Last month, France became the first country in the world to remove transsexualism from its official list of mental disorders, reports Time magazine in what is being considered a major, though some say largely symbolic, victory.

In practice, according to the author of the Time article, Gaelle Faure, this change “will do little” to improve the legal and medical rights of transsexuals in the country, as they will “still be required to have a sex-change operation before they can change their gender in the eyes of the law.”

And to get the green light for surgery, they must still undergo extensive medical and psychiatric evaluations. “It’s a symbolic victory,” says Georges-Louis Tin, president of the Paris-based IDAHO committee, which fights homophobia and what it calls “transphobia,” or discrimination against transsexuals. “Transsexuals are no longer mentally ill,” he says. “They’re normal citizens. But we haven’t yet reached the point where they’re allowed to make their own decisions instead of depending on doctors and psychiatrists.”

While some celebrate the change as a first step, others are worried that by taking this step the French government hopes to avoid debates such as those on gay marriage.

And France is still far from a paradise for transsexual citizens.

As the Faure notes:

A just-released study commissioned by the Health Ministry, for example, paints a dreary picture of the treatment of transsexuals from a legal and medial standpoint. Sex-change surgeries and treatments are covered by the state — as in some other countries — but those who opt for surgery have little choice in selecting their doctor. Surgeons complain that they are poorly equipped to perform the complicated procedures and that few have received specialized training, according to the survey. And some even say they are ostracized by their colleagues if they perform such surgeries. For these reasons, many transsexuals choose to undergo the procedure — at their own cost — across the border in Belgium, home to some of the best sex-change specialists in the world.

And France still requires that transsexuals undergo surgery — and become sterilized — before they can receive identity cards and other official documents confirming their new gender. “If we refuse, we’re basically undocumented,” says one advocate. “According to most advocates,” writes Faure, “about half of transgender people — a term many prefer, though the French state doesn’t use it — have no desire to go under the knife, preferring instead to simply live their lives as a member of the opposite sex in their dress and behavior.”

“This will be the next big battleground,” writes Faure.

Spain and Great Britain have adopted more lenient stances, even though transsexualism is still technically on the books in both countries as a mental illness. Spain requires transsexuals only to undergo some form of hormonal treatment to modify their physical appearance before it will issue new documents, while the British simply ask applicants, with recommendations from their doctors, to promise to live out the rest of their lives as their chosen sex.