"Honestly, taking it out of the WHO book completely would surely eliminate the possibility of insurance coverage," said Claire Louise Swinford, executive director of Transhaven, an advocacy organization based in St. Louis, Miss. "You can't bill for what you can't code. And at the end of the day, the ICD is a coding book."
But, Swinford, who was born male and now identifies as female, said she believes semantics does matter.
"The core of this is we are a community that is tired of being told we are mentally ill and we are not," said Swinford, 41. "There is nothing disordered about my gender, nothing wrong with me in my mind."
Activists say that it is wrong to further stigmatize those who are transgender, but others worry the move might disqualify them from medical and surgical care.
"We are finally starting to see insurance coverage and I certainly do not want to lose that," she said.
Still, Swinford objects to medical protocols that require those seeking gender reassignment surgery to seek out a psychiatric evaluation to thwart potential suicides.
"A middle-class woman can go out and get breast implants and $30,000 in facial surgery in attempt to please her husband..." she said. "No one asks her for a psychiatric evaluation."
"I'd like to see that go away and be more of an informed consent model," said Swinford.
She said counseling is vitally important for those who are transgender. "I do not need a therapist to tell me I am a woman, but I do need one to deal with the crap the world throws at me."
The WHO's Hartl acknowledges that taking "transsexualism" out of the mental disorders section of the ICD-10 could jeopardize those seeking medical services.
"Many countries would not cover this healthwise, especially because a lot of the medical evidence is inconclusive," he said. "They might have to create a whole new category."
After the medical experts commissioned by the WHO arrive at a "common position," it will be published on the organization's website for general worldwide comment before the World Health Assembly votes on the issue.
"But if there is opposition from more socially conservative countries, it won't pass," he said.