{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T09:30:28Z","timestamp":1790847028546,"version":"4.1.0"},"reference-count":42,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2022,9,22]],"date-time":"2022-09-22T00:00:00Z","timestamp":1663804800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"French Ministry of Solidarity and Maison Dispers\u00e9e de Sant\u00e9"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Transgender and gender diverse (TGD) individuals\u2019 depsychopathologization in the eleventh revision of the International Classification of Diseases (ICD-11) faces systemic discriminations built-in epistemic pipelines. Based on an analysis of unexploited data from ICD-11 and the French translation process, this article addresses power issues in participatory research and systemic discrimination within a socio-cultural context. We used a peer-driven participatory approach to conduct qualitative analyses of the French version of the ICD based on contributions from 72 TGD participants in the French study for ICD-11. The results highlight a major incongruence between participants\u2019 propositions and the final official translation. Alternative terms were proposed and discussed by participants in regard to usage and concepts, but also encompassed participation and perceived futility of maintaining pathologization. We found discrepancies in the French publication and translation processes, respectively on gender categorization and back translation. These results question the relevance and implementation of ICD-11 for TGD communities and highlight failures at all three stages of the official French translation. Power issues have an impact on knowledge production and, while mechanisms vary, all relate to epistemic injustice. Involving TGD communities in all stages of medical knowledge production processes would reduce transphobic biases. Individuals with personal stakes involved in politicized research areas appear all the more necessary today.<\/jats:p>","DOI":"10.3390\/ijerph191911983","type":"journal-article","created":{"date-parts":[[2022,9,22]],"date-time":"2022-09-22T21:10:05Z","timestamp":1663881005000},"page":"11983","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Trans Expertise and the Revision and Translation of ICD-11: An Analysis of Available French Data from a Trans Perspective"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2711-9138","authenticated-orcid":false,"given":"Anna","family":"Baleige","sequence":"first","affiliation":[{"name":"EA 75-05 \u00c9ducation \u00c9thique Sant\u00e9, Facult\u00e9 de M\u00e9decine, Universit\u00e9 Fran\u00e7ois-Rabelais Tours, 2 Boulevard Tonnell\u00e9, 37044 Tours, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6789-1835","authenticated-orcid":false,"given":"Mathilde","family":"Guernut","sequence":"additional","affiliation":[{"name":"UMR 8163 Savoirs, Textes, Langage, CNRS, Universit\u00e9 de Lille, Rue du Barreau, BP 60149, 59653 Villeneuve d\u2019Ascq, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fr\u00e9d\u00e9ric","family":"Denis","sequence":"additional","affiliation":[{"name":"EA 75-05 \u00c9ducation \u00c9thique Sant\u00e9, Facult\u00e9 de M\u00e9decine, Universit\u00e9 Fran\u00e7ois-Rabelais Tours, 2 Boulevard Tonnell\u00e9, 37044 Tours, France"},{"name":"Service d\u2019Odontologie, Centre Hospitalier Universitaire de Tours, 2 Boulevard Tonnell\u00e9, 37044 Tours, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1080\/15532739.2019.1640654","article-title":"The terminology of identities between, outside and beyond the gender binary\u2014A systematic review","volume":"20","author":"Thorne","year":"2019","journal-title":"Int. J. Transgend."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1126\/science.361.6406.958","article-title":"\u2018Rapid onset\u2019 of transgender identity ignites storm","volume":"361","author":"Wadman","year":"2018","journal-title":"Science"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1089\/trgh.2020.0143","article-title":"Following ICD-11, Rebuilding Mental Health Care for Transgender Persons: Leads from Field Experimentations in Lille, France","volume":"7","author":"Baleige","year":"2021","journal-title":"Transgender Health"},{"key":"ref_4","unstructured":"Le Carboulec, R. Mineurs trans: Des groupuscules conservateurs passent \u00e0 l\u2019offensive. Mediapart 2022, Available online: https:\/\/www.mediapart.fr\/journal\/france\/170522\/mineurs-trans-des-groupuscules-conservateurs-passent-l-offensive."},{"key":"ref_5","first-page":"39","article-title":"Controverses dans les prises en charge des situations trans: Une ethnographie des conf\u00e9rences m\u00e9dico-scientifiques","volume":"37","author":"Giami","year":"2019","journal-title":"Sci. Soc. Sante"},{"key":"ref_6","unstructured":"World Health Organization (2017). Promoting Health: Guide to National Implementation of the Shanghai Declaration."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Foucault, M. (2008). L\u2019arch\u00e9ologie du Savoir, Gallimard.","DOI":"10.14375\/NP.9782070119875"},{"key":"ref_8","unstructured":"Baleige, A., and Guernut, M. (2021). Constructing a new epistemology of transgender persons: Impact of gender studies on mental health ideologies. Implic. Philos., Available online: http:\/\/www.implications-philosophiques.org\/constructing-a-new-epistemology-of-transgender-persons-impact-of-gender-studies-on-mental-health-ideologies."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Garry, A., Khader, S.J., and Stone, A. (2017). Epistemic Injustice, Ignorance, and Trans Experiences. Routledge Companion to Feminist Philosophy, Routledge.","DOI":"10.4324\/9781315758152"},{"key":"ref_10","unstructured":"Fairclough, N. (2015). Language and Power, Routledge. [3rd ed.]."},{"key":"ref_11","unstructured":"Preciado, P.B. (2020). Je Suis Un Monstre Qui Vous Parle, Grasset."},{"key":"ref_12","unstructured":"Kuhn, T. (2015). The Structure of Scientific Revolutions, Princeton University Press. [4th ed.]."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Castro-Peraza, M.E., Garc\u00eda-Acosta, J.M., Delgado, N., Perdomo-Hern\u00e1ndez, A.M., Sosa-Alvarez, M.I., Llabr\u00e9s-Sol\u00e9, R., and Lorenzo-Rocha, N.D. (2019). Gender Identity: The Human Right of Depathologization. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16060978"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1002\/wps.20354","article-title":"Disorders related to sexuality and gender identity in the ICD-11: Revising the ICD-10 classification based on current scientific evidence, best clinical practices, and human rights considerations","volume":"15","author":"Reed","year":"2016","journal-title":"World Psychiatry"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"100281","DOI":"10.1016\/j.ijchp.2021.100281","article-title":"Validity of Categories Related to Gender Identity in ICD-11 and DSM-5 Among Transgender Individuals who Seek Gender-Affirming Medical Procedures","volume":"22","author":"Robles","year":"2022","journal-title":"Int. J. Clin. Health Psychol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1080\/00224499.2016.1142495","article-title":"Microaggressions Toward Lesbian, Gay, Bisexual, Transgender, Queer, and Genderqueer People: A Review of the Literature","volume":"53","author":"Nadal","year":"2016","journal-title":"J. Sex Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/S2215-0366(15)00586-6","article-title":"Gender incongruence of childhood in the ICD-11: Controversies, proposal, and rationale","volume":"3","author":"Drescher","year":"2016","journal-title":"Lancet Psychiatry"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/S2215-0366(16)30043-8","article-title":"Removal of gender incongruence of childhood diagnostic category: A human rights perspective","volume":"3","author":"Cabral","year":"2016","journal-title":"Lancet Psychiatry"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/S0140-6736(16)00682-6","article-title":"Serving transgender people: Clinical care considerations and service delivery models in transgender health","volume":"388","author":"Wylie","year":"2016","journal-title":"Lancet"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.eurpsy.2019.03.005","article-title":"Why and how to support depsychiatrisation of adult transidentity in ICD-11: A French study","volume":"59","author":"Baleige","year":"2019","journal-title":"Eur. Psychiatry"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1007\/s00127-018-1549-3","article-title":"Participatory research: Real or imagined","volume":"53","author":"Rose","year":"2018","journal-title":"Soc. Psychiatry Psychiatr. Epidemiol."},{"key":"ref_22","first-page":"817","article-title":"From patient to researcher: Personal empowerment journey related to transidentity","volume":"94","year":"2018","journal-title":"Inf. Psychiatr."},{"key":"ref_23","unstructured":"Sweeney, A., Beresford, P., Faulkner, A., Nettle, M., and Rose, D. (2009). This Is Survivor Research, Ross-on-Wye PCCS Books."},{"key":"ref_24","unstructured":"Sweeney, A., Beresford, P., Faulkner, A., Nettle, M., and Rose, D. (2009). Survivor-produced knowledge. This Is Survivor Research, Ross-on-Wye PCCS Books."},{"key":"ref_25","unstructured":"World Health Organization (2010). Translation and Linguistic Evaluation Protocol and Supporting Material, Manual for WHO Disability Assessment Schedule WHODAS 2.0."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1080\/14737167.2020.1734453","article-title":"Translation and back-translation methodology in health research\u2014A critique","volume":"20","author":"Ozolins","year":"2020","journal-title":"Expert Rev. Pharmacoecon. Outcomes Res."},{"key":"ref_27","first-page":"169","article-title":"Vers la CIM-11: Cr\u00e9er un espace pour une diversit\u00e9 de perspectives","volume":"87","author":"Reed","year":"2011","journal-title":"Inf. Psychiatr."},{"key":"ref_28","unstructured":"Skianis, K., Briand, Y., and Desgrippes, F. Evaluation of Machine Translation Methods applied to Medical Terminologies. Proceedings of the 11th International Workshop on Health Text Mining and Information Analysis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1007\/s10676-021-09583-1","article-title":"The practical ethics of bias reduction in machine translation: Why domain adaptation is better than data debiasing","volume":"23","author":"Tomalin","year":"2021","journal-title":"Ethics Inf. Technol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Sun, T., Gaut, A., Tang, S., Huang, Y., ElSherief, M., Zhao, J., Mirza, D., Belding, E., Chang, K.W., and Wang, W.Y. (2019, January 28). Mitigating gender bias in natural language processing: Literature review. Proceedings of the 57th Annual Meeting of the Association for Computational Linguistics, Florence, Italy.","DOI":"10.18653\/v1\/P19-1159"},{"key":"ref_31","unstructured":"Shearer, E., Martin, S., Petheram, A., and Stirling, R. (2022, August 01). Racial Bias in Natural Language Processing: Research Report, August 2019. Available online: https:\/\/ec.europa.eu\/futurium\/en\/system\/files\/ged\/shared_racial_bias_in_natural_language_processing_-_report.pdf."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1086\/643401","article-title":"Experiential Knowledge: A New Concept for the Analysis of Self-Help Groups","volume":"3","author":"Borkman","year":"1976","journal-title":"Soc. Serv. Rev."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/j.schres.2022.03.001","article-title":"Accessibility of psychiatric vocabulary: An international study about schizophrenia essential features","volume":"243","author":"Hazo","year":"2022","journal-title":"Schizophr. Res."},{"key":"ref_34","first-page":"34","article-title":"Accessibility, acceptability, and adequacy of schizophrenia definition according to experts by experience: An ICD-11 field study of patients and relative caregivers in Mexico","volume":"14","author":"Real","year":"2020","journal-title":"Psychosis"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1007\/s00127-020-01836-6","article-title":"How service users and carers understand, perceive, rephrase, and communicate about \u201cdepressive episode\u201d and \u201cschizophrenia\u201d diagnoses: An international participatory research","volume":"55","author":"Roelandt","year":"2020","journal-title":"Soc. Psychiatry Psychiatr. Epidemiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1016\/S2215-0366(16)30165-1","article-title":"Removing transgender identity from the classification of mental disorders: A Mexican field study for ICD-11","volume":"3","author":"Robles","year":"2016","journal-title":"Lancet Psychiatry"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/S0140-6736(16)00683-8","article-title":"Transgender people: Health at the margins of society","volume":"388","author":"Winter","year":"2016","journal-title":"Lancet"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Barnett-Page, E., and Thomas, J. (2009). Methods for the synthesis of qualitative research: A critical review. BMC Med. Res. Methodol., 9.","DOI":"10.1186\/1471-2288-9-59"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1016\/S0140-6736(16)00684-X","article-title":"Global health burden and needs of transgender populations: A review","volume":"388","author":"Reisner","year":"2016","journal-title":"Lancet"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1080\/26895269.2020.1753136","article-title":"Epidemiological considerations in transgender health: A systematic review with focus on higher quality data","volume":"21","author":"Zhang","year":"2020","journal-title":"Int. J. Transgender Health"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1089\/trgh.2020.0050","article-title":"The Complexities of Categorizing Gender: A Hierarchical Clustering Analysis of Data from the First Australian Trans and Gender Diverse Sexual Health Survey","volume":"6","author":"Callander","year":"2021","journal-title":"Transgender Health"},{"key":"ref_42","first-page":"539","article-title":"fairseq: A Fast, Extensible Toolkit for Sequence Modeling","volume":"388","author":"Ott","year":"2019","journal-title":"Nature"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/19\/11983\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:37:18Z","timestamp":1760143038000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/19\/11983"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,22]]},"references-count":42,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["ijerph191911983"],"URL":"https:\/\/doi.org\/10.3390\/ijerph191911983","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,22]]}}}