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Depsychopathologization of transgender and gender diverse (TGD) individuals in the eleventh revision of the International Classification of Diseases (ICD-11) called for a shift in care delivery models, based on free and informed consent. Public health policies face epistemic and discriminatory challenges and consensus built on evidence-based data is needed. TGD communities were consulted but did not actively participate in ICD-11 and the following public health debates. There is a need for TGD perspective—both in research and practice. This study draws on a peer-led participatory approach and explores TGD participants’ recommendations based on unexploited French data from ICD-11, in which 72 TGD gave feedback on public policies. Lexicometric analyses were conducted using the ALCESTE method and resulted in a two-step double Descending Hierarchical Classification. Sex, gender, and health consumption were analyzed as secondary variables. The first classification highlighted five main topics: care pathways, training of professionals, access, literacy, and civil status change, developed into 12 targets in the second classification. While sex and gender appeared to have little impact on discourses, recommendations varied according to received care. This study supports the growing scientific consensus of a public health approach to face TGD health challenges and emphasizes TGD individuals’ expertise.

International audience; Transgender and gender diverse (TGD) individuals’ 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’ 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.

International audience; The depathologization in 2019 of transgender persons by the World Health Organization highlighted epistemological shifts at work at the confluence of sexuality, gender and mental health. If they are accompanied by changes in medical epistemology, they signal what Paul B. Preciado characterizes as the end of the paradigm of sexual difference. Based on the conceptual model developed by Norman Fairclough, we have identified the ideological frameworks in which these epistemic changes are taking place, illustrating in particular the impact of the means of knowledge production and interpretation. In this article, we argue that the development of gender studies has led to the existence of alternative epistemologies which, because of their political impact, have made it possible to support this depathologization process.; La dépathologisation en 2019 des personnes transgenres par l’Organisation Mondiale de la Santé a permis de mettre en évidence les bouleversements épistémologiques à l’œuvre à la confluence entre sexualité, genre et santé mentale. S’ils s’accompagnent de changements de l’épistémologie médicale, ils annoncent ce que Paul B. Preciado caractérise comme la fin du paradigme de la différence sexuelle. En nous appuyant sur le cadre conceptuel développé par Norman Fairclough, nous avons procédé à une identification des cadres idéologiques dans lesquels s’opèrent ces changements épistémiques, en illustrant notamment l’impact des processus de production et d’interprétation des savoirs. Dans cet article, nous défendons que le développement des études de genre a amené l’existence d’épistémologies alternatives qui, de par leur impact politique, ont permis d’appuyer cette dépathologisation.