The International Statistical Classification of Diseases (ICD) and The
Diagnostic and Statistical Manual of Mental Disorders (DSM) formulate a fundament
for biomedical ethics of gender variance, governing clinical practices, systems
and policies. I discuss the diagnostic details and bioethical ramifications of so-called
gender diagnoses in ICD and DSM. I then subject medicalized gender variance to concept
analytical and queer bioethical scrutiny. I find both diagnostic systems to make
sense of gender variance through incongruence, dysphoria and desire in bioethically
confusing ways.

In my treatment, medicalized
gender variance does not necessarily entail pathologization. I conclude that
medicalized gender variance can be used for balancing access to care and stigma
but persist that evaluation of this must be more informed by queer bioethics.
Despite progress compared to previous versions of ICD and DSM, both are still
in need of further queer bioethical scrutiny. This includes a thorough
evaluation of queer vulnerabilities in gender diagnostics, currently building
on convoluted definitions of incongruence, desire and dysphoria. This
convolution confuses medical ethics of gender and sexual variance. Further, it
can trigger moral harms, including cascading queer vulnerabilities.