The right of trans people to self-ID has been the subject of a backlash in Spain and Scotland, while a raft of laws aiming to ‘erase’ LGBTQ people has been unleashed in Uganda and the US. But it isn’t like this everywhere: Argentinian legislation has been granting trans people the right to self-determination for 11 years.

Its gender identity law, passed in 2012, was the first in the world to remove barriers to legal gender recognition such as the need for medical diagnosis, gender-affirming surgery, or the opinion of a judge.

As of April, 16,090 Argentinians – including 1,529 who were under 17 – had applied for and obtained new national identity cards (DNI) to change their legal gender, official figures show.

The law also provides free healthcare for trans young people and adults in public hospitals. The Ministry of Health offers courses and training and has published clear guidelines to avoid institutional violence in the care of trans children and adolescents, as well as a document outlining the current medical consensus on the use of puberty blockers and hormone replacement therapy.

Across the country there are 318 medical teams in state-run hospitals and health centres providing these services.

These are newly won rights, rare in the region and the rest of the world, and hard fought-for.

When Scotland and Spain passed gender self-ID legislation in recent months, a vocal minority fixated on the supposed risk of abuse by male sex offenders. Westminster vetoed Scotland’s law, threatening to spark a constitutional crisis.

In 11 years of Argentina’s law, no such cases have been recorded. “The idea that someone is going to lie to take advantage is to ignore the lives of transgender people, who are still affected by discrimination and rights violations,” Raquel Asensio, a lawyer and coordinator of gender issues at the Public Defender’s Office, told openDemocracy.

In Argentina, the life expectancy of trans people is around 37 years (less than half that of the rest of the population), according to a report published in 2020 based on official figures. 66% of trans women have not completed secondary education, and 80% have informal or precarious jobs (compared to 36% of cis people). In the city of Buenos Aires, 70% of trans women are sex workers (the figure was 89% in 2005).

Violence also continues to mark their lives. Between 2016 and 2022, the Supreme Court counted 32 cases of transfemicide that had been heard by the court system. And there were 7 more just in 2022.

Pioneer girl

But when the gender identity law passed in 2012, institutions still refused to recognise trans children’s ability to express their identity.

The first to speak out was Gabriela Mansilla. In 2013, her daughter Luana, then aged six, was the first trans child in the world to obtain an identity card bearing her self-identified gender through an administrative process, without judicial intervention.

Mansilla documented the struggle for her daughter’s rights in the book ‘Yo nena, yo princesa’ (I girl, I princess). She also founded the Asociación Civil Infancias Libres (Free Childhood Civil Association). A film based on the book was released in 2021.

Luana celebrated her 15th birthday in 2022 with a big party in a historic LGBT nightclub, organised with support and donations from numerous people. Mansilla considered the celebration “a revolutionary act” because trans people are often “excluded, mistreated, discriminated against, thrown out on the streets. And here is a trans teenager who has been embraced since she was a child”.

Her story is mirrored by others we heard while writing this piece.

Romina Pezzelato’s daughter first told her parents she was a girl at the age of two.

Four years later, her family had the name changed on her identity card, marking the occasion with a “beautiful” ceremony.

“We encouraged her to invite whoever she wanted: her teachers, the school principal and about 10 friends; also her grandmothers, grandfathers, uncles, aunts, cousins,” Pezzelato said. “We all went into the registry office and the clerk was waiting for her with a little bag of candy.”

Rights and healthcare for trans children

The first interdisciplinary clinic for trans children and adolescents – founded eight years ago at the Pedro de Elizalde Children’s Hospital in the capital – primarily serves young people aged 14 to 16. “But we also have patients aged 11 and 12,” said paediatrician Carlos Sanz, who heads the team. “We have already seen about 200.”

The clinic brings together paediatrics, adolescent medicine, endocrinology, phonoaudiology, gynaecology, psychology and social work. “Our work ranges from supporting families, to interventions in schools to avoid situations of discrimination and to ensure children’s chosen names are respected,” he explained. Some civil registry offices “continue to put obstacles in the way of compliance with the law,” he added, such as wrongly telling families they can’t change their children’s legal gender or otherwise dragging their feet.

Paediatricians typically used to ignore families seeking advice about their trans kids, Sanz said, but added: “This no longer happens.”

A medical guide on the use of puberty blockers – based on available scientific evidence, recommendations from international organisations, and the experience of local teams – is provided by the Ministry of Health to clinics like Sanz’s. It offers information about the benefits and limitations of medical transition, including the different options available, and their expected side effects and outcomes. The guide advises medical staff to “listen, respect and give credibility to children’s and adolescents’ words… It’s not about imposing, judging, directing or limiting decisions, but about giving appropriate information for autonomous decision-making.”

Those who attend the hospital where Sanz works are told that “there are no ideal bodies”. Not all trans and non-binary people choose to undergo medical transition (including hormone replacement therapy, and gender-affirming surgeries), he explained – and those who do “are not always looking for the same results.”

Among those who attend the hospital (either through self-referral or after being referred by professionals), 35% are given hormone blockers or hormone replacement therapy. Also available are contraceptives to inhibit menstruation, and speech therapy.

Gonzalo*, an 18-year-old trans man, said receiving gender-affirming care – including puberty blockers at 13 and hormone therapy at 16 – and changing his legal name “were the things that helped me most emotionally and to feel comfortable with my body”.

His medical care was provided at the Sor María Ludovica Children’s Hospital in La Plata, capital of Buenos Aires province, but it was far from easy to access. “Five heads of services [told] me that they had no expertise at all and were not qualified to treat him,” said his mother Susana Roussy, a teacher and transfeminist activist. “He was the first trans patient they had ever seen.”

When Gonzalo was 17, he underwent top surgery, which “totally improved my quality of life”. Now in college, where he studies industrial design he has “met a lot of trans people” and is involved in a students’ union organising visibility for trans rights.

Elías*, a 21-year-old trans man who transitioned at 16 and began hormone therapy at 19, told openDemocracy: “Transitioning is personal, and time is needed to figure out what things make you feel comfortable and which not. There is no one way to be a man or woman. It’s good to reflect to what extent you need things yourself or because of what others think. I was able to take that time.”

Elías had family support, “love and understanding” along the way. But he also had to deal with teachers who refused to call him by his name and a high school that never enabled him to access male bathrooms with the privacy he needed. This experience initially discouraged him from entering higher education. “It took me several years to apply for university,” he said, “as I was afraid to have to go through the same thing with the bathroom and teachers.”

Luana Pardo, a 28-year old make-up artist born in Lima, Perú, began transitioning as an adolescent, dressing as a woman at weekends. She had a mammoplasty in 2020, but stopped taking hormones six months ago due to side effects. “Hormones [are] just one option, but there are others,” she said. “My next appointment with the endocrinologist is in August and then I will see.”

Julieta Ruiz, now 35, was able to access gender-affirming care and counselling in a public hospital in La Plata city when she was 25.

Ruiz, who works as a theatre ticket clerk and does entertainment journalism at the public TV station, recalls how it had been her birthday wish “to turn myself into a free and beautiful woman” since she was a child. In order to access gender-affirming surgery, however, she had to file legal action against her healthcare provider. She won the case last year. “It was the success of my life in every sense,” she said. “I had always wished to know what people comfortable with their bodies felt. Now I know it.”

Do not pathologise

A 2019 report carried out by the organisation headed by Mansilla, and based on data from 100 families of trans children, shows that first expressions of gender nonconformity occur on average at the age of five, with 46% of children expressing it between one and four years old, and 31% between five and eight years old.

Only 6% of families said their first reaction was to accept their children’s feelings without linking them to any discomfort or illness. Some 35% had sought help to understand what was happening, most from a health professional such as a psychologist, but eight out of ten of these said the experience was unsatisfactory.

Suggestions to disregard children’s requests around gender expression came most frequently from mental health professionals. “They order families to repress any expression linked to any identity other than the one assigned at birth,” said Pezzelato. “And yet this is something pushing to come out and find recognition. That’s what my daughter needed.”

At the age of four, Pezzelato’s daughter suggested that “to be a girl at all” she had to change her name. Her parents agreed, not without fear of the reaction they would face from the rest of their family and from their daughter’s school – despite legislation that had already been in place in Argentina for some years. “Happily,” she said, “the response was love and emotion, because it is very moving for the adult world when transitions happen at such an early age”.

More legal progress

Argentina’s gender identity law was a starting point for the rights of trans and travesti people – a community with a distinct gender and political identity in Argentina and other Latin American countries.

Argentina has also introduced rules to ensure trans people are not shut out of employment, such as a 2021 law that ensures 1% of public sector jobs are held by trans people. Luana X*, the make-up artist, got a job last year at an Argentinian parliamentary TV channel.

The same year, president Alberto Fernández approved by decree a national identity card that included non-binary as an option. Weeks later, his eldest child, Tani Fernández Luchetti, 26, applied for their non-binary ID card.

But gender diversity and trans bodies are still absent from the comprehensive sex education curriculum, which was made compulsory by a 2006 law in primary and secondary education.

“In most schools there is a person who empathises when a trans student comes out,” said Roussy, who works for Buenos Aires province ministry of women, gender policies and sexual diversity as well as teaching. “Is there still resistance? Yes, but there are many tools in place to deal with this discrimination.”

*Surnames are omitted to protect the identity of the sources.