Category · F60-F69 block
F64 — Gender identity disorders
Terminology note: A person's gender identity is not itself a disorder. This ICD-10 category reflects a diagnostic framework substantially revised in ICD-11, which relocated gender incongruence out of the mental-disorders chapter entirely. This educational tool teaches ICD-10's structure as it is written, while stating this context plainly rather than presenting the classification uncritically.
What is this category?
F64 is where ICD-10 places diagnoses concerning a marked and persistent incongruence between a person's experienced gender and their sex recorded at birth. F64.0 (transsexualism) describes a wish to live and be accepted as a member of the other sex, usually with a wish for hormonal or surgical treatment; F64.1 (dual-role transvestism) describes wearing clothes of the other sex for part of an existence, without any wish for permanent gender transition; F64.2 concerns presentations arising in childhood. No subcode in this category is taught in depth in this build — see this block's scope decision for why.
Core diagnostic concept
Because gender identity itself is not a disorder, applying any F64 code — as this classification is written — requires genuine, persistent incongruence causing clinically significant distress or impairment from the incongruence itself, not distress that is actually attributable to how the person is treated by others (discrimination, rejection, lack of support), which is a social and ethical issue, not a mental disorder.
Key diagnostic features
- Persistent gender incongruence
- A marked and persistent incongruence between experienced gender and sex recorded at birth.
- Distress or impairment from the incongruence, as classified here
- As ICD-10 frames this category, clinically significant distress is a required element — not simply the fact of being transgender or gender-diverse.
- Not a disorder of identity to be corrected
- This classification does not imply that a person's gender identity itself needs to be changed; historical and current good clinical practice focuses on supporting the person, not altering their identity.
How to weigh evidence
These learning labels are teaching aids, not official ICD-10 terminology (see Sources and Method).
- supports As ICD-10 frames it: a documented, persistent, marked incongruence between experienced gender and sex recorded at birth, described by the person themselves and present over a sustained period.
- consistent not decisive A person explores or questions aspects of gender expression without describing persistent incongruence.
- raises alternative Distress is actually attributable to family rejection, workplace discrimination, or social stigma, rather than to the incongruence itself.
- contradicts or weakens No persistent incongruence is described at all — a person's distress relates entirely to how others have responded to a disclosure, not to their own experienced gender.
- missing and necessary to ask Whether the distress described relates to the incongruence itself, or is better explained by external discrimination or lack of support — a distinction this classification, and this tool, treats as important.
Diagnostic boundary
As ICD-10 frames this category, it requires persistent gender incongruence — not general questioning, and not distress that is actually attributable to discrimination or lack of support rather than the incongruence itself.
Full comparisons:
Duration and course
Minimum duration: ICD-10 requires the incongruence to be persistent, generally present for at least two years for F64.0.
Course: Described in ICD-10 as generally persistent once established.
Included presentations
- Transsexualism: a persistent wish to live and be accepted as a member of the other sex, usually accompanied by a wish for hormonal or surgical treatment.
- Dual-role transvestism: wearing clothes of the other sex for part of one's existence, without a wish for permanent gender transition.
- Gender identity disorder of childhood: presentations arising in childhood, before puberty.
Exclusions and distinguishing presentations
| If this is true instead… | Consider | Why |
|---|---|---|
| Distress that is actually attributable to discrimination, family rejection, or lack of social support, rather than to gender incongruence itself | gender orientation sexual preference context capsule | This classification, as ICD-10 defines it, requires distress from the incongruence itself — not distress caused by how others treat the person. |
| Distress or confusion specifically about one's sexual orientation, rather than one's gender identity | F66 | Gender identity (who one is) and sexual orientation (who one is attracted to) are distinct classification dimensions and are frequently, incorrectly conflated. |
Four-character subtypes (orientation)
No F64 subcode is taught in depth in this build. A learner should always check whether described distress is actually attributable to discrimination or lack of support rather than to incongruence itself, and should never treat a person's gender identity as something to be corrected.
- F64.0 — Transsexualism
- Persistent wish to live and be accepted as a member of the other sex. (taught for orientation only, not separately assessed in this pilot)
- F64.1 — Dual-role transvestism
- Wearing clothes of the other sex, without a wish for permanent transition. (taught for orientation only, not separately assessed in this pilot)
- F64.2 — Gender identity disorder of childhood
- Presentations arising in childhood, before puberty. (taught for orientation only, not separately assessed in this pilot)
- F64.8 — Other gender identity disorders
- A presentation not matching the named subtypes. (taught for orientation only, not separately assessed in this pilot)
- F64.9 — Gender identity disorder, unspecified
- A presentation identified but without enough information to specify further. (taught for orientation only, not separately assessed in this pilot)
External causes to check first
Categories in this block require that the disturbance is not better explained by another external cause listed below. These short capsules are reminders, not full teaching modules.
Nosological-context capsule — F64, F65, and F66
A shared context note for F64 (Gender identity disorders), F65 (Disorders of sexual preference), and F66 (Psychological and behavioural disorders associated with sexual development and orientation): a person's gender identity and a person's sexual orientation are not, in themselves, mental disorders. These three ICD-10 categories are presented here for classification literacy — to understand how ICD-10 was structured and how later revisions changed it — not as clinical guidance for assessing or treating a real person's identity or orientation.
What to check:
- Source of distress: where a vignette describes distress, is it clearly attributable to the person's gender identity or sexual orientation itself, or is it better explained by discrimination, family or social rejection, internalized stigma, or an unrelated co-occurring condition? The latter does not support any F64/F65/F66 classification on its own.
- What changed in ICD-11: gender incongruence was reclassified out of the mental-disorders chapter entirely (moved to a chapter on sexual health), and 'egodystonic sexual orientation' (previously F66.1) was removed — both changes reflect a shift away from treating identity or orientation itself as pathology.
- What F65 covers: F65 concerns patterns of sexual preference and their behavioural expression, most of which (e.g. fetishism, exhibitionism) are covered here only at classification-title level; this educational tool authors no scenario, case, or exercise content for F65.4 (Paedophilia) beyond its bare classification title, as a fixed editorial line.
- Level of authored depth: F64, F65, and F66 are deliberately covered at classification-orientation depth only in this tool, with no in-depth subcodes and reduced case/exercise coverage, reflecting the sensitivity of this territory rather than any gap in the underlying classification.
Clinical guidance on gender-affirming care, sexual health, or supporting someone experiencing minority stress or discrimination — all of which are outside this capsule's scope and require qualified professional support.
Worked example — distinguishing distress about incongruence from distress about others' reactions
A clinician's intake note documents two separate features reported at an assessment: a persistent, several-years-long experience of incongruence with the sex recorded at birth, described by the person themselves; and separately, significant distress the person attributes specifically to their family's rejection since disclosing this. The note distinguishes these as two separate sources of the person's overall distress.
- Step 1 — Identify the persistent incongruence as the classification-relevant feature, as ICD-10 frames this category.
- Step 2 — Identify the family-rejection-related distress as a separate, socially-caused source of distress, not itself part of the classification.
- Conclusion — The persistent incongruence is what this classification, as written, would consider; the family-rejection distress is a separate matter for supportive intervention, not evidence of an additional or different disorder here.
Interactive practice
- Type A A documentation review: classification, not narrative Recognition / application · Foundation
Retrieval prompts
Try answering each of these from memory before revealing where to check. Nothing you think or type here is sent or saved anywhere.
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Explain why gender identity itself is not classified as a disorder in this tool's framing.
Reveal answer location
Check Duration and course, Diagnostic boundary, or the rapid revision card below — the cue you need is one of those, in this category's own already-authored wording.
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State the distinction between distress from incongruence itself and distress from others' reactions.
Reveal answer location
Check Duration and course, Diagnostic boundary, or the rapid revision card below — the cue you need is one of those, in this category's own already-authored wording.
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Explain how F64 differs from F66 in terms of what each concerns.
Reveal answer location
Check Duration and course, Diagnostic boundary, or the rapid revision card below — the cue you need is one of those, in this category's own already-authored wording.
These self-checks are a personal study aid only, visible to you on this page for this visit — they are not stored and do not affect your mastery dimensions.
Rapid revision card
F64: F64 reflects ICD-10's now-superseded framing of persistent gender incongruence; gender identity itself is not a disorder, and distress from discrimination is not the same as distress from incongruence.
Decisive boundary cues:
- Persistent incongruence, distress attributable to the incongruence itself, as ICD-10 frames it -> the classification as written.
- Distress attributable to discrimination, rejection, or lack of support -> not evidence of this classification; a social/support issue instead.
- Confusion or distress about sexual orientation rather than gender identity -> a different dimension (see F66).
Duration/course: ICD-10 requires persistence, generally at least two years for F64.0.
Nearest alternatives: f66, f65
Common mistake: Conflating gender identity with sexual orientation, or attributing distress caused by discrimination to the person's identity itself.
Retrieval prompt: Is any distress described here actually about the incongruence itself, or about how others have responded to it?
(or use your browser's print function) Open full-page printable revision view →
Related glossary terms
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Gender incongruence
A marked and persistent incongruence between an individual's experienced gender and the sex assigned at birth. ICD-10 classified this territory under F64 (Gender identity disorders) within the mental-disorders chapter; ICD-11 substantially revised this, relocating gender incongruence out of the mental-disorders chapter entirely and into a chapter on conditions related to sexual health.
Source basis
WHO ICD-10 international classification structure and code/title (ICD-10 Browser, 2019 English release).
Original educational synthesis, informed by general published clinical-education understanding of ICD-10 F60-F69; no verbatim CDDG or DCR text is reproduced. See Sources and Method for the full policy.
Last reviewed: 2026-09-17. Full policy: Sources and Method.
Educational resource only. This page and its cases teach ICD-10 classification reasoning using fictional scenarios. It does not diagnose real people and should not be used to assess yourself or anyone else. A person's gender identity or sexual orientation is not itself a disorder. If you or someone you know is struggling with a pattern of behaviour, an urge you find hard to control, or distress related to discrimination or how you are treated by others, please seek prompt, respectful professional support.