The existing law requires a diagnosis of gender dysphoria and two years of medical treatment for "accommodating physical characteristics to the ones corresponding with the claimed gender." That often means taking cross-sex hormones.

https://www.boe.es/buscar/pdf/2007/BOE-A-2007-5585-consolidado.pdf
Nearly 20 countries, eight of them in the EU, already have laws that require no diagnosis, medical treatment or judge for changing one's registered gender — similar to the proposal by Unidas Podemos, the far-left partner in Spain's coalition govt https://ilga.org/trans-legal-mapping-report
Factions of the Catholic Church and the far-right have focused their opposition to the bill on the fact that it also would allow children under 16 to bypass parental objections and seek a judge’s assistance in accessing treatment for gender dysphoria.
The veteran Socialist and women’s rights advocate, said:

“I’m fundamentally worried by the idea that if gender can be chosen with no more than one’s will or desire, that could put at risk the identity criteria for 47 million Spaniards. It has to come with certain guarantees."
“The problem is that, in democracy, rights are never absolute, they always have limits because they have edges that collide with others’ rights," Calvo told Cadena SER.
Opponents argue that allowing people to choose their gender would lead to “erasing” women from the public sphere: if more Spaniards registered male at birth switch to female it would skew national statistics and create more competition for everything from jobs to sports trophies.
The divide in Spain mirrors a debate between a branch of feminist theorists and LGBTQ rights movements around the globe.
At one end, activists often derogatorily referred to as TERFs (trans-exclusionary radical feminists) posit that the advancement of transgender rights could undercut efforts to root out sexism and misogyny by negating the existence of biological sexes.
The State Federation of Lesbian, Gay, Transgender and Bisexual people @FELGTB says that if passed in its current form, the law would help end discrimination against transgender people and leapfrog Spain to the European vanguard of protecting LGBTQ rights.
The bill sponsored by Equality Minister Irene Montero nonetheless has provoked unusual fury on online platforms, where critics express alarm over provisions that would assign public toilets and prisons according to “registered gender.”
Confluencia Feminista @ConfluenciaMF, an alliance of dozens of women’s rights organizations, also has come out against any changes to Spain’s existing law.
The concern of activist Alexandra Paniagua pivots around the idea that by eliminating the opinions of doctors and judges, state-subsidized hormones and gender reassignment surgery would become more available, ultimately “promoting” more dysphoria among young people.
“More people will see easier access to the invasive treatment, especially girls who have been told that their bodies are less worthy in our society,” Paniagua said.
But Trans Platform Federation @PlataformaTrans President Mar Cambrollé argues that some of the fears cited as reasons to keep existing hurdles are based on outdated ideas that reduce boys and girls, men and women to a handful of socially prescribed characteristics and roles.
“Transphobic attitudes piss me off,” Cambrollé said. “As a woman, I’ve been discriminated against for being a woman in a world made by men for men, but also by cis(gender) people who build it with other cis people in mind.”
Finding a compromise looks like an insurmountable task judging by the virulence of the debate online. For many, it's also part of a dispute for the hegemony of the message in the feminist movement. And in Spain, that's coming weeks away from International Women’s Day on March 8.
But what for many is a theoretical debate is painfully real to Victòria Martínez, who has closed most of her social media accounts. She says the constant chatter feels both too “personal” and “perverse, generalizing about what a trans person is.”
Martínez continues to sign official documents with the name that she, her partner and their two daughters ditched four years ago. Barring any surprises, she expects the Spanish government to recognize her as Victòria by May, closing a patience-wearing chapter.
Changing her legal identity at a civil registry office in Barcelona will allow Martínez to update her passport and driver’s license and to carry a health card that correctly states she is a woman. But the process, which the pandemic prolonged, has been “humiliating."
“Did I want to be stigmatized by being labeled as crazy? Did I want to voluntarily apply for a shrink’s report that says so, to have a judge decide whether I can be what I already am?” Martínez, 44, recalls asking herself. “The whole thing has been emotionally exhausting.”
To come out as transgender, first to herself and then to her partner, required Martínez to grow a kind of confidence that wasn’t part of growing up as a boy in 1980s Spain. There were suicide attempts before she started living as Victòria, and she doesn’t consider herself brave.
Yet Martínez hesitated over taking hormones and updating her civil registry record. She fought hard to be proud of the woman she is, with a deep voice and a way of carrying herself that stands out. Didn’t she want to break with traditional gender molds?
“Unfortunately, to this day, it’s still easier for people to reconcile a certain type of face with a pair of tits,” said Martínez, who wears round-edged glasses and her hair in a bob to soften her sharp facial contours.
In the end, she decided it would be easier to navigate the world with a more socially conforming appearance and an identity card that confirms she is female, even if that meant bowing down to existing legal requirements and the notions of people who still think in binary terms.
“I lived 40 years in hiding,” Martínez said.

“Now I protect myself, but I don’t hide.”
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