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Ethics briefings
  1. Charlotte Wilson,
  2. Sophie Brannan,
  3. Ruth Campbell,
  4. Veronica English,
  5. Olivia Lines,
  6. Julian C Sheather
  1. Medical Ethics and Human Rights, British Medical Association, London, UK
  1. Correspondence to Ms Charlotte Wilson, Medical Ethics and Human Rights, British Medical Association, London WC1H 9JP, UK; cwilson{at}

Statistics from

Proposed changes to the process for changing legal gender in the UK

In mid-2018, following a survey of lesbian, gay, bisexual and transgender groups, the UK government issued a consultation on the proposed reform of the Gender Recognition Act (GRA) for England and Wales.1

When it was first introduced in 2004, the GRA was considered innovative, even world-leading legislation.2 The act enables any adult to seek to change their legal gender provided several criteria are met. These include:

  • A medical diagnosis of gender dysphoria.

  • A report from a medical professional detailing any medical treatment.

  • Proof of having lived for at least 2 years in their acquired gender.

  • A statutory declaration that they intend to live in the acquired gender until death.

If the applicant is successful, he or she is issued with a ‘gender recognition certificate’, their birth certificate is changed and ‘for all purposes’ they become, legally, their acquired or affirmed gender.

Since 2004, cultural change in relation to gender identity has been rapid. During the government’s preliminary survey, several concerns were raised about the GRA, particularly among those who have changed, or who may be seeking to change, their gender. These included:

  • The process was excessively costly and bureaucratic.

  • It was restricted to a binary concept of male and female gender.

  • The requirement for a diagnosis of gender dysphoria medicalised the issue. Respondents argued that people could change gender without experiencing the distress associated with gender dysphoria. Many respondents also felt the requirement for medical involvement to be demeaning and patronising.

The government has stated that being trans is not a mental illness—more a fact of human diversity. It points to the World Health Organisation’s revision of the International Classification of Diseases,  in which ‘gender incongruence’, another term for gender dysphoria, is no longer classed under ‘mental and behavioural disorders’.3

Draft proposals for change

The government considers the reform of the GRA …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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