Gender Change for minors.When is this possible?

gender-change-for-minors

Every year, the number of minors willing to change their gender increases by 12%, according to the data collected by our law firm that specializes in the gender rectification process.

In this article you’ll find out that a minor can indeed change his/her gender and name, but that at the same time, it’s not always either easy or possible. Factors that can make the difference are:

  • Reason for wanting to change gender
  • Age
  • Parental support or not

I am an attorney specialized in the gender rectification process and provide legal assistance during the transition process for both adults and minors.

In this article, I’m going to talk to you specifically about gender rectification and name change for minors.

Reasons for gender reassignment amongst minors

Gender dysphoria

This data has been collected collected by Piemonte Law Firm during 2018, 2019, 2020 and 2021

In general, there are primarily 2 reasons why a minor may request a gender rectification:

  1. Gender dysphoria, for an inconsistency between biological and perceived sex (99.3% of our contacts among minors)
  2. Genital malformation, due to the difficulty at birth in identifying a male or female gender (0.7% of our contacts among minors)

At what age can you obtain a gender change?

what-age-changing-gender
Source: Piemonte Law Firm, specialized in legal assistance for the gender rectification process of minors

The change of gender due to gender dysphoria can be taken into consideration starting from the age of about 14 years (although nothing excludes that it can happen earlier, although in Italy there are no cases). No law sets a specific age.

Whereas the gender change for a malformation or genital defect could occur even after a few months or years after birth. There are theories of gender change to be possible even at the age of 5, decided by the court of Catania (Italy).

Minor’s gender change due to “Gender Dysphoria” (frequent)

99.3% of the cases of sex change of minors occur due to gender dysphoria, i.e., when one identifies himself/herself in the opposite sex compared to the biological one.

Gender identity (male or female) starts developing between the age of 2 and 4. And usually by the age of 5, the child has a certain degree of awareness to be able to not identify himself/herself with his/her own body.

Often, the minor and the parents start the psychotherapeutic or psychological process immediately, but wait until they reach 15-16 years of age before starting hormone therapy along with the legal process accompanied by an attorney.

Swiss studies have shown that after puberty the ability to perceive one’s own body can change (Ruth Baumann-Hölzle, specialized in social ethics).

Waiting until puberty is therefore a reasonable decision, considering that the capacity for self-determination strongly develops starting at the age of 16.

Minors with parental support

process-for-gender-rectification

The transition path of the child who has parental support is certainly easier and faster.

During the last years, thankfully, minors with gender dysphoria are increasingly obtaining parental support.

For the psychological path, the consent of only one parent is sufficient. But for the process in court, the consent of both parents (or the tutelary judge) is required.

The parent must initiate either a psychological or psycho-diagnostic process for the child/teen, all while requesting the assistance of private professionals or the national health system (psychologists or psychotherapists).

The purpose of the psychological path is to be able to :

  • explore their own identity and gender expression
  • support the recognition of their gender identity
  • validate feelings
  • involve their own family members

At the end of the psychological process (step 1), a “gender dysphoria diagnosis” must be made.

With the diagnosis of gender dysphoria, it is suggested to involve an endocrinologist in order to begin hormone therapy (step 2).

At the end of step 1 it is also highly advisable to contact a lawyer specialized in gender rectification, for the entire process in court (step 3).

The lawyer will then file an appeal to request the change of gender (MtF or FtM) and the change of name (from male to female or vice-versa).

In this case, the parents will be the ones to choose the attorney depending on:

  • Their skill as legal representatives of their minor child
  • Their parental authority over the minor child

Minors WITHOUT parental support

Gender-Transition-without-support-parents

Unfortunately, there are many cases in which parents do not recognize or do not want to recognize the gender dysphoria of their son or daughter. This unfortunately increases the discomfort of the child, already disoriented by the social environment.

This is a very delicate subject, where, first of all, the listening of the minor and the protection of his or her psycho-physical well-being should prevail over everything. Therefore, a parent who prevents this choice could cause damage to his or her son or daughter.

It is not easy for children to recognize gender dysphoria on their own, even if they are able to understand the divergence between their internal feelings and biological sex. And it is precisely for this reason, that it also becomes difficult to be able to seek external help if they already have family members who are distracted, disinterested, or, even worse, hostile to recognizing the child’s gender dysphoria.

In these cases, the suggestion is to always try to involve the most available family member and push him/her to seek psychological support. For those who have economic difficulties, the psychological path can also be supported by the national health system, free of charge.

What should the child lacking of parental support do?

In the most difficult cases, children without parental help may:

  • Talk about it at school (to a teacher or school psychologist)
  • call italian helpline (at the free number 19696)

Instead, for minors who are already able to look after their own interests independently, it is also possible to apply to the Juvenile Court of their own town for an appointment with a special guardian. In order to apply to the Juvenile Court, it is not necessary to have a lawyer. Within this court, it is possible to request to speak with a judge who will give the necessary and useful directions.

Authorization of the tutelary judge: how to do it?

The child who lacks parental support therefore has 2 alternatives:

  • To wait for the age of majority (18 years old), in order to act independently
  • Apply to a tutelary judge belonging to the Juvenile Court

To request authorization from the tutelary judge, these are the following steps:

  1. Contact the nearest Juvenile Court
  2. Request an appointment with a special guardian to appoint an attorney for the minor and to be able to request a technical consultation to officially confirm gender dysphoria
  3. File an appeal to another regular court in the place of residency to request gender reassignment and name change

The special caregiver (rather than the parent) will then seek and appoint a psychologist (step 1), an endocrinologist (step 2), and a lawyer (step 3).

The advice for those who have already reached the age of 16-17 years, is to wait until they reach the age of majority (18+).
It’s no secret that the procedure for requesting the authorization of the tutelary judge indeed requires a lot of time.

Gender change of the minor due to “Genital malformation” (rare cases)

changing-gender-for-genital-malformation

More rare are the cases of sex change of minors due to genital malformations or defects (0.7%).

In fact, every year, 1 out of 5,000 babies born has ambiguous genitalia at birth due to:

  • Genital malformation
  • Illnesses that cause genital malformations
  • Congenital anomalies in the genital tract

According to the law, the birth of a child must be declared within 10 days of the birth. In cases of genital malformation, it is possible that the sex declared does not correspond to the chromosomal sex nor to the one to be considered prevalent.

The uncertainty concerns the phenotypic sex, that is, the conformation of the external genitalia. In these cases, some tests (such as amniocentesis) could clarify the chromosomal sex, but the ambiguity of the genitals could have confused the doctors and also the parents.

Can a minor obtain a gender-change surgery?

gender change surgery

If the case involves genital malformation, the surgical operation could be performed upon the decision of the Hospital. In this case, it would not be considered as a surgery to change the gender from boy to girl or from girl to boy, but rather as a “corrective” operation of the malformation. This operation, can be performed at any age from 0 to 18 years.

But the case is different when it comes to gender dysphoria involving a minor.

First of all, the surgical operation must be authorized by the judge with a sentence (usually, with the same sentence that authorizes the gender rectification and name change). The sentence can be issued even before the age of 18 and, generally, in Italy, we have cases of authorization for surgery involving teens only after age of 16. Rarely, the possibility of surgery before the age of 16 can be done.

READ MORE: Read our article Sex change operation: Cost, procedure and useful info

Conclusions: Iter for gender change of minors

the-transition-of-minors

Let’s summarize the transition path of a minor.

First of all, you have to distinguish the cases for which the gender change is requested:

  • Genital Malformations. The parent can immediately (even after one month from the birth) contact a lawyer in order to ask for the rectification of the gender and the name wrongly declared and assigned at birth.
  • Gender Dysphoria (with parental support). At any age a psychological or psychotherapeutic process may initiate (step 1), to reach a diagnosis with gender dysphoria. Once a diagnosis of gender dysphoria has been made, a hormone therapy with an endocrinologist may be requested (step 2). A lawyer specialized in the process of gender rectification must be assigned in order to start the legal process in court (step 3).
  • Gender Dysphoria (WITHOUT parental support). The child must wait until he/she reaches the age of majority in order to start the transition journey autonomously. Or else they may contact the nearest Juvenile Court and ask to be assigned a caregiver.

I am an attorney who specializes in the gender rectification process, and over the past few years I have helped an infinite number of transgender minors change their gender and name on their documents.

FIND OUT MORE: If you want more information on the entire transition process, you can read my article How to change sex in Italy? Guide in 3+1steps

There are 3 ways you can CONTACT ME NOW for free and get more information:

  1. Write an email to: info@studiopiemonte.com
  2. Write on WhatsApp: to the number +393284878806 or by clicking on the WhatsApp icon in the bottom right corner
  3. submit a form from our CONTACT US page

Sex Reassignment Surgery: Cost, Procedure and Information

sex-reassignment-surgery

If you are looking for precise information on the operation for sex reassignment surgery (SRS) in Italy, you are in the right place.On this page you will be able to find all the essential information you need!

Gender reassignment surgery is one of the major concerns for those undergoing gender transition:

  • The clinical picture of some people does not allow the use of general anesthesia for the operation, due to pre-existing pathologies
  • There is a great amount of fear involved, of undergoing a genital demolition or reconstruction surgery
  • Some are afraid of not accepting themselves once they have a new physical aspect
  • The change of the physical appearance tied to primary organs is often considered unnecessary in order to realize one’s personality

Over 70% of transsexual people who have obtained gender reassignment surgery from MtF or FtM in Italy with my assistance do not undergo the operation for sex-change.

As a matter of fact, 98% of these transsexuals did not choose to undergo surgery during the first 3 years after the rectification of gender attribution obtained in Court.

The transition process includes 3 necessary roads and an optional fourth one (not compulsory):

  1. Psychological path, with a psychologist or psychiatrist
  2. Hormonal therapy, with an endocrinologist
  3. Legal process, with a lawyer
  4. Surgical operation (possible, but not mandatory)

I am Gianluca Piemonte, one of the very few lawyers specialized in Italy for what concerns sex-change, and I take extra care when it comes to giving assistance to point n. 3, that is, for the request to the Court to obtain the authorization of name and sex change on all documents.

However, on this particular page, I would like to go into detail on point n. 4, that is, on sex reassignment surgery.

If you would like to read the complete process, you can visit our page complete guide on How to change sex in Italy.

gender-dysphoria-surgery

Is sex-change without a surgical intervention possible?

Let’s start off with the first question that many of my clients ask themselves.

Is surgery necessary for sex-change? Is genital reassignment surgery required by law?

No, it isn’t. As previously mentioned, today it is not mandatory but optional to undergo the surgery.

Since 2015, the Italian Supreme Courts have decided that the surgical operation is no longer mandatory for what concerns sex-rectification and the name change on all personal documents.

What can be changed through surgery?

The transsexuals diagnosed with gender dysphoria, identify themselves with the opposite sex compared to the biological one and feel the deep desire to change their sexual characteristics. This can be distinguished between:

  • Primary sexual characteristics, which involve the genital and reproductive organs (penis and testicles in men, vagina and uterus in women)
  • Secondary sexual characteristics, which are differences which lie in the organs and systems that usually start appearing after puberty (breasts, menstruation, etc. in females; hair, greater muscle mass, lower tone of voice, etc. in males).

For a transsexual, undergoing surgery means allowing you to change primary sexual characteristics and secondary sexual characteristics (such as breasts). Whereas for changing other secondary sexual characteristics (such as muscles, hair and voice tone), hormonal treatment is sufficient.

When is the authorization of the Court necessary for undergoing surgery?

The surgical operation for changing the primary sexual character must be authorized by the Court with a sentence. As a matter of fact, art. 5 of the Italian Civil Code states the prohibition of acts of disposition of one’s own body, such as a transplant, a pregnancy interruption and, as far as we are concerned, sex-change.

During the last few years, authorization for surgery has been requested from the Court in conjunction with the request for the change of name and sex on the documents.

Therefore, surgery is the last step involved in the process of sex-change, as explained on the page complete guide on how to change sex in Italy.

At what age can a sex change be requested?

The question of age definitely creates a lot of confusion among people and parents who contact me willing to start the procedure. Here is a simple explanation of what is expected in Italy:

  • For gender reassignment (MtF or FtM) and name change, you can also be a minor. In fact, it has been possible on more occasions to change the sex of minors, of course with a more strict assessment by the experts of the Court and the judge
  • For what concerns the surgical operation of modification of the primary sexual characteristics (demolition or reconstruction) the ability to act is required, therefore it is necessary to be 18+
  • However, for the change of sex of minors it is necessary to consider other particularities and strategies to be used case by case

FIND OUT MORE: If you want more information, you can read my article Gender Change for minors.When is this possible?

What if I have already went through the operation?

Some people contact me after they have already performed the primary sexual characteristics surgery. This was possible if:

  • They have already had a ruling authorizing the surgery, but they did not ask for authorization to change their name and sex on the documents yet
  • The surgery was performed abroad and now they want to regularize the documents in Italy (both if they are Italian and if they are foreigners with an Italian citizenship or resident in Italy)

Obviously, also in this case it is possible to contact me to present the appeal to the Court and request the change of name and sex on all documents (identity card, passport, etc.). The advice is to start the procedure as soon as possible because these situations are the ones that can create greater problems in social, work, bureaucratic, etc. and relationship realms.

How do you ask the grant for the surgical operation?

Authorization to undergo surgery for the demolition or reconstruction of primary sexual organs must be requested with an appeal to the Court. The appeal can only be presented to the Court by a lawyer, because the person cannot defend himself/herself.

Generally, the lawyer asks for 3 authorizations through the same appeal:

  • Rectify the birth certificate with attribution of the opposite sex (from male to female, or vice-versa)
  • Change of personal name (first name), which does not necessarily have to be a masculine or feminine version of the previous name (for example it is not necessary to change your name from Alessandro to Alessandra, but you may choose a completely different one)
  • Undergo surgery to modify primary sexual characteristics

Where is the sex reassignment operation performed?

The operation can be carried out in Italy or abroad. In Italy, you can be followed by the public service of the National Health System (S.S.N.) or the private service. The differences between public and private services concern many aspects, but the main ones are:

  • waiting time, generally much shorter with the private service
  • cost of the operation for gender reassignment, much higher with the private service
  • protocol used. But the Italian private clinics, in general, require only the sentence for the primary sexual character operation. Whereas abroad, the protocols are much more flexible and simple

The main centers where you may carry out operations with the National Health Service are at:

  • BARI, Giovanni XXIII Hospital Polyclinic
  • BOLOGNA, S. Orsola and Malpighi Polyclinic
  • Etc.

The ONIG or WPATH protocols

Those choosing the public service, with the National Health System, are obliged to follow protocols, which in Italy can be:

  • ONIG: national protocol
  • WPATH: international protocol

Protocols are clinical guides, that professions must use during the transition process. This provides for the necessary steps and mandatory times involved. There is a lot of debate and criticism in the transgender community in regard to these two protocols.

In any case, those who follow this path are not obliged to follow the protocols that follow:

  • private psychologist
  • private endocrinologist
  • no operation or operation abroad

As a matter of fact, once the ruling authorizing the surgery has been obtained, the public hospital is also obliged to perform the operation. This is possible even if the transition process did not follow the ONIG or WPATH protocols (for example, for having carried out a transition path with a private psychologist and endocrinologist).

Sex-change surgical operation abroad

In this article we have talked about the sex-change operation in Italy, in which it is mandatory to respect the Italian law. As we have observed, for the man-to-woman (MtF) operation and the woman-to-man (FtM) operation it is necessary to have the authorization of an Italian court with a sentence.


The operation to change sex abroad, on the other hand, is not subject to Italian law, but to the law of the State in which the operation is carried out. The main foreign countries chosen for sex-change operations are:

  • SERBIA
  • SPAIN
  • GREAT BRITAIN
  • THAILAND

Sex-change operation cost

The cost of sex-change surgical operation with the private service is very high (from 10,000 euros for some interventions involving secondary sexual characteristics).
Needless shall I deny deny that this is the main reason why many decide to undergo operation abroad, where prices are even lower than 70%, but not everywhere.

In the United States, for example, the cost can be:

  • MtF operation, from 7,000 to 24,000 dollars (i.e. from 6,500 euros to 22,000 euros)
  • FtM operation, more than 50,000 dollars (i.e. more than 46,000 euros)

In Italy, on the other hand, the cost of a metoidioplasty operation can be around 13,000 euros in a private clinic.

Whereas in Thailand it can cost around 6,000 euros. Typically, the costs of operations range between 20,000 and 40,000 euros.

Instead, the surgical operation with the public service is free while other services are performed with fixed and controlled prices (i.e. fixed / blocked).
The choice to go abroad is also due to the long waiting times in Italy, due to the bureaucracy of the waiting lists. In recent years, however, the number of transsexuals requesting sex-change without surgery has increased. The choice of the operation is often left to a future date or is not really taken into consideration.

Surgical operation in a foreign country. How to get a refund?

The sex change operation (MtF or FtM) can also be performed abroad, in the countries of the European Union or outside the European Union.

Reimbursement of surgical expenses performed in European Union countries can be:

100% for operations in public hospitals (without advance payment by the patient)
80% for operations in private centers (with advance costs by the patient and reimbursement from the Italian state after making a request to the Local Health Authority – ASL)

While, the reimbursement of surgical expenses performed outside the European Union will be a maximum of 80% (with advance of the costs by the patient).

To get a refund, it is necessary to apply to the ASL and ask for more detailed information. In fact, each Italian region has different protocols.

In general, in order to obtain reimbursement, it is necessary to justify the reasons why that same operation must necessarily be performed abroad and not in Italy to the ASL.

Sex Reassignment Surgery: Conclusions

As you have been able to read on this page, the surgical operation (MtF or FtM) is no longer mandatory for sex-change, but only optional. If you choose to undergo surgical operation in Italy, the authorization of the Court with a sentence is mandatory. In Italy, you can therefore choose to operate with:

  • The public service of the National Health System, in which national (ONIG) or international (WPATH) protocols must be respected, with more bureaucracy, a longer waiting time and less costs
  • The private service, with less bureaucracy, higher costs and less waiting time

If you have already carried out the surgical operation (in Italy or abroad), all you need to do is consider the aspect of involving the Court for the rectification of personal documents.<

The transition path necessarily involves a legal process in court, in order to ask for authorization to:

  • Change sex / gender (from MtF or FtM) on all documents
  • Change name (from male to female or from female to male)
  • Eventually undergo operation

Whether you choose to operate or not, the assistance of a lawyer for the legal process in court will be necessary. Many people ask assistance from Italian centers for gender dysphoria and then are redirected to several law firms indicated by them.
However, it is not mandatory to choose among the lawyers indicated by these gender dysphoria centers. As a matter of fact, a possible option may be to choose a doctor indicated by these centers and a lawyer who has nothing to do in terms of connection with these centers.

I am an Italian lawyer specialized in the legal process for sex change and am not directly connected to gender dysphoria centers. Not to mention, I believe there is no reason why a clinical center should be tied to a lawyer.

I am available to personally follow your legal path in court by putting all my experience and knowledge of human rights and personality at your service. The legal process now involves electronic filing options and therefore I am able to assist you all throughout Italy, no matter in which Provenance.

Find out more on my page How to change sex? Complete guide.

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