If you are in Italy and considering gender-affirming surgery, it’s easy to feel overwhelmed: paperwork, courts, doctors, timelines… Sometimes you’re not even looking for “legal information” as such—you simply want to understand what depends on the law and what depends on the healthcare system, so you can make decisions calmly.
In Italy there is no comprehensive Trans Law like the one in Spain. What exists instead is a law regulating gender recognition, known as Law 164/1982.
Gender Recognition Procedure in Italy
In Italy, gender recognition is possible, but it must go through a judicial process. Italian law establishes that gender rectification is carried out by means of a court ruling. This means it is not a quick administrative procedure like in Spain, but rather a lengthy process that may vary depending on the region and the individual case.
Surgery is not mandatory to change legal gender
This is one of the most common—and understandable—questions. For years, it was assumed that “to change legal sex, you must undergo surgery.” In current legal practice, that idea no longer holds as a general rule.
The Constitutional Court, in ruling 221/2015, made it clear that surgery cannot be considered an indispensable requirement for legal gender recognition in all cases, and that each person should be able to build their own path with clinical support, without a single intervention acting as a mandatory toll.
“Carriera alias” for transgender students
The term “carriera alias” refers to a protocol used in schools and universities that allows transgender or non-binary students to use a chosen name that matches their gender identity in internal documentation and email accounts. This can be very helpful in everyday life, but it does not equate to legal gender recognition and is not applied uniformly everywhere.
Specialized healthcare for transgender people
Italy provides access to transition-related healthcare through both public and private systems. However, there is a significant difference between what is “possible” on paper and what is truly “accessible” in practice. When the goal is surgery, this gap becomes much more evident due to long waiting lists.
Limitations in Gender Affirmation in Italy</
The issue is not so much what can or cannot be done in Italy in terms of gender affirmation, but whether the process is easier, more manageable, or more complex.
The judicial route still sets the pace
The fact that legal recognition depends on the courts often means more steps and greater uncertainty. If you have decided to pursue gender-affirming genital surgery such as vaginoplasty or phalloplasty, the lack of coordination or the need to follow steps without a clear timeline can be emotionally draining.
The system remains binary
In 2026, the Italian civil registry framework still remains focused on male/female categories. Ruling 143/2024 is relevant because it declares inadmissible the proposal to introduce a “third gender” through that route, while at the same time considering partially unconstitutional certain rigid requirements for judicial authorization of surgery in specific cases.
Transgender minors
Between 2025 and 2026, there has been debate and legislative activity aimed at tightening access to medications for transgender minors. Requirements have increased, protocols have become stricter, and registration and supervision have been reinforced. For many families, beyond political opinions, this translates into a sense of a less stable and more closely monitored framework.
Gender-Affirming Surgery
When your priority is to undergo certain types of trans surgery – whether genital surgery or mastectomy – the question stops being only “what does the law allow?” and becomes much more practical: How accessible is the real path?
In Italy, there are specialized units within public hospitals (for example, teams such as SAIFIP in Rome or CIDIGEM in Turin), and in several centers surgery may be covered by the National Health Service.
The delicate issue is time: waiting lists exist and vary by center and technique. Another important factor is the type of technique used. For example, in trans vaginoplasty, many centers offer penile inversion as the only technique. If that is not the most suitable option for you, it may have long-term consequences.
Traveling from Italy to Spain for Gender-Affirming Surgery
Spain is widely recognized as having one of the most advanced legal frameworks in Europe regarding LGTBI+ rights. This is evident not only at a theoretical level, but also socially: there is a more normalized culture around diversity, active community organizations, and a network of healthcare professionals with experience and training in gender-sensitive care. For this reason, traveling to Spain for gender-affirming surgery can be an excellent option.
In addition, in the surgical field, Spain brings together teams with extensive experience and international recognition in gender-affirming surgery—an especially important factor for those traveling from abroad and prioritizing technical quality, continuity of care, and follow-up. In this context, IM GENDER stands out as one of the most advanced and experienced teams in Europe.
The IM GENDER Experience
IM GENDER is a clinic specialized in gender-affirming surgery that opened its doors in 1999 and is an international reference in genital surgery. Here is everything you need to know about the clinic and the process for gender-affirming surgery:
1) Online or in-person assessment
You choose. The first visit – aimed at understanding your situation and goals, reviewing your medical history (general health, previous surgeries, medication), and discussing options, limits, and expectations clearly – can be done online, without the need to travel to Barcelona. If you prefer a face-to-face first contact, you can also request an in-person assessment.
2) Detailed planning of your stay
Gender-affirming surgery may be genital (vaginoplasty, phalloplasty), body-related (trans mastectomy, body contouring, rib remodeling when indicated), or facial (facial feminization). Each procedure requires different planning, and if you are traveling from Italy, it also involves organizing accommodation, follow-up visits, and recovery time with sufficient margin.
3) The importance of information
Making a calm decision is only possible if you feel you truly understand the process. At IM GENDER, information is explained thoroughly and in clear language, supported by guides, FAQs, and well-structured materials covering preoperative care, surgery, and postoperative recovery.
4) The reassurance of proper support
Peace of mind often comes from professional support. Having a point of reference who speaks your language, helps you through the process, explains each step, and a team that understands what you are going through provides real security. At IM GENDER, support begins from the first contact and continues throughout hospitalization and recovery—even once you are back home.
5) A specialized team
IM GENDER has more than 25 years of experience and over 4,000 gender-affirming surgeries performed. The approach is individualized: there is no single technique for everyone, but rather options adapted to your anatomy, goals, and health.
What sets us apart is not only the surgical team: specialized nursing (ANP), physiotherapy, psychology, and patient care are all highly specialized in gender-affirming healthcare.
6) Guided postoperative care
Postoperative care is an essential part of gender-affirming surgery. You will have access to a 24/7 emergency phone line, a direct communication channel for questions, and a team closely monitoring your progress. Follow-up is structured and maintained for at least the first year, with regular check-ups and clear guidelines to support a safe recovery.
7) Autonomy in decision-making
Medical decisions are made with you, through transparent communication about expectations and outcomes, and professional and human support based on trust and empathy.
If you live in Italy and are considering gender-affirming surgery, request an online assessment with the IM GENDER medical team to explore all your options.
