Fact Check: Peru Allegedly Classified Trans People as 'Mentally Ill.' Here Are the Facts

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Peru classified transgender people as "mentally ill."


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In May 2024, rumors spread that Peru had just passed a law that classified transgender and nonbinary people as "mentally ill":

This post on Reddit had gained 29,000 votes as of this writing, as well as 2,600 comments. The claim also spread on X, with users expressing outrage and support.

Looking closely at those claims, we found them to be true. On May 16, 2024, Peru's government sparked a backlash when its president, Dina Boluarte, ratified Supreme Decree 009-2024, which purported to expand access to mental health services for "transsexual" Peruvians. Standing for LGBTQ+ rights, several organizations and individuals accused Boluarte and her government of "pathologizing" trans people, however.

Peru's authorities defended the decree, arguing that it was merely following a classification established by the World Health Organization (WHO) known as the International Classification of Diseases (ICD). They said they did so to allow for better health insurance coverage of mental health conditions related to gender identity, "fetishistic transvestism" and "egodystonic sexual orientation" (which means unhappiness with one's gender identity or sexual orientation paired with the desire to change it).

Decree 009-2024 lists by name the following "disorders," pulled from the ICD:

  • F64.0 Transexualism

  • F64.1 Dual-role transvestism

  • F64.2 Gender identity disorder of childhood

  • F64.8 Other gender identity disorders

  • F64.9 Gender identity disorder, unspecified

  • F65.1 Fetishistic transvestism

  • F66.1 Egodystonic sexual orientation

However, the decree followed the classification used in the 10th revision of the ICD, which the WHO stopped using in 2022, rendering it obsolete. The difference in language between ICD-10 and ICD-11 is striking. For example, focusing on children who do not conform to the gender they were assigned at birth, ICD-10 read:

F64.2 Gender identity disorder of childhood

A disorder, usually first manifest during early childhood (and always well before puberty), characterized by a persistent and intense distress about assigned sex, together with a desire to be (or insistence that one is) of the other sex. There is a persistent preoccupation with the dress and activities of the opposite sex and repudiation of the individual's own sex. The diagnosis requires a profound disturbance of the normal gender identity; mere tomboyishness in girls or girlish behaviour in boys is not sufficient. Gender identity disorders in individuals who have reached or are entering puberty should not be classified here but in F66.-.

ICD-11 considerably adjusted its approach. For starters, it nixed the term "disorder" and replaced it with "incongruence":

HA61 Gender incongruence of childhood

Gender incongruence of childhood is characterised by a marked incongruence between an individual's experienced/expressed gender and the assigned sex in pre-pubertal children. It includes a strong desire to be a different gender than the assigned sex; a strong dislike on the child's part of his or her sexual anatomy or anticipated secondary sex characteristics and/or a strong desire for the primary and/or anticipated secondary sex characteristics that match the experienced gender; and make-believe or fantasy play, toys, games, or activities and playmates that are typical of the experienced gender rather than the assigned sex. The incongruence must have persisted for about 2 years. Gender variant behaviour and preferences alone are not a basis for assigning the diagnosis.

Organizations like Human Rights Watch warned that the Peruvian government's use of ICD-10 could make conversion therapy appear legitimate when the practices can be akin to torture and should be banned, according to a United Nations report.

In response, government spokesman Carlos Alvarado told Agence France-Presse that "transexualism" is "not a mental health problem and we agree with that, to the point where various documents at the ministry that specify this."

He added that while the only goal of the decree was to expand the number of conditions for which people should have access to care, "the idea is to make the transition to ICD-11 as soon as possible." He also said that changing the current classifications would once again restrict coverage of essential mental health care.

Given that Peru does not allow same-sex marriage or even same-sex civil unions, and that it does not let its trans citizens change their gender identity on official identification documents, LGBTQ+ rights organizations expressed concern that this latest move would only set back progress for these groups in the country even more.


'Controversia en Perú por un decreto que describe la transexualidad como trastorno mental'. LA NACION, 17 May 2024, https://www.lanacion.com.ar/el-mundo/controversia-en-peru-por-un-decreto-que-describe-la-transexualidad-como-trastorno-mental-nid17052024/.

Decreto Supremo que modifica el Decreto Supremo N° 023-2021-SA, que aprueba la actualización del Plan Esencial de Aseguramiento en Salud - PEAS - DECRETO SUPREMO - N° 009-2024-SA - SALUD. http://busquedas.elperuano.pe/dispositivo/NL/2287398-1. Accessed 17 May 2024.

ICD-10 Version:2019. https://icd.who.int/browse10/2019/en. Accessed 17 May 2024.

ICD-11. https://icd.who.int/en. Accessed 17 May 2024.

Perú opta por la intolerancia en los servicios médicos | Human Rights Watch. 15 May 2024, https://www.hrw.org/es/news/2024/05/15/peru-opta-por-la-intolerancia-en-los-servicios-medicos.

"Practices of So-Called "Conversion Therapy". Report of the Independent Expert on protection against violence and discrimination based on sexual orientation and gender identity, A/HRC/44/53, 1 May 2020, https://documents.un.org/doc/undoc/gen/g20/108/68/pdf/g2010868.pdf?token=eFvh07FwFG3kuqes9k&fe=true.