OPINIONS AND RECOMMENDATIONS OF THE FRENCH CGLPL 3. Recognition of transsexualism in France Care provision There are currently a number of specialist multidisciplinary teams working not only in the public hospital service but also in private practice. Owing to the lack of a consensus on the care procedure to be implemented and following a request from the Ministry of Health, the organisations representing transsexuals and the sickness insurance funds, the High Authority for Health proposed24 on the one hand the official setting up of multidisciplinary reference teams responsible for the assessment and overall management of transsexuals, and on the other, the implementation of a care procedure (differential diagnosis, real-life experience, hormone substitution and re-assignment surgery if appropriate). Modification of civil status records In two judgments of 11th  December 1992 marking a reversal of precedent (Marc X. and René Y. cases), the plenary assembly of the Court of Cassation allowed the modification of a person’s civil status records subject to four cumulative conditions being met: • • • • Gender dysphoria syndrome must have been medically certified; The person must adopt the social behaviour of the preferred sex; The person must have undergone medical and surgical treatment; The change of gender must be certified by a court expert. The requirement with regard to a gender reassignment operation has been challenged inter alia by the Council of Europe Commissioner for Human Rights,25 who recommended that changes in civil status should no longer be subject to an obligation to undergo medical or surgical treatment. In a circular of 14th May 2010, the Minister for Justice and Freedoms informed public prosecutor’s offices that they can give a favourable Situation actuelle et perspectives d'évolution de la prise en charge du transsexualisme (Current situation and prospects for change in the management of transsexualism), HAS, report published on 18th February 2010 (www.has.fr). 25 Issue paper on “Human rights and gender identity” 2009 (www.coe.int). 24 50