What worries activists and human rights advocates here is legislation in many European countries that forces individuals to undergo sterilization to be officially recognized as transgender. While transgender people are not forced to choose sterilization — and some do not — those who don't have their preferred genders legally recognized face an array of problems.

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"Legal gender recognition is also an essential element of other fundamental rights," Human Rights Watch wrote in its annual report for 2016, "including the right to privacy, the right to freedom of expression, the right to be free from arbitrary arrest, and rights related to employment, education, health, security, access to justice, and the ability to move freely."

Those affected are also forced to explain to airport personnel, bank employees and others why their physical appearance does not match their official gender. The resulting embarrassment, human rights campaigners argue, may stop many people who identify as transgender but do not want to be forced into sterilization from coming out.

Transgender people are also required to be diagnosed with "gender dysphoria" in several European countries before being able to officially change their gender identity — another practice that has been harshly condemned. The World Health Organization listed "gender dysphoria" as a mental illness until last year, when the term was dropped.

Human rights group Transgender Europe (TGEU) has been leading efforts to fight the rules, which were in place in at least 17 European countries as of last year. Eleven of those countries are members of the European Union: Belgium, Finland, Latvia, Lithuania, the Czech Republic, Slovakia, Slovenia, Romania, Bulgaria, Croatia and Greece.

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TGEU communications officer Mina Tolu said the group is optimistic that things are changing for the better, as some countries have recently softened their stance on the issue. France dropped its rule requiring sterilization last year, following Norway, Ireland and other nations. "Slowly but surely there is a shift towards self-determination and the removal of discriminatory requirements to access a change of documents like birth certificates, identity cards or passports," Tolu said.

The Swedish government went further when it announced last April that it would pay compensation to transgender people who were forced to undergo sterilization before the law was dropped in 2013. "No other country has yet taken that up," Tolu said.

But despite growing criticism, supporters of strict gender-change laws say that sterilization remains necessary to make sure individuals seeking to change their gender are serious about their plans.

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It's an argument that is unlikely to last much longer, transgender rights advocates argue. Nearly all countries where lawmakers have recently taken a closer look at existing legislation opted to overrule it. The problem, they say, is a lack of public debate in the nations where such laws persist.