A 16-year-old Spaniard has had a sex change operation, becoming the country's first minor to undergo a procedure that few countries in the world allow for people so young.
The two-and-a-half hour surgery was performed in Barcelona three weeks ago and the patient is doing fine, said reconstructive surgeon Ivan Manero, the patient's doctor.
Dr Manero said the patient had been undergoing hormonal and psychiatric treatment for two years after deciding he wanted to undergo surgery to have the body of a woman.
The boy "said he felt like a woman from the age of four or five," said Dr Manero. The patient's name was not disclosed.
The surgery was authorised by a judge, as required by Spanish law for minors seeking such an operation.
Probably fewer than 50 sex change operations are carried out each year in Spain, said Monica Martin, founder of the Spanish Association of Transsexuals.
The association's position on minors is that they should think very carefully before undergoing such surgery.
"We are not against it, but it is a life-changing decision," said Ms Martin. "It is a good idea to wait until the person has achieved maturity, legal and otherwise."
The World Professional Association for Transgender Health, based in Minneapolis, Minnesota, sets US guidelines for when to offer sex changes that many Western countries follow. According to their guidelines, surgeries should not be carried out prior to adulthood, or prior to a real-life experience of at least two years in the gender role of the sex with which the adolescent identifies. It said the threshold age should be 18.
In Spain, regional governments run their own health care systems and three of them - Catalonia in the northeast, the province which includes Madrid, and Andalucia in the south - pay for sex change operations. In this case, the boy's family paid for the surgery in a private facility. No state-run hospital in Spain performs the procedure on minors.