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Photo: Ariel Gutraich. The World Health Organization (WHO) published on Monday, June 18, the new International Classification of Diseases (ICD-11), which will be debated at the General Assembly in May 2019 for adoption by member states. It will come into effect on January 1, 2022. Transsexuality (code HA4Z) is no longer listed under the heading "mental, behavioral, and neurodevelopmental disorders." The ICD-11, a manual for identifying global health trends and statistics that had not been updated since 1990 (the ICD-10), incorporated a long-standing demand from LGBTI communities worldwide by creating a new chapter on "Conditions related to sexual health." This is now referred to as "gender incongruence" or transsexuality (understood as a marked and persistent incongruence between an individual's experienced sex and their assigned sex). The WHO classifies this “gender incongruence” as a “condition related to sexual health,” and considers that it manifests in traits such as “a profound aversion or discomfort with one’s primary or secondary sexual characteristics,” a “strong desire to be free of” some of these characteristics, and a “strong desire to have the primary or secondary sexual characteristics of the experienced sex.” “The individual experiences a strong desire to be treated (to live and be accepted) as a person of the experienced sex,” the WHO states. The organization also affirms that this “incongruence” must have been present for at least several months and cannot be diagnosed before the onset of puberty. Other categories associated with transvestism, such as “double-role transvestism,” defined as “wearing clothes of the opposite sex for part of an individual’s life to enjoy the temporary experience of belonging to the opposite sex,” and “fetishistic transvestism,” referring to “wearing clothes of the opposite sex to experience sexual arousal and create the appearance of the opposite sex,” which was considered a paraphilia, have also been removed. The classification also included “gender identity disorder in childhood.” The WHO now acknowledges that “there is clear evidence that transsexuality is not a mental disorder” and that “classifying it as such can cause enormous stigma for transgender people.” However, it justifies the decision to keep transsexuality within the list of diseases because “significant health care needs remain that can be better met if this condition is coded in the ICD.” The organization also states that, although “it is crucial to listen to the voices of people affected by gender incongruence,” the decision to move transsexuality to the sexual health section was based on scientific evidence. According to the WHO statement, the new manual “reflects progress in medicine and advances in scientific understanding.” The WHO explained that this manual, the basis for identifying health trends and statistics worldwide, contains approximately 55,000 unique codes for injuries, diseases, and causes of death. The work, it was indicated, “provides a common language that allows health professionals to share information” worldwide. Among the new features, the WHO highlighted the incorporation of new chapters, such as those on traditional medicine (for example, Chinese medicine), which “although used by millions of people worldwide, had never been classified in this system.” The WHO stated that the ICD-11, which has been under development for more than a decade, “provides significant improvements over previous versions,” is entirely electronic, and has a much more user-friendly format. In addition to being a key tool for professionals in the field, the ICD is also used by health insurers whose reimbursements depend on its coding; national health program managers; data collection specialists; and other stakeholders who monitor progress and determine resource allocation. The first edition, known as the International List of Causes of Death, was adopted by the International Statistical Institute in 1893. The WHO was entrusted with the ICD upon its creation in 1948, and published the sixth version, ICD-6, which incorporated morbidity for the first time.