An 'open wound': Europe's trans community reckons with decades of sterilisation requirements
Spoovio/Fanis Kollias
Thousands of trans people across Europe were pushed towards invasive surgery under national ‘sterility’ laws, exclusive Investigate Europe analysis reveals.
The bold black “M” on Alexandra’s ID card was more than a relic of a past life. It was the final barrier to full societal acceptance. “I didn't want to live a life registered by the state as a man when I look the way I look, and society treats me as a woman anyway,” she recalls.
The fear of being outed was constant. At the doctor’s, would they call out “Mr” in front of everyone again? At a hotel, would the receptionist do a double take? The only escape was to change the male marker on her documents through legal gender recognition. And in the Czech Republic, that meant being compulsorily sterilised.
At 22, she had been taking the testosterone blocker Androcur for years but had decided against surgery. It felt too risky, too onerous. The drugs already likely made her infertile, she says. But the 2012 Czech Specific Health Service Act was exacting: trans people were defined as those who had “surgery while disabling reproductive function.” To comply, Alexandra reluctantly underwent an orchiectomy in 2022. The 30-minute, generally low-risk procedure, which removes one’s testicles, went well. But as the days passed, the pain didn’t subside, it worsened.
One week on, dozing at home in Pilsen, she woke up in agony, surrounded by blood. She had developed an infection. “The wound had burst. There were pieces of hematoma and pus around me.” She rushed back to hospital, where she says staff began probing her with no anaesthetic. “It was the worst pain of my life.” She spent two months recovering, bed-ridden for weeks.
Alexandra, now 25, may have been unlucky to fall ill. But the bureaucracy that pushed her to the operating table wasn’t unique. For decades, legally changing your gender in much of Europe required invasive procedures or hormones that left you sterile - regardless of whether you wanted them.
The fear of being outed was constant. At the doctor’s, would they call out “Mr” in front of everyone again? At a hotel, would the receptionist do a double take? The only escape was to change the male marker on her documents through legal gender recognition. And in the Czech Republic, that meant being compulsorily sterilised.
At 22, she had been taking the testosterone blocker Androcur for years but had decided against surgery. It felt too risky, too onerous. The drugs already likely made her infertile, she says. But the 2012 Czech Specific Health Service Act was exacting: trans people were defined as those who had “surgery while disabling reproductive function.” To comply, Alexandra reluctantly underwent an orchiectomy in 2022. The 30-minute, generally low-risk procedure, which removes one’s testicles, went well. But as the days passed, the pain didn’t subside, it worsened.
One week on, dozing at home in Pilsen, she woke up in agony, surrounded by blood. She had developed an infection. “The wound had burst. There were pieces of hematoma and pus around me.” She rushed back to hospital, where she says staff began probing her with no anaesthetic. “It was the worst pain of my life.” She spent two months recovering, bed-ridden for weeks.
Alexandra, now 25, may have been unlucky to fall ill. But the bureaucracy that pushed her to the operating table wasn’t unique. For decades, legally changing your gender in much of Europe required invasive procedures or hormones that left you sterile - regardless of whether you wanted them.
Alexandra is one of thousands of trans people across Europe that were subjected to sterilisation requirements.Jan Kubice
Thousands ‘forced to choose between human rights’ by sterility rules
Fertility was considered the natural sacrifice of physical gender transition, the price one simply had to pay. In practice, across much of Europe, this often meant undergoing a gonadectomy, a term that covers both hysterectomies and orchiectomies.
Elected officials in Belgium, the Czech Republic, Germany, Finland, the Netherlands and Sweden explicitly wrote infertility requirements into the law. The first was introduced in Sweden in 1972, and stayed in place for 40 years. The last to go, the one affecting Alexandra, was only phased out at the end of June this year.
At least 11,000 people were subjected to such conditions in these six countries, Investigate Europe can reveal in a first cross-border estimate based on previously unreported official figures compiled with 10 media partners.
This data, which was gathered from ministries, court records and academic studies obtained in part by freedom of information requests, hints at the broad reach of a policy that was repeatedly condemned by UN experts and the European Court of Human Rights, but long remained reality.
The true toll of people affected by these practices to access legal gender recognition, now widely accepted as a right in most of the EU, could be much higher.
Spoovio/Georgina Choleva
The Slovakian Health Ministry imposed official guidance in 1981 to the same effect, and in Norway and Denmark it was de facto policy too. In other countries - Cyprus, France, Greece, Italy and Romania - judges demanded proof of surgical intervention likely if not certain to leave one sterile. Reliable data was only available for the six countries used for the estimate, and even then was in some respects incomplete.
Sterilisation requirements have forced trans people to “decide between two of their own human rights – the right to bodily integrity or freedom from unwanted medical interventions, and the right to privacy or recognition before the law,” says Cianán Russell (they/them) of LGBTQ+ advocacy group of ILGA-Europe.
“If one must ‘choose’ to be subjected to a medical procedure to be able to live safely and freely - for example, to open a bank account or apply for a job - then the medical procedure isn’t a choice at all,” they stressed.
Legal gender recognition is technically voluntary, but life without it can be untenable. From healthcare to housing, to job-seeking, freedom of movement and residency rights, documents matter.
Alexandra agrees: “I didn't make the decision because I wanted to, I needed to… It was a question of having the same rights, essentially, as other women around me.” She is among some 1,800 people who obtained legal gender recognition between 2012 and 2025, according to figures from the Czech Ministries of Health and Interior obtained in part via freedom of information requests.
In Germany, court records and Justice Ministry figures indicate that more than 5,000 people officially changed their gender entry between 1980 and 2011, when laws required them to show they were “permanently unable to reproduce.”
Sterilisation requirements have forced trans people to “decide between two of their own human rights – the right to bodily integrity or freedom from unwanted medical interventions, and the right to privacy or recognition before the law,” says Cianán Russell (they/them) of LGBTQ+ advocacy group of ILGA-Europe.
“If one must ‘choose’ to be subjected to a medical procedure to be able to live safely and freely - for example, to open a bank account or apply for a job - then the medical procedure isn’t a choice at all,” they stressed.
‘In effect compulsory’
Legal gender recognition is technically voluntary, but life without it can be untenable. From healthcare to housing, to job-seeking, freedom of movement and residency rights, documents matter.
Alexandra agrees: “I didn't make the decision because I wanted to, I needed to… It was a question of having the same rights, essentially, as other women around me.” She is among some 1,800 people who obtained legal gender recognition between 2012 and 2025, according to figures from the Czech Ministries of Health and Interior obtained in part via freedom of information requests.
In Germany, court records and Justice Ministry figures indicate that more than 5,000 people officially changed their gender entry between 1980 and 2011, when laws required them to show they were “permanently unable to reproduce.”
“I didn't make the decision because I wanted to, I needed to… It was a question of having the same rights, essentially, as other women around me.”
— Alexandra, Czech Republic
It is impossible to know how each person granted legal gender recognition under such conditions felt. Many trans people actively seek to change their bodies in ways that will certainly or probably leave them infertile. Some choose to first preserve gametes - eggs or sperm - to use later in assisted fertility.
For many, gonadectomies, vaginoplasty and less frequently phalloplasty are part of desired bodily transition. Hormone treatments used to modify one’s voice, body hair and the presence of breasts are also associated with fertility loss. Generations of trans people have fought to safely and affordably access such treatment, a battle that is still ongoing.
But a significant minority, like Alexandra, do not want so-called bottom surgery, which is expensive, invasive and comes with life-long impacts. One US survey in 2011 suggested that 21 per cent of trans men had no desire for a hysterectomy and 14 per cent of trans women did not want an orchiectomy. Non-binary people, who feel neither strictly male nor female, report being even less interested.
Christian Cristalli’s 2013 hysterectomy had nothing to do with his own vision for his body and everything to do with conditions imposed by Italian judges. “I had top surgery - a mastectomy - willingly, because I wanted it,” he said. “I wanted to change my body in a way that made me feel good.”
“The removal of my uterus and ovaries wasn’t part of my personal path. I was forced to undergo it in order to be granted documents with my new name,” the 37-year-old explains. “If the first operation brought me joy and liberation, the second remains an open wound.”
He tried desperately to avoid it, petitioning local officials in his city Bologna with a photo of himself with a moustache and beard. He would have even accepted keeping the female “F” marker on his ID card, he says, but as graduation approached, he saw no other way to ensure the name “Christian” was used on his diploma. His birth name would have outed him as trans to his entire social circle and any future employer.
Cristalli, today a local activist, feels he and others were forced into sterilisation. Two years after his procedure, Italy’s Constitutional Court struck down surgery requirements. “It was a state-imposed act meant to reassure the system that I could never father children, to preserve the so-called natural order.”
For many, gonadectomies, vaginoplasty and less frequently phalloplasty are part of desired bodily transition. Hormone treatments used to modify one’s voice, body hair and the presence of breasts are also associated with fertility loss. Generations of trans people have fought to safely and affordably access such treatment, a battle that is still ongoing.
But a significant minority, like Alexandra, do not want so-called bottom surgery, which is expensive, invasive and comes with life-long impacts. One US survey in 2011 suggested that 21 per cent of trans men had no desire for a hysterectomy and 14 per cent of trans women did not want an orchiectomy. Non-binary people, who feel neither strictly male nor female, report being even less interested.
Christian Cristalli’s 2013 hysterectomy had nothing to do with his own vision for his body and everything to do with conditions imposed by Italian judges. “I had top surgery - a mastectomy - willingly, because I wanted it,” he said. “I wanted to change my body in a way that made me feel good.”
“The removal of my uterus and ovaries wasn’t part of my personal path. I was forced to undergo it in order to be granted documents with my new name,” the 37-year-old explains. “If the first operation brought me joy and liberation, the second remains an open wound.”
He tried desperately to avoid it, petitioning local officials in his city Bologna with a photo of himself with a moustache and beard. He would have even accepted keeping the female “F” marker on his ID card, he says, but as graduation approached, he saw no other way to ensure the name “Christian” was used on his diploma. His birth name would have outed him as trans to his entire social circle and any future employer.
Cristalli, today a local activist, feels he and others were forced into sterilisation. Two years after his procedure, Italy’s Constitutional Court struck down surgery requirements. “It was a state-imposed act meant to reassure the system that I could never father children, to preserve the so-called natural order.”
Christian Cristalli says that the sterilising surgery he underwent in 2013 was imposed on him by Italian authorities.
Overall, reporters spoke to more than a dozen people with stories like Alexandra’s and Cristalli’s. At least three interviewees said they were not properly informed about the possibility of preserving gametes beforehand and later realised to great sadness that they had restricted their parenthood options. Several suffered serious health complications.
Others were simply angry, haunted by the question of why the state insisted that their bodies be so radically altered as to rule out procreation, and the injustice left for the most part unacknowledged.
The first infertility clauses in Sweden, the Netherlands, and Germany, dated back to the 70s and 80s and were justified in terms of family law. The logic was that a child must have a father who was a legal man and a mother who was a legal woman, according to legal scholar Peter Dunne. Anything else would unleash chaos and possibly present child protection concerns. In the decades that followed, other countries adopted similar policies, often without questioning whether they were truly necessary.
Joz Motmans of Ghent University Hospital believes Belgium's 2007 law stemmed from misguided binary thinking rather than malice. “The whole idea of what they called transsexualism was that a person was born in the wrong body,” the psychologist explains. “That was what medical practitioners did: They helped the person to correct the body.” Those “corrections” were perceived to mean inevitably giving up your chance to have children.
Motmans, who is himself trans, witnessed the legislation’s birth firsthand some twenty years ago, sitting in on sessions in the Belgian Parliament as a PhD student. He still recalls his shock at the proposal that applicants be “no longer able to conceive children in conformity with their previous sex.”
One lawmaker, when challenged by activists, exposed a lingering fear of trans procreation. “You could get into a situation where a man could bear a child and a woman could sire one," Hilde Vautmans, a center-right politician who helped spearhead the law, said at the time.
Others were simply angry, haunted by the question of why the state insisted that their bodies be so radically altered as to rule out procreation, and the injustice left for the most part unacknowledged.
A question of family
The first infertility clauses in Sweden, the Netherlands, and Germany, dated back to the 70s and 80s and were justified in terms of family law. The logic was that a child must have a father who was a legal man and a mother who was a legal woman, according to legal scholar Peter Dunne. Anything else would unleash chaos and possibly present child protection concerns. In the decades that followed, other countries adopted similar policies, often without questioning whether they were truly necessary.
Joz Motmans of Ghent University Hospital believes Belgium's 2007 law stemmed from misguided binary thinking rather than malice. “The whole idea of what they called transsexualism was that a person was born in the wrong body,” the psychologist explains. “That was what medical practitioners did: They helped the person to correct the body.” Those “corrections” were perceived to mean inevitably giving up your chance to have children.
Motmans, who is himself trans, witnessed the legislation’s birth firsthand some twenty years ago, sitting in on sessions in the Belgian Parliament as a PhD student. He still recalls his shock at the proposal that applicants be “no longer able to conceive children in conformity with their previous sex.”
One lawmaker, when challenged by activists, exposed a lingering fear of trans procreation. “You could get into a situation where a man could bear a child and a woman could sire one," Hilde Vautmans, a center-right politician who helped spearhead the law, said at the time.
“If one must ‘choose’ to be subjected to a medical procedure to be able to live safely and freely… then the medical procedure isn’t a choice at all.”
— Cianán Russell, ILGA-Europe
Despite protest - some said it smacked of eugenics - the clause remained. From 2007 until 2017, when Belgium changed its laws, more than 700 people were subject to infertility requirements, Ministry of Justice figures shared with Investigate Europe show.
Asked for comment this year, Vautmans said the law had been “ground-breaking” at the time, but acknowledged such conditions “no longer reflected… values of equality and human dignity.” “The sterility requirement was then seen as the only politically feasible way forward, even if it was restrictive,” she said.
Belgium was among the last countries to introduce such a condition. From 2010, similar ones were gradually struck down in national courts in Germany, Italy, Greece, and beyond.
The European Court of Human Rights also condemned several states, including France, Romania and Italy. In 2017, judges in Strasbourg found for the first time that such requirements violated trans people’s right to private life, under Article 8 of the European Convention on Human Rights. Until 2016, French judges required such extensive surgery or hormone treatment that individuals were likely left infertile, even if sterilisation wasn’t legally mandated.
Yet few states have accepted responsibility. Only two governments have so far offered reparations following years of campaigning by activists. From 2018, Sweden granted 530 people 225,000 SEK each (about €20,000 today). Starting in 2020, the Netherlands awarded 1,259 people €5,000 each. In an official apology, two Dutch ministers called the 1985–2014 law a “violation of bodily autonomy that would be hard to imagine today.”
Germany has been pondering compensation for years, but nothing has materialised. “Discussions on the possibilities of recognising the suffering and injustice suffered by transgender and intersex people have not yet been completed,” said a Ministry of Families spokesperson.
Asked for comment this year, Vautmans said the law had been “ground-breaking” at the time, but acknowledged such conditions “no longer reflected… values of equality and human dignity.” “The sterility requirement was then seen as the only politically feasible way forward, even if it was restrictive,” she said.
The fight for compensation
Belgium was among the last countries to introduce such a condition. From 2010, similar ones were gradually struck down in national courts in Germany, Italy, Greece, and beyond.
The European Court of Human Rights also condemned several states, including France, Romania and Italy. In 2017, judges in Strasbourg found for the first time that such requirements violated trans people’s right to private life, under Article 8 of the European Convention on Human Rights. Until 2016, French judges required such extensive surgery or hormone treatment that individuals were likely left infertile, even if sterilisation wasn’t legally mandated.
Yet few states have accepted responsibility. Only two governments have so far offered reparations following years of campaigning by activists. From 2018, Sweden granted 530 people 225,000 SEK each (about €20,000 today). Starting in 2020, the Netherlands awarded 1,259 people €5,000 each. In an official apology, two Dutch ministers called the 1985–2014 law a “violation of bodily autonomy that would be hard to imagine today.”
Germany has been pondering compensation for years, but nothing has materialised. “Discussions on the possibilities of recognising the suffering and injustice suffered by transgender and intersex people have not yet been completed,” said a Ministry of Families spokesperson.
Transgender Europe claims that 12 EU countries still impose what they term “abusive medical requirements,” such as mandatory diagnosis, surgery, or hormone treatment.Shutterstock
Investigate Europe and associated reporters contacted authorities in all the main countries concerned in this story for comment. Most, including Czech authorities, did not respond. Apart from Germany, none alluded to any possible apology.
The Norwegian state has brushed off calls for compensation, arguing that granting it would set a precedent. Former Health Minister Bent Høie, who helped push through reform in 2016, sees things similarly, but nonetheless believes an apology is due that his country took so long to change.
Moreover, he believes that the process of reform would be much more difficult today. “We see that there is a completely different mood,” he says, with politicians exploiting gender debates to their political advantage. “Trans people become symbols of everything that is going wrong.”
In the past decade, many countries moved to less restrictive models of legal gender recognition. Belgium, Germany, Greece, Luxembourg, Malta, Portugal and Spain now use so-called self-identification, allowing people to change their official gender with a simple declaration rather than proof of surgery or psychiatric diagnosis. While sterility requirements have been dropped in most of Europe, advocacy group Transgender Europe claims that 12 EU countries still impose what they term “abusive medical requirements,” such as mandatory diagnosis, surgery, or hormone treatment.
At the same time, activists warn of dangerous backsliding in some parts. In May, the organisation reported that transgender rights regressed more than they advanced across 54 European countries for the first time in a decade.
There’s a sense that hard-won gains rest on fragile ground. Many look to the US, where President Donald Trump devoted some of his first hours in office to issuing executive orders calling, among other things, for trans women to be moved to male prisons. Hungary’s conservative Prime Minister Viktor Orbán already spent years rolling back queer rights, often citing "child protection". In 2020, legal gender recognition - previously possible - was banned entirely, with or without surgery. “The issue of sterilisation is not really relevant; the problem is much more serious,” Tamás Dombos of the Háttér Society, an LGBT+ advocacy group, said.
In Slovakia, efforts to end sterilisation backfired. In early 2023, the outgoing health minister issued new guidelines expunging a reference. But six months later, under a new government led by populist Robert Fico, the reform was retracted. No alternative followed, and as in Hungary and also Bulgaria legal recognition has stalled.
The Norwegian state has brushed off calls for compensation, arguing that granting it would set a precedent. Former Health Minister Bent Høie, who helped push through reform in 2016, sees things similarly, but nonetheless believes an apology is due that his country took so long to change.
Moreover, he believes that the process of reform would be much more difficult today. “We see that there is a completely different mood,” he says, with politicians exploiting gender debates to their political advantage. “Trans people become symbols of everything that is going wrong.”
A rollback of rights?
In the past decade, many countries moved to less restrictive models of legal gender recognition. Belgium, Germany, Greece, Luxembourg, Malta, Portugal and Spain now use so-called self-identification, allowing people to change their official gender with a simple declaration rather than proof of surgery or psychiatric diagnosis. While sterility requirements have been dropped in most of Europe, advocacy group Transgender Europe claims that 12 EU countries still impose what they term “abusive medical requirements,” such as mandatory diagnosis, surgery, or hormone treatment.
At the same time, activists warn of dangerous backsliding in some parts. In May, the organisation reported that transgender rights regressed more than they advanced across 54 European countries for the first time in a decade.
There’s a sense that hard-won gains rest on fragile ground. Many look to the US, where President Donald Trump devoted some of his first hours in office to issuing executive orders calling, among other things, for trans women to be moved to male prisons. Hungary’s conservative Prime Minister Viktor Orbán already spent years rolling back queer rights, often citing "child protection". In 2020, legal gender recognition - previously possible - was banned entirely, with or without surgery. “The issue of sterilisation is not really relevant; the problem is much more serious,” Tamás Dombos of the Háttér Society, an LGBT+ advocacy group, said.
In Slovakia, efforts to end sterilisation backfired. In early 2023, the outgoing health minister issued new guidelines expunging a reference. But six months later, under a new government led by populist Robert Fico, the reform was retracted. No alternative followed, and as in Hungary and also Bulgaria legal recognition has stalled.
“Our desire to exist outside the norm frightened people. The idea of a trans person becoming a parent, loving, raising, creating life, shattered an entire ideological structure.”
— Christian Cristalli
‘It must never happen again’
Czech activists, who fought for years to overturn the clause, still fear a grey zone. The Constitutional Court condemned it last year, instructing the government to replace it. So far, no proposal has materialised. ILGA now expects the system to hinge on ministerial guidance, which it sees as flimsy and vulnerable to rewriting by future governments.“Trans people in Czechia will be left in legal limbo, without access to a safe, dignified, and timely process,” the campaign group warned in June.
Alexandra says she is “genuinely happy” that her country has changed its system, even if it is unclear how things will work and it came too late for her. When her revised papers came through a month after her operation, she didn’t feel joy, just pain. Three years on, the anger is still with her. “I am bitter, and rightfully so… I went through all of this trouble for something that should have been mine already.”
In Italy, Christian Cristalli has also not forgotten. “Our desire to exist outside the norm frightened people. The idea of a trans person becoming a parent, loving, raising, creating life, shattered an entire ideological structure. And I keep talking about this violence because it must never happen again. To anyone.”
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Additional reporting: Lorenzo Buzzoni, Paula Zwolenski, Martin Vrba, Pascal Hansens, Eurydice Bersi, Leïla Miñano, Amund Trellevik and Matúš Zdút.
Coordination: Attila Kálmán
Editing: Chris Matthews, Mei-Ling McNamara
Fact-checking: Wojciech Cieśla
This project is led and coordinated by Investigate Europe, a cross-border team of investigative journalists. The investigation is being published with media partners in 10 countries: Arte, Dagsavisen, Delfi, Dennik N, Il Manifesto, New Lines, Partizan, Reporters United, Taz, TransTelex.
IJ4EU (Investigative Journalism for Europe) provided funding support for the investigation.