In the scope of the current revision process of the diagnostic manuals Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Statistical Classification of Diseases and Other Health Problems (ICD), an international trans depathologisation movement has emerged that demands, among other claims, the removal of a diagnostic classification of gender transition processes as a mental disorder. The call for submissions launched by the American Psychiatric Association (APA) and World Health Organization (WHO) seems to provide the opportunity for a participation of civil society in the DSM and ICD revision processes. These developments open up a number of questions for us that will be discussed in this article. We conducted a meta-narrative review to explore the trans depathologisation movement’s contribution to the DSM and ICD revision process, uncover evidence of a ‘democratised turn’ in the process and review depathologisation proposals implemented in trans healthcare practices, human rights frameworks and legal gender recognition processes. We argue that the trans depathologisation movement has had little impact on medical practices in trans healthcare. However, there is some movement in local health services towards an informed consent model for limited healthcare interventions. Within some European and South/Central American legal frameworks, the depathologisation movement’s demands to free legal gender recognition from medical interventions and examinations have, in different degrees, been incorporated into legal recommendations and enacted in some recent gender recognition laws.