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Sexual Self in Disquiet - Gender Incongruence in ICD-11 The ICD-11 represents a shift in the clinical conceptualization and diagnostic assessment of variant gender identity developments. The revised approach to describing individuals whose gender identity does not align with their natal sex is reflected in the departure from the previous pathogenetic understanding and is demonstrated by the introduction of the diagnosis of "gender incongruence" as a "condition related to sexual health". In this article, the diagnostic and theoretical revisions in the ICD-11 are discussed in the context of previous and ongoing debates about the appropriate classification of this phenomenon in children and adolescents. The practical implications for the treatment of minors are then examined, with a particular focus on adolescents after the onset of puberty. At this age, requests for body-modifying procedures are frequently expressed and present significant clinical and ethical challenges in treatment practice. The diagnostic revisions in the ICD-11 are recognized as a pivotal advance in the de-stigmatization of variant gender identity developments. At the same time, this article argues for the necessity of a clinically oriented approach, which includes careful differential diagnosis and psychotherapeutic exploration, to address the complex needs of adolescent patients, particularly those who seek irreversible body-modifying interventions and often experience significant psychological distress.