Sex Reassignment Surgery: Cost, Procedure and Information

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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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