Surgery for trans adolescents: the laws in Switzerland

Male body, female body: For young people who don't feel they have the right body, the pressure to change something about their birth gender is great. Keystone

The Swiss parliament is discussing a ban on gender reassignment surgery for minors. However, the laws in Switzerland are still liberal. We explain what rights parents and children have.

The issue was launched in Switzerland by Zurich Health Minister Natalie Rickli from the right-wing Swiss People’s Party. In July she called for a national law banning gender reassignment surgery for minors and allowing puberty blockers only for scientific studies.

Now her party colleague Nina Fehr Düsel, also from canton Zurich, has submitted a corresponding motion in Bern. Parliament will therefore have to decide on a ban on puberty interventions in minors.

The issue is ideologically charged, but it affects only a small group. Gender reassignment surgery on minors has increased in Switzerland recently, but is at a low level.

The newspaper 20 Minuten writesExternal link, citing the federal government, that the number of operations increased from seven to 32 between 2018 and 2023. These were all breast operations.

Trans terms

Gender dysphoria refers to the suffering that arises when the gender assigned at birth does not match the gender identity experienced.

Transition refers to the entire process of social (adaptation of clothing, pronouns), legal (administrative change of gender) and/or medical (surgical or hormonal) gender reassignment of a trans person.

Puberty blockers are drugs that temporarily stop or delay physical puberty and are intended to give adolescents time to think about their gender identity without irreversible physical changes (e.g. voice change, breast development) becoming more pronounced.

Hormone therapy is the medical treatment with sex hormones (e.g. testosterone or oestrogen) with the aim of harmonising physical characteristics with the perceived gender.

Torsoplasty refers to surgical procedures on the chest, usually to remove the breast (mastectomy) or reshape it (breast reconstruction). The shape of the breast can be corrected later, but the procedures are considered irreversible because they change the breast structure. A mastectomy, for example, leads to the loss of the ability to breastfeed.

Genital operations include the construction of a vagina for trans women (neovagina) or, in the case of trans men, the construction of a penis (phalloplasty) or the lengthening of the clitoris to form a small penis (metoidioplasty). There are also procedures on the testicles, urethra, ovaries and uterus.

To date, there is no specific law in Switzerland that regulates the treatment of adolescents with gender dysphoria. The legal framework is complicated, and practice is not standardised.

So what applies today, what rights do parents and children have and what is the treatment practice? Here are answers to the most important questions.

Who decides on gender reassignment, the parents or the child?

That depends on the individual case. In Switzerland, children and teenagers can make their own decisions about medical interventions, even against their parents’ wishes. This principle also applies to gender reassignment surgery. However, the prerequisite is that they are capable of judgement.

What does ‘capable of judgement’ mean in relation to gender reassignment surgery? 

The term is relative. The capacity of judgement depends on personal maturity as well as the medical measure, and its assessment is subject to medical clarification.

There is no legally binding age limit at which the capacity for judgement is assumed. However, the Swiss Academy of Medical Sciences specifies key values in its medical-ethical guidelinesExternal link.

According to these guidelines, a minimum age of seven is appropriate for minor medical decisions. For simple interventions, 12, and for complex treatments, 16, are considered the reference points. Sex reassignment surgery and the administration of puberty blockers fall into this third category.

Does gender reassignment surgery require the capacity of judgement?

The National Ethics Committee issued extensive recommendations External linkon the treatment of minors with gender dysphoria in 2024.

According to these recommendations, irreversible measures, i.e. gender reassignment surgery, always require the affected person to have capacity of judgement. Even if the parents would agree, those affected must wait with an intervention until they are considered capable of judgement in the specific case.

The administration of puberty blockers, on the other hand, is considered reversible and is possible before the person reaches the age of judgement. The prerequisite here is that the person concerned wants this, that the parents consent and that there is a medical indication.

The rate of trans people who regret an intervention is low, but the study situation is not yet optimal. Nadja Brönimann told us what it’s like to regret transitioning:

What happens in cases with divorced parents who do not agree?

The authorities have a say. If divorced parents have joint parental responsibility, which is the norm today, they must both consent to serious medical interventions if their minor children are not yet capable of judgement.

If the parents cannot agree, the child and adult protection authority can be called upon. It will examine what is in the best interests of the child and can delegate the decision-making power in the case to one of the parents.

Does clinical practice in Switzerland deviate from the legal framework?

In short, yes. To understand this, you have to look at two points. First, Switzerland has a liberal legal framework for gender reassignment surgery that relies on medical expertise. This goes so far that the federal government explicitly rejects the development of treatment guidelines.

Second, the Ethics Council states in its recommendations that the “withholding of a medically indicated treatment desired by the person with capacity of judgement in primary care is ethically impermissible”.

Despite this starting position, gender reassignment surgery on minors is extremely rare in Switzerland. The procedures are generally limited to torsoplasty, i.e. changing the shape of the breast. On the other hand, most clinics refuse to perform surgery on the primary sexual organs of minors.

Do doctors have to inform parents about the treatment?

If children are not yet capable of judgement, parents must always be involved in the treatment decision. However, adolescents who are capable of judgement have the right to information. Their treatment is subject to medical confidentiality.

In a guideline, the Swiss Medical Association advises doctors to release themselves from their duty of confidentiality – wherever there is no breach between parents and children – in order to be able to share information with parents.

Are there any known cases of parents and children arguing about treatment?

Cases in which parents reject their child’s transition and attempt to legally prevent it have only been publicised a few times in Switzerland.

The best-known example comes from Geneva, where a 13-year-old girl wanted to start transitioning in 2022. The parents refused puberty blockers and demanded psychological counselling. The girl was separated from her parents by order of the authorities. A Geneva court later ruled that the parents could no longer prevent their child’s gender reassignment from the age of 16.

The case was followed by the conservative Christian organisation ADF International and used for propaganda worldwide.

Is there any criticism of medical facilities?

In 2024 parents made public accusations against several institutions specialising in the treatment of children and adolescents with gender dysphoria.

In four out of nine cases, the criticism was aimed at the Clinic for Child and Adolescent Psychiatry in Zurich, which was accused of acting prematurely and putting parents under pressure by emphasising the suicide risk in trans children. The clinic denied the allegations.

The parents wrote a letter to the cantonal doctor and Natalie Rickli, who subsequently commissioned a report and went to the media in 2025 calling for a national ban.

Can minors decide on administrative gender changes themselves?

Administrative gender reassignment requires the person concerned to be capable of judgement. According to the federal government, this is generally assumed for this specific decision from the age of 12. 

However, those who are under 16 must also have the consent of their parents. From the age of 16, the decision lies solely with the person concerned, if they have the capacity of judgement.

Since January 1, 2022, it has been possible to change the administrative gender in Switzerland with little effort, and interest is high.

How does Switzerland compare internationally when it comes to gender reassignment surgery?

On paper at least, Switzerland is one of the most progressive countries when it comes to dealing with surgery for trans adolescents. In practice, however, openness is limited to “top surgeries”, i.e. operations on the breasts.

The current discussion about a ban follows the example of other formerly progressive countries such as Norway, Sweden, Denmark, Finland and the UK, which have tightened their guidelines and now only allow transition surgery on minors in exceptional cases. These countries have also restricted the dispensing of puberty blockers.

What is your opinion? Join the debate:

Edited by Balz Rigendinger. Translated from German by DeepL/ts