Forced Sterilization and Reproductive Rights of Trans People

For decades, in Europe, the State has imposed a condition on transgender people: to have their identity recognized, they had to give up the possibility of having children. An investigation by Investigate Europe has documented at least 11,000 people subjected to mandatory sterilization in six European Union countries between 1972 and 2025 [1]. It is a figure that the researchers themselves define as underestimated, because many states—including Italy—have never kept a national registry of these procedures.

This is the story of how the principle of bodily autonomy was denied to trans people, of who apologized and who did not. And of how the same logic is returning, in different forms, across the Atlantic.

Forced Sterilization in Europe: A Suppressed History

Sweden was the first country in the world to allow legal gender change, in 1972. The same law imposed sterilization as a mandatory requirement [1][5]. A person seeking recognition of their identity had to undergo the removal of their uterus and ovaries, or testicles, before being able to obtain documents consistent with their gender.

The Swedish model spread rapidly. In 2013, twenty-four European countries required sterilization—or procedures resulting in it—as a condition for the legal recognition of gender identity [7]. The methods varied. In Belgium, the Czech Republic, Germany, Finland, the Netherlands, and Sweden, the law set an explicit requirement of infertility [1]. In Slovakia, Norway, and Denmark, the obligation was imposed through guidelines or established practices, without a written rule [1]. In Cyprus, France, Greece, Italy, and Romania, judges verified that the person had completed gender reassignment surgery, which in practice entailed sterilization [7][11].

The testimonies collected by Investigate Europe convey the individual scale of what aggregated numbers fail to capture. In Finland, the gender identity law required the person to be “incapable of reproducing” until 2023. In the Czech Republic, the requirement was gonadectomy—the surgical removal of the gonads—maintained until June 2025 [1].

The Council of Europe, the Commissioner for Human Rights, and the UN Special Rapporteur on Torture have classified these practices as violations of the right to physical integrity and reproductive health [7].

The Italian Case: Law 164 and Thirty-Three Years of Ambiguity

Italy passed Law 164 on April 14, 1982, becoming one of the first European countries to regulate the process of rectifying registered sex. The text of the law did not explicitly mention sterilization. But for thirty-three years, Italian courts interpreted the norm as an implicit obligation to undergo the removal of reproductive organs before obtaining a change of documents [4][10].

Christian Cristalli underwent a hysterectomy in 2013, not by choice but as a judicial requirement. His words, collected by Investigate Europe: “I was forced to undergo the surgery” to obtain documents with his name [1].

The turning point came in 2015 with two converging rulings. The Court of Cassation, with ruling no. 15138, established that genital reassignment surgery is not an indispensable prerequisite for the rectification of civil status [2][10]. The Constitutional Court, with ruling no. 221, recognized “the right to gender identity as a constitutive element of the right to personal identity”, protected by Article 2 of the Constitution and Article 8 of the European Convention on Human Rights [2]. The Court specified that surgical treatment must not be a prerequisite, but a possibility left to the free determination of the individual [2][10].

In 2018, the European Court of Human Rights condemned Italy for violating Article 8 of the ECHR, in a case where a trans woman had been denied the rectification of her civil status for not having completed the surgery—despite the domestic rulings of 2015 [4].

The remaining problem is quantitative. Italy does not have a national registry of sterilization procedures performed on trans people as a requirement for legal recognition. The only partial data available document 232 interventions at the Urological Clinic of Trieste between 1994 and 2013 [1]. The true number, on a national scale and over a time span of thirty-three years, is unknown. ISTAT (the Italian National Institute of Statistics) has never published statistics on the matter.

Who Apologized, Who Did Not

Sweden was the first country to acknowledge the harm caused. In March 2018, the Swedish parliament approved compensation for people subjected to forced sterilization in the application of the gender identity law: about 530 people received 225,000 Swedish kronor each, equivalent to approximately 20,000 euros [5]. RFSL, the main Swedish LGBTQ+ organization, also requested a formal apology from the State, in addition to financial compensation [5]. Some of the people involved stated they preferred an apology to the money. As one of them said: “The apology is what somehow restores my human dignity” [5].

The Netherlands followed in 2020. The government acknowledged that the sterilization requirement constituted “a violation of bodily autonomy” and allocated a compensation of 5,000 euros for each of the 1,259 people who requested it [1].

Italy has never offered official apologies or compensations. The government has not established inquiry commissions. Italian individuals who were sterilized as a condition to obtain their documents have received no formal recognition of the wrong suffered.

As of 2025, twelve European countries still require sterilization or impose medical requirements that the Council of Europe qualifies as abusive: Bosnia and Herzegovina, Cyprus, Kosovo, Latvia, Liechtenstein, Montenegro, Romania, San Marino, Serbia, Slovakia, and Turkey [6]. At the opposite end, ten European countries have adopted self-determination models that require no medical prerequisites: among them Argentina (a global pioneer since 2012), Belgium, Denmark, Germany, Ireland, Luxembourg, Malta, Norway, Portugal, and Spain [6].

The ECHR Ruling: The Insoluble Dilemma

On April 6, 2017, the European Court of Human Rights issued the ruling that redefined the European legal framework on trans sterilization. In the case of A.P., Garçon and Nicot v. France, the Court ruled unanimously that the French requirement to undergo a sterilizing operation to obtain the rectification of sex on the civil registry violated Article 8 of the Convention—the right to respect for private life [3].

The Court’s reasoning focused on what it defined as an “insoluble dilemma”: French legislation forced transgender people to choose between giving up the full exercise of their right to physical integrity, by undergoing an unwanted surgical operation with irreversible consequences on their reproductive capacity, or giving up the recognition of their gender identity [3].

The Court held that subordinating the recognition of gender identity to the permanent relinquishment of reproductive capacity amounts to conditioning the enjoyment of one fundamental right on the renunciation of another fundamental right [3]. The established principle is clear: no State can impose sterilization as a price for the legal recognition of identity.

One aspect of the ruling has been subject to criticism by trans rights organizations: the Court confirmed the legitimacy of requiring a diagnosis of “transsexual syndrome” and the possibility for States to mandate medical examinations [3]. Legal recognition thus remains anchored to a medical model, even if freed from the surgical obligation.

From the US to Europe: The Same Logic, New Forms

The connection between abortion restrictions and those on trans rights in the United States is not a coincidence: it is a strategy. As Ms. Magazine documented, “both cases are about banning a medical treatment vital for the self-determination of a portion of the population. In both cases, conservative lawyers argue that the Constitution’s protections do not apply” [8].

The same organizations are leading both battles. The Alliance Defending Freedom (ADF), designated as an anti-LGBTQ+ hate group by the Southern Poverty Law Center, helped draft both the Mississippi abortion law at the center of the Dobbs case and the anti-trans sports laws adopted in over 22 states [8]. The Heritage Foundation, through Project 2025, has outlined an agenda that includes both restricting access to abortion and dismantling protections for LGBTQ+ people [8].

The legal thread is direct. In 2022, the US Supreme Court decided Dobbs v. Jackson Women’s Health Organization, eliminating the federal right to abortion and returning the matter to the discretion of individual states. In 2025, in the case of United States v. Skrmetti, the same Court applied similar reasoning to gender-affirming care for minors: Tennessee defended its ban (Senate Bill 1) by explicitly citing Dobbs, arguing that restricting access to a medical procedure falls within legitimate state discretion [8][9].

The Center for American Progress noted that Skrmetti “is about bodily autonomy for everyone”, not just trans people [9]. The organization Reproductive Freedom for All called the ruling a decision that “undermines the rights and bodily autonomy of the LGBTQIA+ community” [13]. The analysis by the State Court Report highlighted that, post-Dobbs and Skrmetti, state courts have become the main battlefield for both reproductive rights and transgender rights [14].

Tennessee is the epicenter of both waves. It is the state whose law banning trans care for minors was upheld by the Supreme Court in Skrmetti. It is the same state where, in February 2026, a bill (HB 570) proposed classifying abortion as homicide, with an amendment that would have introduced the death penalty. The geographical coincidence is not accidental: it reflects a legislative ecosystem where restrictions on bodily autonomy mutually reinforce each other.

Italy Today: What Is Missing

In Italy, the framework of reproductive rights for trans people presents specific gaps that no reform has yet filled.

Medically assisted reproduction (PMA) is regulated by Law 40 of 2004, which allows access exclusively to married or cohabiting heterosexual couples. A couple consisting of a trans man and a cisgender woman could theoretically access it, but in practice, bureaucratic and cultural barriers remain significant [12].

The cryopreservation of gametes—eggs or sperm—before starting hormone therapy is recommended by all major international guidelines, including the WPATH Standards of Care (version 8) [12]. But in Italy, the cost of cryopreservation is not covered by the National Health Service (SSN) for trans people, unlike what happens for oncology or endometriosis patients [12]. A 2023 systematic review analyzing 76 studies found that about 50% of trans people express the desire to have biological children, but only 9.6% of trans women and 3.1% of trans men actually proceed with gamete preservation [15]. Cost is the main barrier.

Surrogacy (GPA) was made a universal crime by Law 169 of 2024: it is now criminally prosecutable even if performed abroad. The law disproportionately affects same-sex couples and trans people.

The gender dysphoria bill, approved by the Meloni government, adds another layer of complexity. By introducing a national registry of trans minors and making access to care conditional on the approval of an ethics committee, the bill risks delaying access to care and, consequently, to the fertility preservation counseling that should accompany it.

The Thread That Connects It All

Forced sterilization in Europe and the new legislative restrictions in the United States are different expressions of the same principle: the State deciding what a person can do with their own body. For decades, the price of legal recognition was giving up reproductive capacity. Today, the ban on medical care for trans minors and abortion restrictions share the same legal architecture and organizational networks.

These are the numbers: 11,000 people sterilized in six European countries [1]. Thirty-three years of an implicit mandate in Italy, removed in 2015 but never compensated [2][4]. Twelve European countries that in 2025 maintain abusive requirements [6]. In the United States, 27 states with bans on care for trans minors after Skrmetti [9], and a documented intertwining between the organizations promoting both abortion restrictions and those against trans rights [8].

The 2017 ECHR ruling established that no one can be forced to choose between the right to identity and the right to physical integrity [3]. But between the legal principle and its full application lies a space where trans people continue to navigate a system that, in different forms, places conditions on the recognition of their existence.