Die (psycho-)soziale Kodierung des Körpers und deren Auswirkung auf die Trans*-Gesundheit

For a long time, transgender-specific health care was marked by a definite tendency to psychopathologize trans-identities. Little attention was given to the perspectives of the people affected. This led to a call for a species of health care attentive to human rights, an approach seriously responsive to the needs of transsexual individuals. Accordingly, the criteria listed in the diagnostic classification systems DSM-5 and ICD-11 were revised, introducing the new terms »gender dysphoria« and »gender incongruence«. Before 2018, the treatment and expert assessment of transsexuals in Germany was undertaken in accordance with Good Practice standards laid down in 1997 by different specialist associations. At the same time, new Standards of Care (SoC) were being developed by the World Professional Association for Transgender Health (WPATH). In 2018, Germany updated its treatment standards and published them in the S3 Guideline on Gender Incongruence, Gender Dysphoria and Transgender Care (AWMF registration no. 138 001). The present article discusses a number of central treatment recommendations set out in the Guideline, notably the principle of participatory decision-making. It also comments on new expert-assessment instructions proposed by the Medical Service of the Central Federal Association of Health Insurance Funds (»Sexual Assimilation Measures for Transsexuals«) and offers critical discussion of the diagnostic categories underlying them.