Stonewall Scotland strongly supports the removal of the requirement for a medical diagnosis of gender dysphoria and supporting medical evidence.
Under section 3 of the Gender Recognition Act 2004, applicants are currently required to submit medical reports to the Gender Recognition Panel detailing their diagnosis of ‘gender dysphoria’ and any treatment that they have undergone, are undergoing, or has been prescribed or planned, 'for the purpose of modifying sexual characteristics', such as hormone treatment or surgery. This process can be arduous, humiliating, and invasive for trans people, and applicants can encounter financial barriers obtaining medical reports.
De-medicalising the application process and adopting a model based upon self-declaration is crucial for Scotland to align itself with modern systems of gender recognition, for example those adopted in Argentina (2012), Denmark (2014), Malta (2015), Ireland (2015), Colombia (2015), Norway (2016), Belgium (2017), Portugal (2018), Luxembourg (2018), Iceland (2019), New Zealand (2021) and Switzerland (2022). Across these jurisdictions, trans men and trans women are able to access legal recognition through making a simple application or request, usually involving only a statutory declaration or other written statement, and do not have to have obtained any medical diagnoses or have medical evidence assessed by a third-party panel. This would further reflect the changes made as part of the World Health Organisation’s ICD-11, which moved redefined categories of ‘gender incongruence’ out of the ‘mental and behavioural disorders’ chapter.
The de-medicalised model of self-declaration for gender recognition legislation is further supported by the Yogyakarta Principles, which maintain that UN member states should “take all necessary legislative, administrative and other measures to fully respect and legally recognise each person’s self-defined gender identity” and “ensure that procedures exist whereby all state-issued identity papers which indicate a person’s gender/sex — including birth certificates, passports, electoral records and other documents — reflect the person’s profound self-defined gender identity” (Principle 3, The Right to recognition before the law).
Principle 31, The Right to legal recognition, recommends that states institute “a quick, transparent, and accessible mechanism that legally recognises and affirms each person’s self-defined gender identity” for which “no eligibility criteria, such as medical or psychological interventions, a psycho-medical diagnosis, minimum or maximum age, economic status, health, marital or parental status, or any other third party opinion, shall be prerequisite to change one’s name, legal sex or gender”. This aligns with Resolution 2048 of the Parliamentary Assembly of the Council of Europe, which called on member states to “develop quick, transparent and accessible procedures, based on self-determination” for legal gender recognition, to “abolish sterilisation and other compulsory medical treatment, as well as a mental health diagnosis” as requirements for obtaining legal recognition, “consider including a third gender option in identity documents for those who seek it”, and “ensure that the best interests of the child are a primary consideration in all decisions concerning children”.
In 2018, the UN Independent Expert on protection against violence and discrimination on the basis of sexual orientation and gender identity recommended that legal gender recognition procedures should:
• Be based on self-determination by the applicant
• Be a simple administrative process
• Not require applicants to fulfil abusive requirements, such as medical certification, surgery, treatment, sterilization or divorce
The current psychiatric diagnosis and medical evidence requirements fall far short of international best practice in this area, with a growing number of jurisdictions around the world introducing ‘quick, accessible and transparent’ processes, on the basis of self-determination.