When submarine captain John Remø received a call from his wife to ask about a bag of women’s clothes she had discovered in the cellar of their home, he feared his secret would end his career.

It was a secret the Norwegian naval officer, then in his late 20s and on duty in the Barents Sea at the height of the Cold War, dared not reveal over a military line.

That night Remø wrote to his wife, and shared the burden he had kept to himself for as long as he could remember.

“I knew at the age of four that I was a girl, not the boy that I was born as,” Remø said. “But I had to be tough, fight and act like a boy. I didn’t like it, yet I had a role to play.”

It was an act that Remø kept up until five years ago when, having just turned 60, the former captain decided to start living openly as a woman and be recognised as transgender.

Amnesty International estimates that as many as 1.5 million people across Europe are transgender, a term used to describe men and women who feel they have been born into the wrong body.

While many European countries are becoming more accepting of transgender people, there is still a long way to go before they are granted equal legal rights, campaigners say.

Norway is often ranked as one of the world’s most progressive nations when it comes to human rights.

Yet it is one of 19 European countries, including France, Belgium and Italy, that require transgender people to undergo genital removal surgery and sterilisation before they can legally change gender, according to human rights organisation Transgender Europe (TGEU).

Sitting in her apartment in Oslo, Remø, who goes by the name John Jeanette to highlight the legal plight of transgender people in Norway, is adamant that changing one’s legal gender should not be dependent on medical intervention.

“I refuse to be operated on to be recognised as who I am,” she told the Thomson Reuters Foundation.

In many European countries like Norway, the requirement of sterilisation, known in the Nordic nation as a ‘real sex conversion’, is based on an administrative practice from the 1970s, and has no legal basis.

“Some insist that sterilisation is necessary because it proves that people are serious about changing gender,” said Richard Köhler, senior policy officer at TGEU.

“There is also the belief that if someone, who is legally a man, became pregnant and gave birth to a child, this could be a threat to social order and shake up basic perceptions of gender,” he told the Thomson Reuters Foundation by phone.

Not all countries in Europe require sterilisation or surgery in order to legally change gender.

But the majority, including Germany, Spain and Britain, demand a psychiatric diagnosis of gender dysphoria or trans-sexualism.

This is classified as a mental illness by the World Health Organisation.

The WHO plans to declassify transsexualism – defined as discomfort with the body a person is born with and a desire to live as the opposite sex – as a mental illness, which activists say results in stigmatisation of transgender people worldwide.

Transgender people also tend to face greater levels of discrimination and violence than lesbian, gay and bisexual communities because gender identity is often poorly understood compared to sexual orientation, campaigners say.

Malta became only the second European nation, after Denmark, to allow transgender people to change legal gender without medical intervention

In Europe, transgender people are twice as likely as gay people to be attacked, threatened or insulted, according to a Europ-ean Union report published in December 2014.

From going to the library and visiting the doctor to picking up a parcel or boarding a plane or train, everyday tasks can prove publicly humiliating for transgender people when their documents do not match their gender identity.

The medical process for transgender people seeking state-funded treatment to change legal gender can take up to a decade in Norway, according to transgender activist Luca Dalen Espseth.

Yet the majority of those who want to take hormones or have surgery are denied the required diagnosis of transsexualism from healthcare professionals, who often treat transgender people with hostility and suspicion, he said.

At the Oslo office of LGBT organisation LLH, Espseth recalls his visits to the Oslo University Hospital, the only facility in Norway where transgender people can receive medical treatment.

“The doctors addressed me as female, doubted my history and identity, and asked very intrusive questions about my sex life,” Espseth, 28, who was born female and transitioned to a man in his early 20s, told the Thomson Reuters Foundation.

Espseth went through eight appointments in one year at the hospital before he received the diagnosis of transsexualism that allowed him to receive the hormone treatment he desired, although, like Remø, he refuses to be sterilised.

“I feel like I’m deprived of my right to legal gender recognition just because I choose to exercise my right to refuse medical treatments,” he said.

“Why should someone else determine our identity?”

Despite the struggle to change legal gender in Europe, campaigners say transgender rights are gaining more attention.

“Five years ago we had to explain to most policy-makers what being transgender meant; now it is about how to enact change and improve trans rights,” said Evelyne Paradis, executive director of ILGA-Europe, a network of European LGBT groups.

On the first of this month Malta became only the second European nation, after Denmark, to allow transgender people to change legal gender without medical intervention, and Köhler from TGEU hopes this will influence other countries to follow suit.

“Rule of law is vital. It sends a message to trans people as to whether they’re seen as equal citizens or seen as backward and needing to be protected from themselves,” he said. “But laws can only go so far, to change mentalities takes time.”

In Norway, expert groups have been set up to assess whether the requirement of sterilisation should be removed and consider what criteria should apply to change legal gender status. They will deliver their findings to the government this month.

Having waited her whole life to be recognised as a woman, Remø is hopeful a new law will be passed this year, allowing transgender people to determine their own identity.

“It would give so many transgender people, who are still in the closet, the confidence to come out and be themselves,” she said.

To watch the video of John Jeanette’s story please go to https://www.youtube.com/watch?v=k5zgoOdhrJY .