Policy Tag: Stigmatisation

Adopted by the 66th WMA General Assembly, Moscow, Russia, October 2015
and revised by the 76th WMA General Assembly, Porto, Portugal, October 2025

 

PREAMBLE

  1. People who are LGBTQIA+ (Lesbian, Gay, Bisexual, Trans, Queer, Intersex, Asexual, and other identities beyond these) represent a spectrum of natural sexual orientations, gender identities, gender expressions, and sex characteristics. While LGBTQIA+ people may share common experiences and shared goals of justice and equity in the face of detrimental, discriminatory treatment and even violence, these are diverse communities facing distinct challenges and with specific needs in healthcare and beyond.
  2. This statement is specifically focused on the challenges and needs of trans(-gender) people. The term “trans” is used throughout this document in keeping with its increasingly prevalent use in scientific literature, advocacy work, and social spaces. Children and adolescents experiencing gender incongruence require a sensitive and supportive approach, as well as individualized, evidence-based care that considers their unique needs.
  3. In most cultures, an individual’s sex is assigned at birth according to primary physical sex characteristics. Gender identity is a person’s individual experience of gender, which may or may not align with the sex they were assigned at birth. This along with gender expression, the way in which individuals outwardly present their gender identity to the world, contribute to the concept of gender itself.
  4. Individuals who experience gender incongruence, or a marked and persistent incongruence between their experienced gender and assigned sex, are referred to by the umbrella term “trans”. Gender incongruence can be expressed in very different ways.
  5. Under the umbrella term of “trans” (or “transgender”), there are people who, despite having a distinct anatomically identifiable sex, seek to change their primary and secondary sex characteristics to affirm their gender identity (formerly referred to as “transsexual”)[1]. Some experience their gender as falling outside the sex/gender binary of either male or female or do not exclusively see themselves as male or female (genderqueer or non-binary). The umbrella term “trans” represents an attempt to describe these groups without pathological characterisation and instead as a term of positive self-identification. This statement does not explicitly address individuals who dress in a style or manner traditionally associated with a sex/gender different from the sex assigned at birth or individuals who are born with variations of sex characteristics (e.g., intersex individuals); however, there are such individuals who are trans. Additionally, some cultures have historically recognised three or more gender identities embodying distinct sociocultural beliefs and traditions. It is important to point out that trans identity, as well as non-binary identity, relate to gender identity, which must be considered separately from an individual’s sexual orientation.
  6. Being trans does not constitute a disorder or illness. At the same time, trans people may require interdisciplinary gender-affirming care (e.g., gender-affirming hormones, surgeries, mental healthcare) and counselling to help them navigate their gender and to address the complex social and relational issues that are affected by it.
  7. The World Health Organization’s (WHO) International Classification of Diseases (ICD 11) moved the terms “Gender incongruence of adolescence and adulthood” and “Gender incongruence of childhood” from the “Mental and behavioural disorders” chapter into a newly added chapter entitled “Conditions related to sexual health” to reflect that gender diverse identities should no longer be classified as mental health disorders.
  8. Because this is a complex ethical and socially relevant issue, the WMA would like to acknowledge the crucial role played by physicians in a wide range of medical specialties in advising and consulting with trans people and their families about the risks and benefits of desired care, especially in a time of widely propagated misinformation and disinformation on the topic. As a potential first point of contact, physicians need to understand the social and political challenges facing trans people and be aware of the health consequences of discrimination and the importance of providing support to people experiencing gender incongruence on the basis of their needs. The WMA intends for this statement to serve as a guideline for patient-physician relations and to foster better training, enabling physicians to increase their knowledge of and understanding toward trans people and the specific health issues they face.
  9. Interdisciplinary gender-affirming care, including pharmacologic therapy or surgical interventions, can be beneficial to people with gender incongruence who seek medical interventions. However, trans people are often denied access to or forgo appropriate and affordable gender-affirming healthcare due to, among other things, the policies of health insurers and national social security benefit schemes, a lack of relevant clinical and social competence among healthcare providers, and the fear of discrimination concerning one or multiple facets of their identity. These situations show how physicians and health professionals play an important role in creating a safe, respectful, and inclusive healthcare environment for trans people seeking care.
  10. Trans people are often put at a professional and social disadvantage and experience a relatively higher rate of direct and indirect discrimination, as well as physical violence. In addition to being denied equal civil rights, anti-discrimination legislation, which protects other marginalised communities, may not extend to trans people. Being disadvantaged or discriminated against can have a negative impact upon physical and mental health. These negative outcomes can be exacerbated by other intersectional factors, including but not limited to national origin, race, ethnicity, gender, sexual orientation, age, religion, socioeconomic status, or disabilities.
  11. In addition, the psychopathologisation of trans people leaves such individuals at risk of being forced or coerced into so-called “conversion” or “reparative” procedures. These harmful and unethical practices, also sometimes referred to as Sexual Orientation and Gender Identity Change Efforts (SOGICE), are intended to suppress or change a person’s natural sexual orientation or gender identity. These practices have no evidence-based background, no medical indication of effectiveness, and represent a serious threat to the health and human rights of those subjected to them. Such practices can lead to anxiety, depression, low self-esteem, substance abuse, suicide, worsened cardiovascular health, and other somatic health issues.
  12. Negative experiences in healthcare affect the patient-physician relationship, leading trans people to avoid accessing care even when it is available. When trans people feel secure and confident that their gender identity will be affirmed in a respectful, confidential environment, they are more likely to share their personal experiences openly. This transparency enables physicians to provide targeted care that addresses the specific health needs of trans patients.
  13. Trans physicians, medical students, and other health professionals also face discrimination, disadvantages, marginalisation and bullying in the workplace, in schools, in professional organisations, and beyond. Harmful working and learning environments can lead to stress, social isolation, and burnout, especially among marginalised individuals.

General principles

  1. The WMA emphasises the right of all people to determine and live out their own gender and recognises diversity of gender.
  2. The WMA strongly asserts that gender incongruence (ICD 11) does not represent a disease or a mental disorder; however, it can lead to discomfort, distress, or the desire to transition in order to live, and be accepted, as a person of the experienced gender.
  3. The WMA condemns all forms of discrimination, stigmatisation, and violence against trans people and calls for appropriate legal measures to protect their equal civil rights.
  4. The WMA affirms that, in general, any health-related procedure or gender-affirming care related to an individual’s trans identity, (e.g. surgical interventions, hormone therapy or mental health care), requires the provision of accurate scientific information regarding the consequences of gender-affirming care and the freely given informed consent of the patient.
  5. The WMA unequivocally condemns so-called “conversion” or “reparative” practices or SOGICE. These constitute violations of human rights and are unjustifiable practices that should be denounced and subject to sanctions and penalties. It is unethical for physicians to participate in any step of such procedures. Healthcare systems must aim to enable trans people to have the best possible quality of life.
  6. The WMA affirms its position that no person, regardless of age, medical condition, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, culture, sexual orientation, social standing, or any other factor should be subjected to forced or coerced sterilisation of any kind (in line with the WMA Statement on Forced or Coerced Sterilisation). This also includes sterilisation as a condition for rectifying the recorded sex on legal documents independent of gender reassignment.

 

RECOMMENDATIONS

  1. The WMA urges that every effort be made to make individualised, multi-professional, interdisciplinary and affordable gender-affirming care (including, as appropriate, counselling, hair removal, speech therapy, hormonal treatment, surgical interventions, reproductive and mental healthcare) available to all people who experience gender incongruence. In order to reduce potentially negative health consequences, this care should be guided by due consideration of the available scientific evidence and tailored to the individual’s needs and goals.
  2. The WMA calls upon all physicians to:
  • respect each individual’s right to self-identification with regards to gender;
  • ensure that children and adolescents receive special consideration and individual assessment recognising their specific vulnerability before any potential form of medical care is initiated;
  • classify physical diseases and mental health issues on the basis of clinically relevant symptoms according to ICD 11 criteria regardless of gender identity, and to provide quality care in accordance with internationally recognised treatments and protocols and in keeping with the principles set forth in the WMA International Code of Medical Ethics;
  • provide a safe, respectful, and inclusive healthcare environment for trans patients;
  • where appropriate, refer trans patients to physicians with more knowledge of and experience with trans health issues to ensure the highest standard of care is provided;
  • foster safe, respectful, and inclusive work and learning environments for trans physicians, medical students, and other health professionals;
  • engage in continuing medical education and professional development in an attempt to encourage the further study and understanding of the specific health needs of trans patients and the benefits or risks of certain treatments;
  • where appropriate, involve those close to the patient in healthcare discussions in keeping with the patient’s preferences, respecting their consent, and with due regard for patient confidentiality;
  • speak out against legislation and practices violating the human rights of trans people;
  • reject and refuse to participate in any step of so-called “conversion” or “reparative”
  1. The WMA calls upon its Constituent Members and professional associations to:
  • take action to identify and combat barriers to healthcare faced by trans people;
  • advocate for safe and inclusive working and learning environments for trans physicians, medical students, and other health professionals;
  • establish and enforce non-discriminatory policies in keeping with the WMA Statement on Non-Discrimination in Professional Membership and Activities of Physicians;
  • create guidelines for physicians outlining the specific physical and mental health challenges facing trans patients, where appropriate;
  • where possible, promote changes to medical education, specialty training and CME/CPD curricula to support the provision of gender-affirming care and to help physicians provide appropriate care to meet the specific health needs of trans patients and to recognise and avoid discriminatory practices;
  • promote the establishment of channels for physicians to report incidents of discrimination or bias against trans physicians or trans patients;
  • in environments where confidentiality and patient safety are guaranteed and data cannot be abused, encourage voluntary data collection in the clinical setting and regular reporting on the health outcomes of trans patient groups, while also taking intersectionality into account, to ensure and further improve targeted and appropriate healthcare provision;
  • actively condemn so-called “conversion” or “reparative” practices as unethical.
  1. The WMA calls upon governments to:
  • adopt and implement a comprehensive legal framework to protect trans people from discrimination and violence, and to support their full participation in society, including access to affordable and quality gender-affirming care;
  • strive to ensure that administrative processes, medical records, and care pathways respect and reflect the patient’s self-identified name and gender, avoiding practices that undermine their dignity or safety;
  • maintain continued interest in the healthcare rights of trans people by conducting health services research at the national level and using these results in the development of health and medical policies. The objective should be a responsive healthcare system adapted to each patient;
  • reject and repeal anti-trans legislation;
  • condemn and ban so-called “conversion” or “reparative” practices;
  • promote policies that counteract health-related and other inequities caused by overt and implicit discrimination against trans people;
  • encourage education on the many manifestations of gender identity and gender expression to increase acceptance and with the ultimate aim of promoting better physical and mental health for all individuals;
  • promote and fund more research in this area to enable the best, evidence-based standard of care for trans people, and combat censorship of research regarding trans people;
  • safeguard physicians and other health professionals providing gender-affirming care, and offer additional protections against discrimination and violence;
  • involve organizations representing trans people as valuable stakeholders and expert contributors in the development of health policies, clinical protocols, educational materials, and models of care.

 

[1] Although the term “transsexual” is outdated and inappropriate, and its usage has been discontinued in the medical field, it is referred to here because it is still sometimes used in legal provisions relating to trans people.

Adopted by the 64th General Assembly, Fortaleza, Brazil, October 2013 and
revised by the 74th WMA General Assembly, Kigali, Rwanda, October 2023

 

PREAMBLE

Individuals who identify as LGBTQIA+ (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and other identities beyond these) represent a broad and fluid spectrum of natural sexual orientations, gender identities, gender expressions, and sex characteristics. While LGBTQIA+ people may share common cultural and social experiences and shared goals of justice and equity in the face of detrimental, discriminatory treatment and even violence, these are diverse communities facing distinct challenges and with specific needs in healthcare and beyond.

This statement is specifically focused on lesbian, gay, and bisexual people.

Healthcare professionals encounter many aspects of human diversity when providing care, including different natural variations of human sexuality.

A large body of scientific research indicates that being lesbian, gay, or bisexual constitute natural variations of human sexuality without any intrinsically harmful health effects. They do not constitute a disorder or illness that requires treatment or cure and any efforts to do so are contrary to the ethical practice of medicine.

Homosexuality and bisexuality are consequently not included in the World Health Organization’s (WHO) International Classification of Diseases (ICD 11).

However, direct and indirect discrimination, both interpersonally and at the institutional level, anti-homosexual or anti-bisexual legislation and human rights violations, stigmatisation, criminalisation of same-sex partnerships, peer rejection, and bullying continue to have a serious impact upon the psychological and physical health of lesbian, gay, or bisexual people. These negative experiences are perpetuated by a lack of education in society on the different natural variations of human sexuality. They lead to poorer health outcomes, including higher prevalence rates of depression, anxiety disorders, substance misuse, and suicidal ideations and attempts. As a result, the suicide rate among lesbian, gay, or bisexual adolescents and young adults significantly higher than that of their heterosexual peers.

These negative outcomes can be exacerbated by other intersectional factors, including but not limited to national origin, race, ethnicity, gender, age, religion, gender identity, socioeconomic status, or disabilities.

In addition, false and baseless pathologisation of lesbian, gay, or bisexual identities leaves such individuals at risk of being coerced into so-called “conversion” or “reparative” procedures. These harmful and unethical practices, also sometimes referred to as sexual orientation and gender identity change efforts (SOGICE), are intended to suppress or change a person’s natural sexual orientation or gender identity. These methods have no medical indication, lack any evidence of effectiveness, and represent a serious threat to the health and human rights of those subjected to these practices. They can lead to anxiety, depression, low self-esteem, substance abuse, problems with intimacy, and suicide.

Negative experiences in healthcare may affect the patient-physician relationship, leading lesbian, gay, and bisexual individuals to avoid accessing care where it is available. They may also withhold their sexual orientation from physicians due to the resulting lack of confidence that they will receive the appropriate treatment and concerns about the safety and confidentiality of their healthcare environment. Without this information, it may be more challenging for physicians to provide targeted care that takes into account the specific health needs of lesbian, gay, or bisexual patients.

Lesbian, gay, or bisexual physicians, medical students, and other health professionals also face discrimination, disadvantages, marginalisation and bullying in the workplace, in schools, in professional organisations, and beyond. Harmful working and learning environments can lead to stress and burnout, especially among marginalised individuals.

 

RECOMMENDATIONS

  1. The WMA strongly asserts that being lesbian, gay, or bisexual does not represent a disease, but rather natural variations within the range of human sexuality.
  2. The WMA condemns all forms of stigmatisation, criminalisation of and discrimination against people based on their sexual orientation.
  3. The WMA asserts that psychiatric or psychotherapeutic support, when needed, must not focus upon the variations of sexuality itself, but rather upon conflicts which arise between those variations and religious, social and internalised norms and prejudices, as well as the health needs of the individual patient.
  4. The WMA unequivocally condemns so-called “conversion” or “reparative” methods. These constitute violations of human rights and are unjustifiable practices that should be denounced and subject to sanctions and penalties. It is unethical for physicians to participate during any step of any such procedures.
  1. The WMA calls upon all physicians to:
    • classify physical and psychological diseases on the basis of clinically relevant symptoms according to ICD 11 criteria regardless of sexual orientation, and to provide quality, evidence-based care in accordance with internationally recognised treatments and protocols and in keeping with the principles set forth in the WMA International Code of Medical Ethics;
    • provide a safe, respectful, and inclusive healthcare setting for lesbian, gay, and bisexual patients;
    • foster safe, respectful, and inclusive work and learning environments for lesbian, gay, and bisexual physicians, medical students, and other health professionals;
    • engage in continuing education and professional development to better understand the specific health needs of lesbian, gay, and bisexual patients and the benefits of certain treatments;
    • where appropriate, involve patients’ same-sex partners and same-sex parents in healthcare discussions in keeping with the patient’s preferences, respecting their consent, and with due regard for patient confidentiality;
    • speak out against legislation and practices violating the human rights of lesbian, gay, and bisexual people, which may also negatively impact the healthcare system at large;
    • reject and refuse to participate in any step of so-called “conversion” or “reparative” methods.
  1. The WMA calls upon constituent members and professional associations to:
    • advocate for safe and inclusive working and learning environments for lesbian, gay, and bisexual physicians, medical students, and other health professionals;
    • establish and enforce non-discriminatory policies in keeping with the WMA Statement on Non-Discrimination in Professional Membership and Activities of Physicians;
    • create guidelines for physicians outlining the specific physical and mental health challenges facing lesbian, gay, and bisexual patients, where appropriate;
    • Where possible, promote changes to medical education, specialty training and CME/CPD curricula to create sensitivity and awareness of the specific health needs of lesbian, gay, and bisexual patients;
    • establish channels for lesbian, gay, and bisexual physicians to report incidents of discrimination or bias against themselves or lesbian, gay, or bisexual patients;
    • in environments where confidentiality and patient safety are guaranteed and data cannot be abused, encourage voluntary data collection in the clinical setting and regular reporting on the health outcomes of lesbian, gay, and bisexual patient groups, while also taking intersectionality into account, to ensure and further improve targeted and appropriate healthcare provision;
    • actively condemn so-called “conversion” or “reparative” methods as unethical.
  1. The WMA calls upon governments to:
    • reject and repeal anti-homosexual or anti-bisexual legislation;
    • condemn and ban so-called “conversion” or “reparative” methods;
    • promote policies that counteract health-related and other inequities caused by overt and implicit discrimination against lesbian, gay, and bisexual people;
    • encourage education from an early age on diverse natural variations of human sexuality to increase acceptance and with the ultimate aim of promoting better physical and mental health for all individuals.