Activists and academics who have tracked gender identity laws and customs worldwide said Thursday that no other country has gone so far to embrace gender self-determination. In the United States and Europe, transgender people must submit to physical and mental health exams and get past a series of other hurdles before getting sex-change treatments.

Argentina’s law also is the first to give citizens the right to change their legal gender without first changing their bodies, said Justus Eisfeld, co-director of Global Action for Trans Equality in New York.

“The fact that there are no medical requirements at all — no surgery, no hormone treatment and no diagnosis — is a real game changer and completely unique in the world. It is light years ahead of the vast majority of countries, including the U.S., and significantly ahead of even the most advanced countries,” said Eisfeld, who researched the laws of the 47 countries for the Council of Europe’s human rights commission.

Marcela Romero, who was born a man but got a sex-change operation 25 years ago, spent 10 years arguing in Argentina’s courts before a judge ordered the civil registry to give her a new identity card listing her gender as female.

“It’s something humiliating … many of us have had to endure psychiatric and physical tests,” she told The Associated Press on Thursday. “With this law we’ll no longer have to go through this.”

Romero, 48, said she personally knows 40 people who had to get judicial approval for sex-change operations, and are still on waiting lists. The law should help them get the treatment they need, she said.

Romero leads the Argentine Transvestite, Transsexual and Transgender Association, whose legal team helped draft the law with help from an international coalition of activist groups pushing for governments to drop barriers to people determining their own gender identity. None of those groups have managed to find politicians willing to go as far as Argentina’s, however.

“This law is saying that we’re not going to require you to live as a man or a woman, or to change your anatomy in some way. They’re saying that what you say you are is what you are. And that’s extraordinary,” said Katrina Karkazis, a Stanford University bioethicist who wrote “Fixing Sex,” a study of the legal and medical boundaries around gender identity issues in the United States.

“Rather than our more sedimented ideas about what it is to be male or female, this sort of throws all of that up in the air in a really exciting way,” she said.

Next up for Argentina’s government is an overhaul of the country’s civil and penal codes, an often-contradictory conglomeration of laws dating back nearly two centuries that cover all aspects of society. Encouraged by the president, congressional commissions representing all leading parties and the Supreme Court are drafting wide-ranging legislation to modernize how the country deals with abortion, adoption, artificial insemination, divorce and many other difficult issues.

The Catholic Church, which had an outsized role in forming these codes over the country’s 200-year history, has opposed many social reforms, and not just those affecting gay, lesbian and transgender people.

“The Argentine lawmakers are introducing profound changes in society that don’t respond to any social demand and without taking into account the real consequences,” Nicolas Lafferriere, who directs the church-sponsored Center for Bioethics, Personhood and Family, complained Thursday in “Religious Values,” an online publication sponsored by the archbishop of Buenos Aires.

“We have found ourselves faced with the most permissive law in the world in this area. Now, to change all the civil registries you don’t need any more justification than a personal desire, based on someone’s self-perception. It won’t be easy to predict the consequences.” Lafferriere warned.

Most Argentines still identify themselves as Catholic, and Catholicism remains the nation’s official religion.

But fewer and fewer Argentines regularly attend Mass, and priests and bishops don’t have the same power of the pulpit anymore. The church has become so weakened politically that the government has treated it more like a useful enemy than a force capable of influencing vast numbers of voters.

The Catholic hierarchy also has been inexorably linked with the military junta that killed as many as 30,000 people during the dictatorship. Both enforced conservative social values at the time.

Karla Oser, 38, underwent hormone therapy before surgeons transformed her male organ into a vagina in 2006, becoming one of only 40 people to have sex-reassignment surgery at a public hospital in the provincial capital of La Plata over the years. But first, she said, she had to present a judge with testimony from two psychologists, a psychiatrist, an ear-nose-and-throat specialist, a gynecologist and a urologist.

Even after her sex-reassignment surgery, she has failed to get judicial permission to update her national identity card to reflect her new gender, according to a public health ministry announcement.

The new law gives her hope, she said: “The operation changed my life and today I’m celebrating that everyone who faces a situation similar to mine can get their surgery without having to make it through the judicial labyrinth I went through.”

The ministry quoted Oser as part of an announcement saying government surgeons are now open for business, ready to provide similar treatment for anyone who decides they want it — no more questions asked.

___

Anita Snow in Mexico City and Almudena Calatrava in Buenos Aires contributed to this report.

Activists and academics who have tracked gender identity laws and customs worldwide said Thursday that no other country has gone so far to embrace gender self-determination. In the United States and Europe, transgender people must submit to physical and mental health exams and get past a series of other hurdles before getting sex-change treatments.

Argentina’s law also is the first to give citizens the right to change their legal gender without first changing their bodies, said Justus Eisfeld, co-director of Global Action for Trans Equality in New York.

“The fact that there are no medical requirements at all — no surgery, no hormone treatment and no diagnosis — is a real game changer and completely unique in the world. It is light years ahead of the vast majority of countries, including the US, and significantly ahead of even the most advanced countries,” said Eisfeld, who researched the laws of the 47 countries for the Council of Europe’s human rights commission.

Marcela Romero, who was born a man but got a sex-change operation 25 years ago, had to spend 10 years making her case in Argentina’s courts before a judge ordered the civil registry to give her new identity card listing her gender as female. “It’s something humiliating … many of us have had to endure psychiatric and physical tests,” she told The Associated Press on Thursday. “With this law we’ll no longer have to go through this.”

Romero, 48, said she personally knows 40 people who had to get judicial approval for sex-change operations, and are still on waiting lists. The law should help them get the treatment they need, she said.

Romero leads the Argentine Transvestite, Transsexual and Transgender Association, whose legal team helped draft the law with help from an international coalition of activist groups pushing for governments to drop barriers to people determining their own gender identity.

Now that gay marriage and sex-changes have been legalized, the government is pushing for fundamental reforms of Argentina’s civil and penal codes, an often contradictory conglomeration of laws that date back more than a century and cover all aspects of society. Encouraged by the president, congressional commissions including members of all leading parties are working with the Supreme Court to draft wide-ranging legislation.

The Roman Catholic Church, which had an outsized role in forming these codes over the country’s 200-year history, has opposed many social reforms, and not just those affecting gay, lesbian and transgender people.

“The Argentine lawmakers are introducing profound changes in society that don’t respond to any social demand and without taking into account the real consequences,” Nicolas Lafferriere, who directs the church-sponsored Center for Bioethics, Personhood and Family, complained Thursday in “Religious Values,” an online publication sponsored by the archbishop of Buenos Aires.

“We have found ourselves faced with the most permissive law in the world in this area. Now, to change all the civil registries you don’t need any more justification than a personal desire, based on someone’s self-perception. It won’t be easy to predict the consequences.” Lafferriere added.

Most Argentines still identify themselves as Catholic, and Catholicism remains the nation’s official religion; the constitution says only Catholics can be president.

But fewer and fewer Argentines regularly attend Mass, and local priests and bishops don’t have the same power of the pulpit anymore. The church but has become so weakened politically that the government has treated it more like a useful enemy than a force capable of influencing vast numbers of voters.

The Catholic hierarchy also has been inexorably linked with the military junta that killed as many as 30,000 people during the dictatorship. Both enforced conservative social values at the time, even determining what names parents could choose for their own children. Even after democracy was restored, parents had to go to court to get special permission for any name that wasn’t on the approved list, where names from the Bible and each day’s saint predominated.

Karla Oser, 38, underwent hormone therapy before surgeons transformed her male organ into a vagina in 2006, becoming one of only 40 people to have sex-reassignment surgery at a public hospital in the provincial capital of La Plata over the years. First, she had to present a judge with testimony from two psychologists, a psychiatrist, an ear-nose-and-throat specialist, a gynecologist and a urologist.

Even after her sex-reassignment surgery, she has failed to get judicial permission to update her national identity card to reflect her new gender, according to a public health ministry announcement. But the law gives her hope, she said: “The operation changed my life and today I’m celebrating that everyone who faces a situation similar to mine can get their surgery without having to make it through the judicial labyrinth I went through.”

The ministry quoted Oser as part of an announcement saying government surgeons are now open for business, ready to provide similar treatment for anyone who decides they want it — no more questions asked.

___

Anita Snow in Mexico City and Almudena Calatrava in Buenos Aires contributed to this report.

“I think it’s very good,” said Angel Robles, a 71-year-old retired taxi driver with terminal esophageal cancer who entered a hospice last week. “If I’m OK, these are things that I have to decide. But if not, I have confidence in my daughter.”

The law was being debated in the Senate after passing the lower house last year. Overwhelming approval was expected in part because the measure expressly forbids euthanasia — actions that provoke death — and instead focuses on the rights of patients and their families. It also absolves doctors of any legal responsibility when they follow the patient’s wishes.

The law applies to the terminally ill as well as patients suffering irreversible and incurable illness or injury, declaring their right to refuse surgical procedures, hydration and nutrition, reanimation and life-support systems. Rather than seek a court order, all they need do is prepare an advanced health-care directive and sign it before a notary, with two witnesses.

The ethical challenges surrounding end-of-life issues become more difficult when the patient can no longer speak for himself and has not prepared such a formal document. In these cases, the Argentine law empowers family members or legal representatives to make the decision on the patients’ behalf.

“This is important because in general Latin America has been very behind on these issues and so it’s nice to see Argentina leading the way,” said Dan Brock, who teaches medical ethics at Harvard University in Cambridge, Mass.

Some lawmakers expressed discomfort about withdrawing feeding tubes or life support to someone who can no longer communicate.

Deputy Julian Obligo of the conservative PRO party pleaded with senators to eliminate this reference, alleging that it amounts to euthanasia by hastening death. Sen. Sonia Escudero, a dissident member of the governing Peronist party, alleged that withdrawing nutrition and hydration could cause pain to a dying person.

Medical and bioethical experts say otherwise — that an abundance of scientific evidence shows that dying people naturally stop eating and drinking for a reason — their bodies are shutting down — and that force-feeding them at that point actually causes pain. In contrast, without food and drink, the metabolism produces substances that actually produce feelings of euphoria.

By withdrawing feeding tubes, “you make their time more comfortable, not less, when they are near death,” Brock said. “All the evidence suggests they are not suffering.”

“This was highly controversial 20 years ago when it began to be debated in the United States, and the Catholic Church still officially opposes it, but here anyway it’s now a matter of accepted medical practice,” Brock added.

“I don’t have a single doubt that we’re doing the right thing here. Of course, without a doubt there are still many other things that need to be done,” said Alfredo Martinez, a senator with the opposition Radical party, which is supporting the measure.

By tipping the balance in end-of-life decisions toward patients and their families, the law should help reform a medical system that has been far too paternalistic, with doctors or judges making decisions that ignore or conflict with the patients’ wishes, said Dr. Isabel Pincemin, the medical director of the Hospice San Camilo, which has cared for hundreds of dying people in a home just blocks from the presidential residence.

“This law is in a way an invitation to all the doctors to take into account the patient’s wishes, but what has to happen now is a cultural change,” she said. “Death is the thing most denied in our society: We have lost the understanding that death is natural, and so we too often try to maintain life even in impossible situations.”

What Argentina needs next is a palliative care law requiring health care providers to support hospices for the terminally ill, she said. There are only a half-dozen hospices in the country of 40 million, and too few people know that dying people are supposed to get pain medicine for free, she said.

“Far too many people are dying horribly bad deaths, alone and abandoned,” she said.

Robles says he’s grateful his doctor pointed him to the hospice, where he now gets close 24 attention for free.

“Hopefully no one will have to suffer,” Robles said, thinking about the law. “Nobody wants to see a person suffer.”