. Emma’s first question to the GIC was to ask for “the numerical designation and diagnostic criteria for Primary Transsexualism in DSM-IV”. This is as a result of some interesting statements on their web site, including one referring to “primary transsexualism… (In accordance DSM IV)”.

Why is listing “Primary Transsexualism” odd? It is a diagnosis regarded as outdated at best and appears in no current credible medical literature. It is certainly not in the DSM-IV – the Diagnostic and Statistical Manual of Mental Disorders and has never appeared in any edition. Even more so, the latest editions – DSM-IV onwards, first published nearly two decades ago in 1994, avoid the use of the term “transsexualism” at all and instead refers to “Gender Identity Disorder”. The last time “transsexualism” as a diagnosis appeared in the DSM, “homosexuality” was also listed.

This isn’t just playing with words, as they are very different diagnoses. If you have a diagnosis of “Primary Transsexualism”, you can’t identify as homosexual in your preferred gender.

Is this some confusion on behalf of administrative staff who put some outdated documentation up on the web site for their FAQs? It seems not.

The first part of the answer the GIC supplied was a cut-and-paste response from the World Health Organisation’s International Classification of Diseases edition 10 (ICD10) entry on transsexualism. This is a completely different document from the DSM-IV, plus the word “primary” still does not appear anywhere in the ICD definition. The second part of their answer is headed “Primary Transsexualism in DSM-IV” (Remember, that term doesn’t exist in the DSM!) and the criteria they give do not match those in the DSM-IV for Gender Identity.

So what do we have so far – a GIC that is a little confused over the differences between two of the three key documents defining the main diagnosis they would expect to be dealing with?

Sadly, their response continues to dig them a deeper hole when it comes to the third key source.

They were also asked what training their staff had in “as mandated by the WPATH Standards of Care (SoC)”. The response? “Although our Trust takes into consideration guidance such as the WPATH Standards of Care (SoC), our Trust primarily follows the guidance of the Harry Benjamin International Standards of Care.”

That’s a big oops: The HBIGDA renamed itself to WPATH in 2006. It’s the same organisation, and this response rather suggests they’re working off the older (2001) version 6 of the standards of care published before the HBIGDA renamed, not the latest

It’s pretty unforgivable for a Gender Identity Clinic to have no idea about any of these documents and suggests they’re not really sure what they’re diagnosing. Sadly, although Leeds GIC were the target of this request, it’s not unusual to hear of such things within other areas of NHS healthcare for trans folk too.

P.S. I’m not endorsing the DSM-IV-TR wording or definition here – it’s problematic in a number of ways, but it’s the most progressive one.


  1. Bah commenting here is easier

    “Sadly, although Leeds GIC were the target of this request, it’s not unusual to hear of such things within some areas of NHS healthcare for trans folk.”

    makes it sounds like Leeds GIC is not part of “NHS Healthcare”. Although on rereadng it’s more ambiguous than I first thought.

  2. Personally i feel that this blog is just using the focus on wording to have a go on the Leeds GIC, Yes the website is out of date and some of the terms mentioned are outdated. i can honestly say that the NHS overall still use outdated terminology and this is not limited to the Leeds GIC.

    Indeed when i transitioned in 2000 i was diagnosed with Transsexualism. However i feel that the point of this blog misses the point altogether, as terminology does not define the skills clinician.

    1. If they can’t get the terminology right and are so confused they don’t even realise that HBIGDA and WPATH are the same organisation, it’s pretty clear they’re making no attempt to keep up with developments and can hardly claim to be skilled clinicians.

      The point of Emma’s FOI request was to see what they were really doing, rather than what they’d put on their web site. Sadly it seems that the web site is about right in terms of their understanding. You’re right about some other parts of the NHS being just as bad though, it just so happens that Emma lives in Leeds GIC’s catchment area. (I’d note this does not apply to the entire NHS)

  3. Leeds GIC is the only GIC in the country that employs a Occupational Therapist a skill that elsewhwhere is associated with helping the severly physically and mentally handicapped.

    If the patients are ether of the above they are referred to another unit with a OT to assist with these disabilities. So why does Leeds GIC neet a OT?

  4. I had one of my assessment appointments at Leeds about a month or so after the latest WPATH SoC came out, and I was chatting to the therapist about it, because it was related to my academic work, and I thought that the changes in it were pretty exciting for non-binary people. He was interested to hear that there had been new standards released…

    It’s not that I would have expected Leeds staff to have already figured out how this would affect their policies, but you would have thought that they would have known!

  5. Given that Leeds GIC insists upon upon 4/5 MANDATORY monthly assesment appointments they should know what they are diagnosing but dont.

    After the final assemsnent appointment if you havnt already started to transistion your told you have just a few months to do so otherwise you will be discharged from the GIC. No pressure then.

    Incidentaly Charing Cross and simular reputable gender services require just two assesment apppintments to get it right.

  6. As mentioned in the post, it’s not just Leeds: my first Charing Cross assessment in 2011 resulted in a diagnosis of “Secondary Transsexualism”.

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