[5][7][8][9] As of November 2024, 21 countries have enacted laws allowing gender self-identification without requiring judicial or medical approval: Argentina, Belgium, Brazil, Chile, Colombia, Costa Rica, Denmark, Ecuador, Finland, Germany, Iceland, Ireland, Luxembourg, Malta, New Zealand, Norway, Pakistan, Portugal, Spain,[10] Switzerland and Uruguay.
[23][24][25] A 2018 study published in BMC International Health and Human Rights found that "the majority of countries from South America allow their transgender citizens to change name and gender in legal documents in a fast, easy, and inexpensive manner" and noted that "legislation to protect [sexual and gender minority] rights in South America underwent fundamental and positive transformations" during the 2010s.
It concluded that "a more institutionalized group played a major role in getting the issue on the agenda, while a more radical challenger coalition was crucial in developing and advancing the ground-breaking content.
[31] On March 1, 2018, the Supreme Federal Court ruled that transgender individuals have the right to change their official name and sex based solely on self-declaration of their psychosocial identity.
On June 29, 2018, the Corregedoria Nacional de Justiça, a body of the National Council of Justice, published regulations for registry offices to follow regarding this process.
[38][39] Nova Scotia adopted an affidavit process in 2019,[40] and in 2022, British Columbia removed the medical letter requirement for adults seeking legal gender changes.
[41] As of October 2021, Alberta, British Columbia, Prince Edward Island, Ontario, Saskatchewan, and all territories do not permit legal gender changes for those born outside of their jurisdictions.
For individuals over the age of 18, the change is made by submitting a request to the Civil Registry and Identification Service without needing to provide evidence of medical interventions.
The law enshrines key principles, including non-pathologization, protection from arbitrary discrimination, confidentiality, dignity in treatment, the best interests of the child, and recognition of progressive autonomy.
[46][47] In 2016, a bill was introduced to Costa Rica's Legislative Assembly to allow transgender individuals to legally change their name and gender without requiring surgery or judicial permission.
In January 2018, following a ruling by the Inter-American Court of Human Rights and the 2018 Costa Rican general election, President Carlos Alvarado Quesada issued an executive decree mandating that all state institutions allow transgender individuals to modify their documents and internal records, including passports, driving licenses, ID cards, work permits, university identifications, based on self-declaration.
[56] Under its provisions, individuals only need to notify the Civil Registry of their wish to update the gender information on their birth certificates, without requiring sex reassignment surgery, psychological therapy, or any medical diagnosis.
The Act allows changes based on an affidavit and introduced a third, non-binary gender marker for California birth certificates, driver's licenses, and identity cards.
[93][94] Under the Transgender Person (Protection of Rights) Act 2018 (Urdu: مُتَجَنَّس افراد کے لیے (تحفظ حقوق) قانون 2018ء), Pakistanis are allowed to self-identify their gender as male, female, both, or neither.
[95] As of November 2024, 12 countries have established legal gender recognition procedures based on self-determination: Belgium, Denmark, Finland, Germany, Iceland, Ireland, Luxembourg, Malta, Norway, Portugal, Spain and Switzerland.
"[96] In 2017, the Belgian federal parliament passed a law enabling individuals to change their legal gender through a statutory declaration, without requiring medical intervention.
The proposed legislation would grant transgender people over the age of 18 the right to change their legal gender based on self-determination, without requiring medical intervention.
[109] In June 2014, the Danish Parliament voted 59–52 to remove the requirement for a mental disorder diagnosis and surgery with irreversible sterilization for legal gender changes.
[110] Since 1 September 2014, Danes aged 18 or older can apply for a legal gender change by stating their intent, followed by a six-month "reflection period" to confirm the request.
[121][122] In 2015, the Löfven Government introduced a bill allowing legal gender changes without psychiatric or psychological evaluation or diagnosis, and without medical intervention.
[10] In May 2018, the Swiss Federal Council proposed an amendment to allow transgender individuals to change their registered gender and first name(s) without "red tape", requiring only a declaration to civil status registry officials.
However, this is not equivalent to gender self-identification, and the Act permits providers of sex-segregated services to exclude transgender individuals on a case-by-case basis if it constitutes "a proportionate means of achieving a legitimate aim.
[178] A 2019 paper in International Journal of Environmental Research and Public Health reported that legal gender recognition frameworks based on medicalization can have negative effects on transgender and intersex individuals.
The study also noted that many countries permitting gender marker changes impose abusive requirements, such as forced or involuntary surgery, medical diagnoses, and lengthy, costly judicial procedures.
[26] A 2017 study in Critical Social Policy reported that legal requirements based on trans-related diagnoses may inadvertently reintroduce surgical and hormonal practices as prerequisites, acting as gatekeepers to healthcare services and citizenship rights.
[180] Sex/gender self-determination has entered the international public consciousness due to media commentary, governmental debates, and rapid legal and policy changes regarding trans and intersex individuals in law and medicine.
[181] A 2020 study from the University of Bristol found that allowing legal gender changes without requiring medical diagnosis or treatment could significantly improve the experience of older transgender individuals transitioning later in life.
[182] A 2021 study in Labour Economics demonstrated that the removal of surgical requirements for legal gender recognition is associated with a 9–20% increase in the employment rate for female-to-male transgender individuals.
Positivity around Denmark's law was mitigated by reforms centralizing transgender healthcare under the Sexological Clinic at Copenhagen’s National Hospital, effectively creating a monopoly on treatment authorization.
[189] A 2021 paper in the Journal of Human Rights reported that in India, many authorities claim ignorance of legal processes, denying transgender individuals' applications for identity documents due to procedural misunderstandings.