Jump to content

Legal status of gender-affirming healthcare

From Wikipedia, the free encyclopedia

The legal status of gender-affirming surgery and gender-affirming hormone therapy varies by jurisdiction, often interacting with other facets of the legal status of transgender people. Key considerations include whether people are allowed to get such surgeries, at what ages they are allowed to if so, and whether surgeries are required in order for a gender transition to be legally recognized. As of 2007, the countries that perform the greatest number of gender-affirming surgeries are Thailand and Iran.[1]

Africa

[edit]

Democratic Republic of the Congo

[edit]
Further information: Transgender rights in the Democratic Republic of the Congo

There are no protective rights or supportive legislations for any type of medical transitional procedures in the Democratic Republic of the Congo.[2]

Egypt

[edit]
Further information: Transgender rights in Egypt

Sex reassignment surgery is allowed and can be performed in the country after obtaining approval from Al-Azhar Mosque or the Coptic Orthodox Church of Alexandria.[3][4][5]

Ethiopia

[edit]
Further information: Transgender rights in Ethiopia

Medical procedures for trans people in Ethiopia are illegal. Gender expression out of the 'norm' faces major issues in violence and social stigmatisation.[6]

Morocco

[edit]
Further information: Transgender rights in Morocco

Casablanca, Morocco, is notable for being the home of Clinique de Parc, Georges Burou's clinic for transgender women. Burou is considered one of the pioneers of gender-affirming surgery.[7] A French gynecologist, Burou created the anteriorly pedicled penile skin flap inversion vaginoplasty, still considered the "gold standard" of skin-lined vaginoplasty.[8] He is credited with having performed over 3000 vaginoplasties in 1973.[9]

Nigeria

[edit]
Further information: Transgender rights in Nigeria

Medical procedures such as hormone replacement and gender-affirming surgeries are illegal in Nigeria. Additionally, it is not possible to change one's name or gender marker in the country of Nigeria, and trans individuals in Nigeria are not legally protected for gender expression.[10][11]

South Africa

[edit]
Further information: Transgender rights in South Africa

Trans and gender diverse peoples are protected and acknowledged under South African law, where no sterilisation or other forced procedures are necessary to have legal recognition of a person's gender identity. Gender-affirming surgery is legal and accessible, but not covered by medical aid.[12]

Asia

[edit]

China

[edit]
Further information: Transgender rights in China

Gender-affirming surgeries and changing one's legal name and gender are all accessible in the People's Republic of China, but there are rigorous steps to follow to do so. To change one's legal gender, they must show a gender determination certificate as proof of gender-affirming surgery, which cannot be undergone without: psychiatric diagnosis, verification of no prior criminal record, proof that the family has been notified, written agreement from their family and work unit, that they are unmarried and over 20 years old. The psychiatric diagnosis is not given to someone who is not exclusively heterosexual.[10]

India

[edit]
Further information: Transgender rights in India

Transgender people in India need to undergo a gender-affirming surgery to change their legal gender from male to female or vice-versa. This has been opposed by Indian transgender activists.[13] India also requires proof of having undergone a gender-affirming surgery for changing the gender listed on one's passport. This requirement has been challenged in courts.[14] The government's flagship national health insurance scheme may soon cover gender-affirming surgeries for transgender individuals.[15] India is offering affordable gender-affirming surgeries to a growing number of medical tourists[16] and to the general population.[17]

Indonesia

[edit]
Further information: Transgender rights in Indonesia

In Indonesia, it has been possible to undergo gender-affirming surgery since 1973. Vivian Rubianti was the first transgender woman to have legal gender changes in the country. Indonesia requires gender-affirming surgery and judicial approval for a person to legally change gender.[citation needed]

Iran

[edit]
Further information: Transgender rights in Iran

The Iranian government's response to homosexuality is to endorse, and fully pay for, gender-affirming surgery.[18][19] The leader of Iran's Islamic Revolution, Ayatollah Ruhollah Khomeini, issued a fatwa declaring gender-affirming surgery permissible for "diagnosed transsexuals".[18] Eshaghian's documentary, Be Like Others, chronicles a number of stories of Iranian gay men who feel transitioning is the only way to avoid further persecution, jail, or execution.[18] The head of Iran's main transsexual organization, Maryam Khatoon Molkara, who convinced Khomeini to issue the fatwa on transsexuality, confirmed that some people who undergo operations are gay rather than transsexual.[1] According to the research study of Zara Saeidzadeh who questioned fourteen trans men, nine had completed their medical transition and the remaining five had the intention of completing their medical transition.[20]

Japan

[edit]
Further information: Transgender rights in Japan

In October 2023 the Supreme Court unanimously ruled to no longer require sterilization for legal gender change and requested a lower court to review the requirement of gender-affirming surgery.[21]

Pakistan

[edit]
Further information: Transgender rights in Pakistan

In Pakistan, the Council of Islamic Ideology has ruled that gender-affirming surgery contravenes Islamic law as construed by the council.[22]

Singapore

[edit]
Further information: Transgender rights in Singapore

The first gender-affirming surgery in Singapore was successfully performed on 30 July 1971. Singapore was the first country in Asia to legalize gender-affirming surgeries in 1973. Singapore's first gender-affirming operation on a transmasculine patient took place three years later, and was carried out in three stages between August 1974 and October 1977, as gender-affirming surgeries for transmasculine people are much more complex. Medical tourism for such surgeries are also prevalent in Singapore as local hospitals also accepts foreigners. In 1996, the Singaporean government legalized marriage for transsexuals.[23]

Thailand

[edit]
Further information: Transgender rights in Thailand

Thailand is the country that performs the most gender-affirming surgeries, followed by Iran.[1]

United Arab Emirates

[edit]
Further information: Transgender rights in the United Arab Emirates

Gender-affirming surgery is illegal in the United Arab Emirates.[24]

Europe

[edit]

France

[edit]
Further information: Transgender rights in France

Since 2016, France no longer requires gender-affirming surgery as a condition for a gender change on legal documents.[25][26] In 2017, a case brought earlier by three transgender French people was decided. France was found in violation of the European Convention on Human Rights for requiring the forced sterilization of transgender people seeking to change their gender on legal documents.[27]

Malta

[edit]
Further information: Transgender rights in Malta

As late as 2010, transgender people in Malta who have undergone gender-affirming surgery can change their gender on legal documents.[28][needs update]

Russia

[edit]
Further information: Transgender rights in Russia

Psychiatric evaluation is necessary to receive a diagnosis of "transsexualism" before one can be authorized for hormone therapy or gender-affirming surgeries in Russia. Neither hormone replacement therapy nor gender-affirming surgeries are covered by the Federal Compulsory Medical Insurance Fund.[29]

Spain

[edit]
Further information: Transgender rights in Spain

Despite a resolution from the European Parliament in 1989 suggesting advanced rights for all European Union citizens, as of 2002 only Andalusia's public health system covers gender-affirming surgery.[30][better source needed][needs update]

Switzerland

[edit]
Further information: Transgender rights in Switzerland

In 2010, Switzerland's Federal Supreme Court struck down two laws that limited access to gender-affirming surgery. These included requirements of at least 2 years of psychotherapy before health insurance was obligated to cover the cost of gender-affirming surgery[31][32] and inability to procreate.[33]

Ukraine

[edit]
Further information: Transgender rights in Ukraine

In 2015, the Administrative District Court of Kyiv, Ukraine, ruled that forced sterilization was unlawful and no longer required for legal gender change.[citation needed]

United Kingdom

[edit]
Further information: Transgender rights in the United Kingdom

The minimum age for gender-affirming surgery varies from 16 in Scotland to 17 in England and 18 in Wales.[34] It is not a requirement for legal gender change.[35]

North America

[edit]

Canada

[edit]
Further information: Transgender rights in Canada

Gender-affirming surgery is not a requirement for legal gender change in Canada.[36][37][38]

Cuba

[edit]
Further information: Transgender rights in Cuba

On 4 June 2008, MINSAP, the Cuban Ministry of Public Health, issued Resolution 126 – which resulted in all aspects of transition related healthcare being covered for Cubans under Cuba's public healthcare system. Cuba was the first country in Latin America to do so.[39][40] Prior to being approved, it was suggested that the bill would make Cuba the most progressive nation in Latin America on gender issues.[41] The resolution was heavily pushed for by CENESEX a government-funded body dedicated to advocating LGBT rights and sexual diversity.[39][42]

Haiti

[edit]
Further information: Transgender rights in Haiti

Gender-affirming surgery does not exist in Haiti.[10][43]

Mexico

[edit]
Further information: Transgender rights in Mexico

As of a 2014 law,[44] Mexico City no longer requires gender-affirming surgery for changes of gender on birth certificates, and several states have followed suit.[45][needs update]

United States

[edit]
Further information: Transgender rights in the United States

Some U.S. states treat gender-affirming as a prerequisite for recognition of a legal sex change on official documents such as passports, birth certificates, or IDs, and historically (prior to the legalization of same-sex marriage) for marriage licenses.[citation needed]

Alabama and Arkansas passed laws in 2022 and 2021, respectively, that prohibit gender-affirming surgery and hormonal treatment for minors. Plaintiffs have challenged the legislation in Alabama, and a May 2022 federal court injunction blocked enforcement of the law while litigation is pending. Implementation has been challenged in state, and then federal court also in Arkansas, delaying implementation, as of January 2023.[46][47] An estimated 9,000 gender-affirming surgeries take place annually in America.[48]

As of November 2023 twenty-two states have banned gender-affirming medical care for people under 18 years old, including twenty-one states that have specifically banned or restricted hormonal treatment in addition to surgery.[49]

At the same time, many Democrat-controlled states have gone in the opposite direction and enacted laws protecting access to gender affirming care for minors and adults. These laws, often called "shield" laws, often explicitly combine protections for gender-affirming care and abortion and cover a variety of protections including protecting both providers and patients from being punished, mandating insurance providers to cover the procedures and acting as "sanctuary states" that protect patients traveling to the state from other states that have banned such treatments among other things.[50] As of November 2023, 14 states and the District of Columbia have enacted "shield" laws.

South America

[edit]

Argentina

[edit]
Further information: Transgender rights in Argentina

In 2012, Argentina began offering government subsidized total or partial gender-affirming surgeries to all persons 18 years of age or older.[51][52][19] Private insurance companies were prohibited from increasing the cost of gender-affirming surgery for their clients. At the same time, the Argentinian government repealed a law that banned gender-affirming surgery without authorization from a judge.[53] It is not required for Argentines to undergo gender-affirming surgery to change gender on legal documents.[54]

Brazil

[edit]
Further information: Transgender rights in Brazil

Dr. Roberto Farina performed the first male-to-female gender-affirming surgery in Brazil in 1971.[55]

In March 2018, Brazil's Supreme Court unanimously removed medical and judicial criteria for all trans persons to change their names and legal gender.[10] Trans people in Brazil can receive government funded hormone replacement therapy at the age of 16, and gender-affirming surgery at the age of 18.[56] Brazilian civil registry offices recorded 3,165 gender affirming surgeries in 2022.[57]

Chile

[edit]
Further information: Transgender rights in Chile

In 2012, a bill was introduced in Chile that stated gender-affirming was no longer a requirement for legal name change and gender recognition.[58] In 2013, Chile's public health plan was required to cover gender-affirming surgery.[58] The cost is subsidized by the government based on a patient's income.[58][needs update]

Colombia

[edit]
Further information: Transgender rights in Colombia

In Colombia, gender marker changes are often granted only[vague] when a medical precondition is met, including, but not limited to, psychiatric diagnosis or sterilisation. Gender-affirming surgery is not always necessary[vague] for gender change but it is still available under Colombian insurance or if paid out of pocket.[59]

Peru

[edit]
Further information: Transgender rights in Peru

Although gender-affirming surgeries are available, trans people in Peru often face barriers to gender-affirming care (e.g., lack of qualified and willing providers, high cost, restrictive gatekeeping in assessment for hormones and surgery), and trans individuals may face malpractice and various forms discrimination.[60]

Uruguay

[edit]
Further information: Transgender rights in Uruguay

The Comprehensive Law for Trans People (La Ley Integral para Personas Trans), which was passed on 19 October 2018, improves the access of surgeries for transgender people in Uruguay. It says that the state will pay for them. For those under 18 wishing to undergo surgery, a request to change their legal name and gender must accompany their registration. For minors who do not have consent from guardians, judicial authorization may be sought in its place.[61]

References

[edit]
  1. ^ a b c Tait, Robert (26 September 2007). "Sex change funding undermines no gays claim". The Guardian. Archived from the original on 7 July 2015. Retrieved 20 September 2008.
  2. ^ Swedish International Development Cooperation Agency (2014), The Rights of LGBTI People in the DR of Congo (PDF), archived (PDF) from the original on 25 April 2022, retrieved 12 April 2022
  3. ^ Amin, Shahira (December 12, 2021). "Al-Azhar rhetoric alarms LGBTQ community - Al-Monitor: Independent, trusted coverage of the Middle East". www.al-monitor.com. Retrieved 30 July 2022.
  4. ^ Skovguard-Peterson, Jakob (Spring 1995). "Sex Change in Cairo: Gender and Islamic Law". Journal of the International Institute. 2 (3). ISSN 1558-741X.
  5. ^ Mahmoud, Ebtsam (7 January 2018). "Transgender in Egypt: Islam's stance on sex reassignment surgery". Egypt Independent. Retrieved 30 July 2022.
  6. ^ "Ethiopia". Human Dignity Trust. 15 February 2019. Archived from the original on 21 April 2022. Retrieved 17 April 2022.
  7. ^ Hage, J.J.; Karim, R.B.; Laub, D.R. (December 2007). "On the origin of pedicled skin inversion vaginoplasty: life and work of Dr Georges Burou of Casablanca". Annals of Plastic Surgery. 59 (6): 723–9. doi:10.1097/01.sap.0000258974.41516.bc. PMID 18046160. S2CID 25373951.
  8. ^ Perovic, S.; Djinovic, R. (November 2009). "Genitoplasty in male-to-female transsexuals". Current Opinion in Urology. 19 (6): 571–6. doi:10.1097/MOU.0b013e3283312eb3. PMID 19707142. S2CID 5424447.
  9. ^ Reed, H.M. (May 2011). "Aesthetic and functional male to female genital and perineal surgery: feminizing vaginoplasty". Seminars in Plastic Surgery. 25 (2): 163–74. doi:10.1055/s-0031-1281486. PMC 3312144. PMID 22547974.
  10. ^ a b c d Chiam, Zhan; Duffy, Sandra; Gil, Matilda González; Goodwin, Lara; Patel, Nigel Timothy Mpemba (2020), Trans Legal Mapping Report 2019: Recognition before the law, Geneva: ILGA World
  11. ^ Cole, Timinepre. "'I feel invisible': The challenges of being trans in Nigeria". AlJazeera. Archived from the original on 17 April 2022. Retrieved 17 April 2022.
  12. ^ "Principle 3 – Yogyakartaprinciples.org". Archived from the original on 25 March 2022. Retrieved 17 April 2022.
  13. ^ "India's Transgender Rights Law Isn't Worth Celebrating". Human Rights Watch. 5 December 2019. Retrieved 1 May 2022.
  14. ^ Bureau, The Hindu (11 April 2022). "Cannot insist on gender reassignment surgery certificate for issuance of passport: Delhi HC". The Hindu. ISSN 0971-751X. Retrieved 1 May 2022. {{cite news}}: |last= has generic name (help)
  15. ^ Sharma, Nidhi. "Ayushman Bharat to cover sex change of transgenders". The Economic Times. Retrieved 1 May 2022.
  16. ^ "Sex-change surgery: India's new line in medical tourism". The Hindu. 7 May 2016. Archived from the original on 9 December 2019. Retrieved 10 December 2016.
  17. ^ "Growing recognition of transgender health". Bulletin of the World Health Organization. 94 (11): 790–791. November 2016. doi:10.2471/BLT.16.021116 (inactive 2024-11-12). PMC 5096349. PMID 27821880.{{cite journal}}: CS1 maint: DOI inactive as of November 2024 (link)
  18. ^ a b c Hays, M. "Iran's gay plan". CBC News. Archived from the original on 16 April 2009. Retrieved 23 September 2008.
  19. ^ a b "Argentina Adopts Landmark Legislation in Recognition of Gender Identity". outrightinternational.org. 14 May 2012. Archived from the original on 18 December 2018. Retrieved 17 December 2018.
  20. ^ Saeidzadeh, Zara (2 April 2020). ""Are trans men the manliest of men?" Gender practices, trans masculinity and mardānegī in contemporary Iran". Journal of Gender Studies. 29 (3): 295–309. doi:10.1080/09589236.2019.1635439. ISSN 0958-9236. S2CID 199145725.
  21. ^ "Victory for Transgender Rights in Japan | Human Rights Watch". 2023-10-25. Retrieved 2024-02-18.
  22. ^ "Islamic Ideology body okays test tube babies, terms sex-change operations 'un-Islamic'". tribune.com.pk. 5 November 2013. Archived from the original on 24 February 2021. Retrieved 23 May 2021.
  23. ^ Chan, Meng Choo (4 August 2011). "First sex reassignment surgery". eresources.nlb.gov.sg. Retrieved 17 September 2022.
  24. ^ "New UAE law does not legalise sex change | the National". 25 September 2016. Archived from the original on 20 December 2016.
  25. ^ "French Law Removes the Surgical Requirement for Legal Gender Recognition". National Center for Transgender Equality. 21 October 2016. Archived from the original on 3 March 2020. Retrieved 14 December 2018.
  26. ^ Toor, A. (14 October 2016). "Transgender people no longer required to undergo sterilization in France". The Verge. Archived from the original on 14 December 2018. Retrieved 14 December 2018.
  27. ^ "Why transgender people are being sterilised in some European countries". The Economist. 1 September 2017. Archived from the original on 22 March 2018. Retrieved 14 December 2018.
  28. ^ "Malta: UN Committee on the Elimination of Discrimination against Women (CEDAW)". outrightinternational.org. 11 October 2010. Archived from the original on 19 December 2018. Retrieved 18 December 2018.
  29. ^ Transgender Legal Defense Project (2017), The situation of transgender persons in Russia (PDF), archived (PDF) from the original on 8 April 2022, retrieved 12 April 2022
  30. ^ "Spain: Health Care For All!". outrightinternational.org. 10 June 2002. Archived from the original on 18 December 2018. Retrieved 17 December 2018.
  31. ^ "Switzerland drops 2-year therapy as surgery-requirement". tgeu.org. 17 September 2010. Archived from the original on 1 April 2019. Retrieved 11 December 2018.
  32. ^ "Schlumpf v. Switzerland (European Court of Human Rights)". genderidentitywatch.com. 23 December 2013. Archived from the original on 1 April 2019. Retrieved 11 December 2018.
  33. ^ "Guide on Article 8 of the European Convention on Human Rights: Right to Respect for Private and Family Life, Home and Correspondence". European Court of Human Rights. 31 August 2018. Archived from the original on 7 April 2007. Retrieved 10 December 2018.
  34. ^ "Access to sex reassignment surgery". 29 October 2018.
  35. ^ "who can apply".
  36. ^ "C.F. v. Alberta (Vital Statistics), 2014 ABQB 237 (CanLII)". canlii.org. 22 April 2014. Archived from the original on 11 February 2021. Retrieved 23 May 2021.
  37. ^ "Application Forms – Vital Statistics Agency – Ministry of Health". gov.bc.ca. Archived from the original on 22 March 2015. Retrieved 24 May 2021.
  38. ^ Bird, H. (14 June 2016). "Trans activist celebrates proposed N.W.T. Vital Statistics changes". cbc.ca. Archived from the original on 16 September 2021. Retrieved 23 May 2021.
  39. ^ a b Kirk, E. J.; Huish, R. (2018). "Transsexuals' Right to Health? A Cuban Case Study". Health and Human Rights. 20 (2): 215–222. PMC 6293354. PMID 30568415.
  40. ^ "HEALTH-CUBA: Free Sex Change Operations Approved". Inter Press Service. 6 June 2008. Archived from the original on 12 June 2010.
  41. ^ Israel, Esteban (3 July 2006). "Castro's niece fights for new revolution". Reuters. Archived from the original on 22 August 2006.
  42. ^ "Anderson, Tim. "hiv/aids in cuba: a rights-based analysis." health and human rights (2009): 93–104" (PDF). Archived (PDF) from the original on 8 June 2021. Retrieved 8 June 2021.
  43. ^ "BUILDING SAFE SPACES FOR TRANS PEOPLE IN HAITI". Latin America and the Caribbean. Programa De Naciones Unidas Para El Desarrollo. Archived from the original on 25 April 2022. Retrieved 17 April 2022.
  44. ^ "Aprueban reforma a la ley de identidad de género en la Ciudad de México". SDPnoticias.com (in Spanish). 13 November 2014. Archived from the original on 5 May 2019. Retrieved 5 May 2019.
  45. ^ "Mexico Transgender Ruling a Beacon for Change". Human Rights Watch. 29 October 2018. Archived from the original on 21 April 2019. Retrieved 5 May 2019.
  46. ^ Dawson, Lindsey; Kates, Jennifer (1 June 2022). "Youth Access to Gender Affirming Care: The Federal and State Policy Landscape". KFF. Retrieved 29 January 2023.
  47. ^ Ellis, Dale (24 October 2022). "State to finish putting on its case in transgender care trial late next month". Arkansas Democrat-Gazette. Retrieved 29 January 2023.
  48. ^ Mani, Vishnu R.; Valdivieso, Sebastian C.; Hanandeh, Adel; Kalabin, Aleksandr; Ramcharan, Alexius; Donaldson, Brian (2021). "Transgender surgery – Knowledge gap among physicians impacting patient care". Current Urology. 15 (1). Ovid Technologies (Wolters Kluwer Health): 68–70. doi:10.1097/cu9.0000000000000002. ISSN 1661-7649. PMC 8137065. PMID 34084125.
  49. ^ Pereira, Ivan (29 April 2023). "Montana blocks gender-affirming care for trans minors". ABC News. Retrieved 8 May 2023.
  50. ^ Panetta, Grace (June 9, 2023). "Lawmakers in blue states are linking protections for abortion and gender-affirming care". The 19th. Archived from the original on February 5, 2024. Retrieved 2024-01-01.
  51. ^ Ansari, A. (23 February 2017). "Transgender rights: These countries are ahead of the US". CNN. Archived from the original on 23 May 2021. Retrieved 23 May 2021.
  52. ^ Salum, Alejandro Nasif (13 May 2012). "Argentina Has Passed the Most Progressive Gender Identity Legislation in Existence". Leading Global LGBTIQ Human Rights Organization. Archived from the original on 18 December 2018. Retrieved 17 December 2018.
  53. ^ "English Translation of Argentina's Gender Identity Law as approved by the Senate of Argentina on May 8, 2012". tgeu.org. 12 September 2013. Archived from the original on 14 June 2020. Retrieved 11 December 2018.
  54. ^ "Six-year-old becomes first transgender child in Argentina to change identity – Telegraph". 11 April 2014. Archived from the original on 11 April 2014. Retrieved 5 May 2019.
  55. ^ "'Monstro, prostituta, bichinha': como a Justiça condenou a 1ª cirurgia de mudança de sexo do Brasil". BBC News Brasil (in Brazilian Portuguese). Retrieved 2023-10-25.
  56. ^ Lopez, Oscar (9 January 2020). "Brazil issues new rules, lowers age for gender reassignment surgery". Reuters. Thomson Reuters Foundation. Archived from the original on 17 April 2022. Retrieved 17 April 2022.
  57. ^ "Cresce em 70% número de pessoas que mudaram nome e gênero". ViDA & Ação (in Portuguese). 31 January 2023. Retrieved 11 April 2023.
  58. ^ a b c brian (13 August 2012). "Chilean Paradoxes: LGBT rights in Latin America". Outright Action International. Archived from the original on 18 December 2018. Retrieved 17 December 2018.
  59. ^ Osella, Stefano; Rubio-Marin, Ruth (2021). "The Right to Gender Recognition before the Colombian Constitutional Court: A Queer and Travesti Theory Analysis". Bulletin of Latin American Research. 40 (5): 650–664. doi:10.1111/blar.13297. S2CID 245023800.
  60. ^ Reisner, Sari L.; Silva-Santisteban, Alfonso; Salazar, Ximena; Vilela, Jesse; D'Amico, Lynne; Perez-Brumer, Amaya (2 August 2021). Garcia, Jonathan (ed.). ""Existimos": Health and social needs of transgender men in Lima, Peru". PLOS ONE. 16 (8): e0254494. Bibcode:2021PLoSO..1654494R. doi:10.1371/journal.pone.0254494. ISSN 1932-6203. PMC 8328288. PMID 34339444.
  61. ^ "Uruguay: Congress Adopts New Law on Transgender Rights". Library of Congress. Archived from the original on 31 March 2022. Retrieved 30 March 2022.
Retrieved from "https://en.wikipedia.org/w/index.php?title=Legal_status_of_gender-affirming_healthcare&oldid=1265195957"