Legal status of gender-affirming healthcare
From Wikipedia, the free encyclopedia
The legal status of gender-affirming surgery and gender-affirming hormone therapy varies by jurisdiction, often interacting with other facets of the legal status of transgender people. Key considerations include whether people are allowed to get such surgeries, at what ages they are allowed to if so, and whether surgeries are required in order for a gender transition to be legally recognized.
Democratic Republic of the Congo
There are no protective rights or supportive legislations for any type of medical transitional procedures in the Democratic Republic of the Congo.[1]
Egypt
Sex reassignment surgery is allowed and can be performed in the country after obtaining approval from Al-Azhar Mosque or the Coptic Orthodox Church of Alexandria.[2][3][4]
Ethiopia
Medical procedures for trans people in Ethiopia are illegal. Gender expression out of the 'norm' faces major issues in violence and social stigmatisation.[5]
Morocco
Casablanca, Morocco, is notable for being the home of Clinique de Parc, Georges Burou's clinic for transgender women. Burou is considered one of the pioneers of gender-affirming surgery.[6] A French gynecologist, Burou created the anteriorly pedicled penile skin flap inversion vaginoplasty, still considered the "gold standard" of skin-lined vaginoplasty.[7] He is credited with having performed over 3000 vaginoplasties in 1973.[8]
Nigeria
Medical procedures such as hormone replacement and gender-affirming surgeries are illegal in Nigeria. Additionally, it is not possible to change one's name or gender marker in the country of Nigeria, and trans individuals in Nigeria are not legally protected for gender expression.[9][10]
South Africa
Trans and gender diverse peoples are protected and acknowledged under South African law, where no sterilisation or other forced procedures are necessary to have legal recognition of a person's gender identity. Gender-affirming surgery is legal and accessible, but not covered by medical aid.[11]
Asia
China
Gender-affirming surgeries and changing one's legal name and gender are all accessible in the People's Republic of China, but there are rigorous steps to follow to do so. To change one's legal gender, they must show a gender determination certificate as proof of gender-affirming surgery, which cannot be undergone without: psychiatric diagnosis, verification of no prior criminal record, proof that the family has been notified, written agreement from their family and work unit, that they are unmarried and over 20 years old. The psychiatric diagnosis is not given to someone who is not exclusively heterosexual.[9]
India
Transgender people in India need to undergo a gender-affirming surgery to change their legal gender from male to female or vice-versa. This has been opposed by Indian transgender activists.[12] India also requires proof of having undergone a gender-affirming surgery for changing the gender listed on one's passport. This requirement has been challenged in courts.[13] The government's flagship national health insurance scheme may soon cover gender-affirming surgeries for transgender individuals.[14] India is offering affordable gender-affirming surgeries to a growing number of medical tourists[15] and to the general population.[16]
Indonesia
In Indonesia, it has been possible to undergo gender-affirming surgery since 1973. Vivian Rubianti was the first transgender woman to have legal gender changes in the country. Indonesia requires gender-affirming surgery and judicial approval for a person to legally change gender.[citation needed]
Iran
The Iranian government's response to homosexuality is to endorse, and fully pay for, gender-affirming surgery.[17][18] The leader of Iran's Islamic Revolution, Ayatollah Ruhollah Khomeini, issued a fatwa declaring gender-affirming surgery permissible for "diagnosed transsexuals".[17] Eshaghian's documentary, Be Like Others, chronicles a number of stories of Iranian gay men who feel transitioning is the only way to avoid further persecution, jail, or execution.[17] The head of Iran's main transsexual organization, Maryam Khatoon Molkara, who convinced Khomeini to issue the fatwa on transsexuality, confirmed that some people who undergo operations are gay rather than transsexual.[19] According to the research study of Zara Saeidzadeh who questioned fourteen trans men, nine had completed their medical transition and the remaining five had the intention of completing their medical transition.[20]
Japan
In October 2023 the Supreme Court unanimously ruled to no longer require sterilization for legal gender change and requested a lower court to review the requirement of gender-affirming surgery.[21]
Pakistan
In Pakistan, the Council of Islamic Ideology has ruled that gender-affirming surgery contravenes Islamic law as construed by the council.[22]
Singapore
The first gender-affirming surgery in Singapore was successfully performed on 30 July 1971. Singapore was the first country in Asia to legalize gender-affirming surgeries in 1973. Singapore's first gender-affirming operation on a transmasculine patient took place three years later, and was carried out in three stages between August 1974 and October 1977, as gender-affirming surgeries for transmasculine people are much more complex. Medical tourism for such surgeries are also prevalent in Singapore as local hospitals also accepts foreigners. In 1996, the Singaporean government legalized marriage for transsexuals.[23]
Thailand
Thailand is the country that performs the most gender-affirming surgeries, followed by Iran.[19]
United Arab Emirates
Gender-affirming surgery is illegal in the United Arab Emirates.[24]
Europe
France
Since 2016, France no longer requires gender-affirming surgery as a condition for a gender change on legal documents.[25][26] In 2017, a case brought earlier by three transgender French people was decided. France was found in violation of the European Convention on Human Rights for requiring the forced sterilization of transgender people seeking to change their gender on legal documents.[27]
Malta
As late as 2010, transgender people in Malta who have undergone gender-affirming surgery can change their gender on legal documents.[28][needs update]
Russia
Psychiatric evaluation is necessary to receive a diagnosis of "transsexualism" before one can be authorized for hormone therapy or gender-affirming surgeries in Russia. Neither hormone replacement therapy nor gender-affirming surgeries are covered by the Federal Compulsory Medical Insurance Fund.[29]
Spain
Despite a resolution from the European Parliament in 1989 suggesting advanced rights for all European Union citizens, as of 2002 only Andalusia's public health system covers gender-affirming surgery.[30][better source needed][needs update]
Switzerland
In 2010, Switzerland's Federal Supreme Court struck down two laws that limited access to gender-affirming surgery. These included requirements of at least 2 years of psychotherapy before health insurance was obligated to cover the cost of gender-affirming surgery[31][32] and inability to procreate.[33]
Ukraine
In 2015, the Administrative District Court of Kyiv, Ukraine, ruled that forced sterilization was unlawful and no longer required for legal gender change.[citation needed]
United Kingdom
The minimum age for gender-affirming surgery varies from 16 in Scotland to 17 in England and 18 in Wales.[34] It is not a requirement for legal gender change.[35]