Medical insurance claims in the United States are built around the federal government’s standardized system of diagnostic codes, designed to classify every conceivable injury and condition.
Yet among its more than 70,000 designations, there is no dedicated classification for a growing class of patients: regretful recipients of transgender “health care.”
Patients requiring hormone replacement following gonad removal … may face barriers to coverage without clearer diagnostic pathways.
The omission is all the more glaring when you consider some of the system’s more unusual distinctions.
Duck and cover
“There’s a code for a spacecraft collision injuring the occupant, getting … struck by a duck” as well as “walking into a lamppost,” said Dr. Kurt Miceli in a recent interview with Align. “But nothing for those who are trying to revert a gender transition.”
“So effectively, if you are someone who has been harmed by the medical system and you are trying to get medical care, there’s really no diagnosis,” he continued.
Miceli’s work centers on helping children through Stop the Harm, an organization that tracks gender-related medical interventions among minors. According to its database, more than 5,700 surgical procedures were performed on minors in the United States between 2019 and 2023.
California accounted for an estimated 1,359 of those cases, while Massachusetts reported approximately 300.
Miceli said he wants to “give a voice” to detransitioners by creating at least “some visibility” within the existing system of more than 70,000 codes. Such recognition, he argued, would signal that “this is a condition that we must direct resources to, we must appropriately treat, [and] we must build guidelines to help support.”
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Cease and desistance
Beyond recognition, Miceli said the absence of a dedicated classification complicates care. Without it, patients may face challenges navigating billing systems, obtaining reimbursement, or receiving coordinated follow-up treatment.
He added that there is room for multiple distinctions — separating medical complications, social transition, and surgical outcomes, for example.
One step in that direction may come as soon as October 2026, when an update to the ICD-10-CM is expected to include a new designation: “Gender Identity Disorder, in Remission.”
The term, petitioned by Miceli, is defined as the resolution of “clinical symptoms associated with gender dysphoria, where the cognitive experience of incongruence between experienced/expressed gender and natal sex has remitted, leading to alignment of experienced/expressed gender and natal sex.”
Miceli said he hopes future updates will go further, including classifications that explicitly recognize “desistance.”
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In a bind
At the same time, he argued that legislative action may be necessary to ensure patients receive appropriate care and to “correct the harms that have been done to them.”
For example, patients requiring hormone replacement following gonad removal — or medical care after practices such as breast binding or genital tucking — may face barriers to coverage without clearer diagnostic pathways.
More comprehensive coding, he added, would also improve research and communication across the medical system.
“It’ll allow our physicians, our medical community to place that code onto the chart. We can get a better understanding of what’s going on,” Miceli said. “We can look at that code in association with other potential complications and, again, collect much more accurate real-world data.”
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