Gender surgery for minors in Italy: what the law says

In Italy, no minor undergoes gender-affirming surgery. This is a matter of fact, not opinion: Italian law, national and international clinical guidelines, and the established practice of specialized centers all agree in reserving surgical procedures exclusively for adults [1][4]. Yet, in Italian public discourse — fueled by sensationalist headlines and unfounded claims — the narrative persists that “children are being operated on to change their sex.” This claim is false, and it is important to explain why.

This article analyzes what Italian law actually provides, what clinical pathway exists for minors with gender dysphoria, what the leading international scientific authorities say, and how Italy fits within the European landscape. The goal is to provide verified and verifiable information to families, adolescents, healthcare workers, and anyone who wants to understand what is actually happening — and what is not happening — in Italy.

What Italian law says

Law 164/1982

Law 164 of April 14, 1982, titled “Rules on the rectification of sex attribution,” is the legal foundation of gender transition in Italy [1]. Article 3 establishes that the court, when it deems necessary an adaptation of sexual characteristics through medical-surgical treatment, authorizes it by ruling. This means that any surgical procedure aimed at sex reassignment requires judicial authorization.

For minors, the legal framework is even more restrictive. Law 164/1982 does not contain an explicit prohibition worded as “surgery is prohibited for minors,” but the combination of several factors makes it impossible, in practice, for a court to authorize surgical intervention on a minor:

• Judicial authorization is a mandatory prerequisite. The court evaluates the necessity of the intervention on a case-by-case basis, taking into account the applicant’s age, maturity, and the stability of their gender identity.
• Established case law records no instance in which an Italian court has authorized genital surgery or sex reassignment surgery on a minor.
• Italian clinical protocols, developed by ONIG (the National Gender Identity Observatory) and adopted by specialized centers, explicitly state that surgery is reserved for adults [14].

Constitutional Court ruling no. 221/2015

A fundamental development in Italy’s legal framework is ruling no. 221 of 2015 by the Constitutional Court [13]. With this ruling, the Court established that vital records sex rectification does not necessarily require surgical intervention: the right to gender identity is a fundamental right of the person, not contingent on surgical modification of sexual characteristics.

This ruling has a relevant implication for the topic at hand: if even for adults surgical intervention is not required to obtain rectification, all the more reason there is no legal basis for subjecting a minor to surgery.

The Gender Dysphoria Bill (2025)

Bill 2575, approved by the Council of Ministers on August 4, 2025, introduced new provisions on the administration of medications for gender dysphoria in minors [7][12]. The bill does not concern surgery — which remains precluded for minors as before — but addresses access to pharmacological treatments, introducing:

• mandatory multidisciplinary diagnosis;
• a national AIFA registry for the prescription and dispensing of medications;
• a mandatory preliminary opinion from the pediatric ethics committee;
• exclusive dispensing through hospital pharmacies.

Bill 2575 did not alter the legal framework governing surgery for minors in any way, simply because such surgery was not — and is not — being performed. The debate generated by the bill concerns exclusively access to puberty blockers and hormone therapy.

The actual clinical pathway for minors in Italy

A gradual and monitored approach

The gender affirmation pathway for minors in Italy follows a gradual, reversible, and multidisciplinary model, defined by ONIG protocols and consistent with the international guidelines of WPATH and the Endocrine Society [2][3][14]. This pathway does not include surgery before age 18 at any step. Here are the phases:

1. Psychological and psychotherapeutic support

The first step is always a thorough psychological evaluation, conducted by professionals with specific experience in gender identity. This pathway is not intended to “confirm” or “deny” the minor’s gender identity, but to support them in exploring their identity, managing distress, and involving the family. It has no age limit: it can begin in childhood or adolescence.

2. Social transition

Social transition — adopting a name, clothing, and gender expression consistent with one’s identity — is a completely reversible and non-medical step. It can occur at any age and does not require any pharmacological or surgical intervention. Many Italian schools offer the possibility of activating an alias career for students who request it.

3. Puberty blockers (Tanner stage 2-3)

Puberty blockers, in Italy typically triptorelin, can be administered starting from Tanner stage 2-3, meaning at the onset of pubertal development [5][11]. AIFA ruling no. 21756/2019 authorized the use of triptorelin under Law 648, covered by the National Health Service, for adolescents with a confirmed diagnosis of gender dysphoria by a multidisciplinary team [5].

Puberty blockers are a reversible intervention: they temporarily suspend the development of secondary sex characteristics, giving the minor more time to consolidate their identity without the pressure of unwanted bodily changes. When the medication is discontinued, puberty resumes its natural course.

4. Hormone therapy (from ages 16-18)

Hormone therapy with testosterone or estrogen can generally be initiated between ages 16 and 18, with informed consent from parents or legal guardians [3][14]. This is a partially irreversible intervention: some effects (such as voice deepening induced by testosterone) persist even after possible discontinuation.

5. Surgery (only after age 18)

Gender-affirming surgical procedures — which may include mastectomy (top surgery), vaginoplasty, phalloplasty, and other interventions — are reserved exclusively for adults. In Italy, access to surgery also requires court authorization under Article 3 of Law 164/1982 [1][4].

The principle of gradualism

The central principle of this pathway is gradualism: progress occurs in stages, from least to most invasive, from reversible to irreversible. Each phase requires a specific evaluation and informed consent appropriate to the patient’s age. Surgery sits at the last rung of this ladder, accessible only to adults who have completed a documented pathway.

Reversible and irreversible interventions: a fundamental distinction

In the public debate about gender dysphoria in minors, one of the most common errors is conflating very different interventions, treating them as if they were all equivalent. It is essential to understand the difference between reversible, partially reversible, and irreversible interventions.

Reversible interventions

• Social transition: adoption of a name, pronouns, and clothing consistent with gender identity. Completely reversible, no medical intervention.
• Puberty blockers (GnRH analogs, such as triptorelin): temporarily suspend pubertal development. Upon discontinuation, puberty resumes spontaneously [11]. The Endocrine Society classifies them as reversible [3].

Partially reversible interventions

• Hormone therapy (testosterone, estrogen): some effects — such as voice changes, beard growth, breast tissue development — may persist even after discontinuation. For this reason, hormone therapy is classified as partially reversible and requires more thorough informed consent [2][3].

Irreversible interventions

• Surgery: mastectomy, vaginoplasty, phalloplasty, hysterectomy, orchiectomy, and other surgical procedures are by definition irreversible. This is precisely why they are reserved for adults who have reached full capacity to provide informed consent and who have completed an adequate support pathway [2][3].

This distinction fundamentally dismantles the equation, often promoted in public discourse, that “transition in minors = surgical procedure.” In reality, the only interventions available to minors in Italy are reversible ones (social transition, blockers) and, at a later stage, partially reversible ones (hormones), always under strict medical supervision and with parental consent.

What international guidelines say

WPATH SOC-8

The Standards of Care Version 8 (SOC-8), published by the World Professional Association for Transgender Health in 2022, represent the most authoritative international reference for healthcare for transgender people [2]. Regarding surgery in minors, the SOC-8 recommend that:

• genital surgery (vaginoplasty, phalloplasty, orchiectomy, hysterectomy) be reserved for people who have reached the age of majority in their country;
• phalloplasty, given its complexity, not be performed before age 18 under any circumstances;
• possible exceptions for chest surgery (mastectomy) may be considered on a case-by-case basis, but only with parental consent and the recommendation of two qualified mental health professionals.

The SOC-8 repeatedly emphasize that every decision must be individualized and that adolescents are not a homogeneous group: the clinical pathway must account for the cognitive, emotional, and social maturity of each individual.

Endocrine Society

The Endocrine Society guidelines, published in 2017, provide specific recommendations on age thresholds [3]:

• Puberty blockers: from the onset of puberty (Tanner stage 2), with confirmed diagnosis and support from a multidisciplinary team.
• Hormone therapy: generally from age 16, although the age may vary depending on maturity and individual circumstances.
• Genital surgery: recommended only after age 18 or after reaching the legal age in the country of residence.
• Chest surgery (mastectomy for trans men): the Endocrine Society does not set a rigid minimum age, but recommends that the patient be fully able to understand risks and benefits. In practice, the majority of procedures occur after age 18.

International scientific consensus

Both the WPATH SOC-8 and the Endocrine Society guidelines converge on one point: gender-affirming surgery is not an appropriate treatment for minors, with the very limited exception of mastectomy in selected cases and in some countries. In Italy, not even this exception is applied.

The European Academy of Paediatrics, in its 2024 statement, reiterated that interventions for minors with gender dysphoria must follow a principle of gradualism and proportionality, favoring the least invasive approaches and reserving irreversible ones for adulthood [8].

The European comparison

The general rule: surgery after age 18

Italy is not an exception in the European landscape. The vast majority of European Union countries reserve gender-affirming surgery for adults [9]. According to data from the European Union Agency for Fundamental Rights (FRA), the minimum age to access sex reassignment surgery is set at 18 in Austria, Croatia, Denmark, Finland, Germany, Italy, Latvia, Lithuania, Poland, Portugal, Spain, and Sweden [9].

The mastectomy exception

Some European countries — particularly the Netherlands and France — allow, on a case-by-case basis, mastectomy (chest surgery, also called “top surgery”) starting at age 16 for transmasculine adolescents [9]. This is an exception limited to chest surgery and not extended to genital surgery, which remains reserved for adults even in these countries.

In Italy, this exception does not apply: mastectomy, like any other gender-affirming surgical procedure, requires court authorization under Law 164/1982 and is not authorized for minors [1][4].

Recent restrictions in Europe

In recent years, several European countries have adopted more restrictive approaches to treatments for minors with gender dysphoria, but it is important to clarify that these restrictions concern pharmacological treatments (puberty blockers and hormones), not surgery, which was already precluded for minors in nearly all cases:

• Finland (2020): restricted the use of puberty blockers to research settings.
• Sweden (2022): limited prescriptions of blockers and hormones to academic research centers only.
• United Kingdom (2024): the Cass Review led to the suspension of blocker prescriptions outside of clinical trials.
• Denmark (2024): strongly limited access to pharmacological treatments for minors.

None of these countries “banned surgery on minors” because surgery on minors was not being performed even before.

“Children are being operated on”: a myth to debunk

The origin of the narrative

The narrative that “children are being operated on to change their sex” is one of the most persistent and harmful myths in the gender dysphoria debate. This claim is entirely without factual basis, both in Italy and in the vast majority of Western countries [10].

The organization FactCheck.org documented in 2023 that prepubertal children receive no medical treatment for gender transition — neither pharmacological nor surgical [10]. The only possible intervention for children (not adolescents) is psychological support and, optionally, social transition.

Why this myth is dangerous

The spread of this false narrative produces concrete harm:

• It fuels fear in families of transgender adolescents, who may delay or avoid seeking specialist help out of concern their child will be “operated on.”
• It distorts the political debate, leading to legislative proposals based on false premises rather than scientific evidence.
• It stigmatizes transgender minors and their families, who are portrayed as victims or accomplices of extreme medical practices that do not exist in reality.
• It obscures the real needs of minors with gender dysphoria, who need psychological support, listening, and, in some cases, gradual and monitored pharmacological treatments.

The numbers in Italy

Available data confirm the extremely limited scope of gender dysphoria treatments for minors in Italy. Italian specialized centers collectively follow a few hundred minors, and the number who access puberty blockers is in the range of a few dozen per year — by some estimates, between 15 and 20 [6][11]. The number of minors who undergo surgery is zero.

Careggi hospital in Florence, which for years was the main reference center for transgender minors in Italy, saw its service significantly scaled back following the ministerial inspection of January 2024, with resulting difficulty in access for families who needed specialist support [6].

The role of Italian scientific societies

ONIG and Italian protocols

The National Gender Identity Observatory (ONIG) is the body that coordinates Italian centers dedicated to transgender people. ONIG protocols, consistent with the WPATH SOC, establish clear criteria for access to different levels of treatment and confirm that surgery is reserved for adults [14].

The 2025 inter-society statement

In December 2025, eight Italian scientific societies — including ONIG, SIGIS (Italian Society of Gender, Identity, and Health), SIE (Italian Society of Endocrinology), SIEDP (Italian Society of Pediatric Endocrinology and Diabetology), ACP (Cultural Association of Pediatricians), and FISS (Italian Federation of Scientific Sexology) — published a joint statement in response to Bill 2575. The societies reiterated that pathways for minors with gender dysphoria follow rigorous protocols, that no minor undergoes surgery, and that the available pharmacological treatments — puberty blockers and hormones — are administered only after careful multidisciplinary assessment and with parental consent.

The National Institute of Health

The National Institute of Health (ISS), in its 2022 document “Therapeutic Appropriateness for Transgender People,” confirmed the gradual intervention model for minors, reiterating that the pathway must proceed from least to most invasive and that surgery is not among the appropriate interventions for minors [14].

The pathway after age 18

For completeness, it is useful to explain what happens when a young transgender person reaches adulthood. Upon turning 18, the individual can:

• continue or begin hormone therapy without the need for parental consent;
• file a petition with the court to obtain vital records sex rectification under Law 164/1982;
• request judicial authorization for possible surgical procedures;
• access gender-affirming surgery, following clinical evaluation and court authorization.

It is important to emphasize that even after age 18, surgery is neither automatic nor mandatory. Many transgender people choose not to undergo any surgical procedure, and the Constitutional Court ruling no. 221/2015 confirmed that vital records rectification can be obtained even without surgery [13].

What this means for families

If you are a parent of an adolescent exploring their gender identity, or if you are a transgender adolescent, it is essential to know that:

• No one will operate on a minor. Gender-affirming surgery in Italy is reserved exclusively for adults. There is no clinical protocol, no guideline, and no judicial practice that provides for surgical procedures on people under 18.
• The pathway is gradual. It always starts with listening and psychological support. Each subsequent step — social transition, blockers, hormones — is optional, monitored, and requires informed consent appropriate to age.
• Blockers are reversible. If prescribed, puberty blockers temporarily suspend pubertal development. If discontinued, puberty resumes normally. They are not a “point of no return.”
• Time is an ally. The gradual model exists precisely to give the minor time to explore their identity without pressure and without irreversible interventions. Haste is not part of any serious clinical protocol.
• Seeking help is the right thing to do. Approaching a specialized center does not mean “starting a transition.” It means accessing professionals who can support the minor and their family in understanding what is happening and what options exist.

The specialized centers in Italy — such as those listed by ONIG and the Infotrans network — offer support pathways that respect each person’s timing [4]. Starting the pathway means, first and foremost, talking to someone who has the expertise to listen.

In summary

Gender-affirming surgery on minors is not performed in Italy. It is not performed by law, not by clinical practice, not by national and international guidelines. Claiming otherwise is spreading misinformation.

What exists for minors with gender dysphoria is a gradual support pathway: listening, psychological accompaniment, possible social transition, possible reversible or partially reversible pharmacological treatments — always with family involvement and under the supervision of specialized multidisciplinary teams.

Public debate on these topics should start from facts, not from fears. And the fact is that Italy, like the vast majority of European countries, has chosen a prudent, gradual, and minor-centered approach. An approach that reserves surgery — the irreversible intervention par excellence — for those who have reached adulthood and have had time to make an informed decision.