This article contributes to the burgeoning literatures on the sociology of diagnosis and transgender studies by examining the relationship between diagnostic processes and the legitimation of gender identity—the medicalization of transgender people. In order for trans-identified people to access medical and surgical services, they must submit to a complex mental health diagnostic process that relies on criteria set by the American Psychiatric Association and the World Professional Association of Transgender Health (WPATH). By focusing on provider experiences of using the Gender Identity Disorder (GID) diagnosis in the Diagnostic Statistical Manual of Mental Health Disorders, Fourth edition, text revision (DSM-IV-TR) to meet the requirements of WPATH’s Standards of Care (SOC-6), we show that diagnostic processes can both support and inhibit a transpatient’s abilities to access services. Participants reveal how deeply held cultural views pertaining to gender, mental health, and patient competency are entrenched in diagnostic categories. While the new DSM-5 has relabeled GID as Gender Dysphoria and the SOC-7 has somewhat lessened the requirements for accessing hormone treatments, our data suggest that these changes will not be enough to alter the underlying structure of social control and power that diagnostic categories have over transpeople and their providers.
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