6.  The applicant was born in 1987 and lives in Skopje. 7.  At birth the applicant was registered as a girl, with a clearly female name. The applicant submitted that from an early age he became aware that he was male rather than female. Not being able to obtain appropriate medical treatment in the respondent State, in 2010 the applicant went to a specialist clinic in Belgrade, where a psychologist and sexologist diagnosed him with “transsexuality”. A medical certificate dated 20 September 2010 included a recommendation that the applicant pursue hormone treatment with a view to eventual genital reassignment surgery. The applicant started taking hormones to increase his testosterone levels. 8.  On 1 June 2011 the applicant applied for a change of his first and family name. In a decision of 7 June 2011 the Ministry of the Interior allowed that application, registering the applicant under a clearly male forename (the applicant also changed his surname). Soon after, it issued the applicant with a new identity card bearing his new name. However, the sex/gender marker and numerical personal code (composed of ten digits, some of which indicate the person’s sex) remained the same, identifying the applicant as a female. 9.  On 5 July 2011 the applicant lodged an application to have the sex/gender marker and the numerical personal code on his birth certificate corrected (корекција) to indicate that he was male. In support of his application he submitted copies of a medical report by a surgeon at the specialist clinic in Belgrade (see paragraph 7 above) and referred to the paper entitled “Human rights and gender identity” of October 2009 issued by the Commissioner for Human Rights of the Council of Europe (see paragraph 34 below) and the Yogyakarta Principles on the Application of International Human Rights Law in Relation to Sexual Orientation and Gender Identity. 10.  In a decision of the same date, the Civil Status Registry (“the Registry”) – a body within the Ministry of Justice (“the Ministry”) ‑ dismissed the applicant’s application, stating that “no certificate [has been] issued by a competent authority [attesting to the fact] that [the applicant’s] sex [had] been changed, the application having been corroborated only with a certificate that gender reassignment surgery [was] in preparation, which cannot be regarded as proof that it [would] take place.” 11.  The applicant appealed to the Ministry, alleging that there was no statutory provision that regulated the matter in hand. Sex reassignment surgery was unavailable in the respondent State and unjustified in his case. Furthermore, such a requirement would subject him to unwanted medical treatment and sterilisation, in breach of his rights. He argued that he had already been diagnosed as transsexual, which was sufficient to obtain legal gender recognition. In a decision of 17 October 2011 the Ministry dismissed the appeal, finding that the impugned decision had been based on section 23 of the Civil Status Registration Act (Закон за матичната евиденција) (“the Act”; under the 2016 amendment this provision became section 22(2) – see paragraph 25 below) and that the evidence produced had not been “sufficient and relevant” in respect of the alteration (промена) sought. 12.  In November 2011 the applicant challenged the refusal of the lower administrative authorities to modify his sex/gender marker on the birth certificate before the Administrative Court. He argued that there was no statutory provision proscribing or specifying any conditions for the alteration of a person’s sex/gender marker and personal code. 13.  On 28 February 2013 the Administrative Court quashed the Ministry’s decision. Since the applicant’s request had not been in the case file, the court could not ascertain whether the applicant had sought the rectification or alteration of the sex/gender marker only or also of the personal code, the latter having not been addressed in the impugned decision. It also held that the Ministry should have specified the appropriate evidence required and set a time-limit for the applicant to provide it. Lastly, the court found that the Ministry had neither established the relevant facts nor provided adequate reasons for its decision. In this connection it held that section 23 of the Civil Status Registration Act did not specify any requirement to have the sex/gender marker changed; it only contained an instruction to administrative authorities regarding the evidence to be adduced and assessed in such proceedings. 14.  On 11 June 2013 the applicant underwent a double mastectomy (breast removal) in Belgrade and continued his hormonal therapy. 15.  In the resumed proceedings, the Registry instructed the Forensic Institute (Институт за судска медицина) to examine the applicant. As reported in the Registry’s decision (see paragraph 17 below), on 20 June 2014 the Forensic Institute drew up a report, which stated: “[O]wing to his mastectomy and on-going hormonal therapy, [the applicant] displays male sexual characteristics which affect his everyday life. Although there is no statutory regulation ... and the second genital surgery has not been carried out, [the experts] consider that [the applicant] should be provided with a document attesting to his new sex ...” 16.  The Registry also requested that the Ministry of Health specify the nature of the certificate and the authority competent to attest to the change of the applicant’s sex. In reply, the Ministry of Health stated that the sex alteration procedure was not specified in health-related regulations and suggested that evidence regarding prior medical intervention in respect of the applicant should be taken into consideration. 17.  On 29 December 2014 the Registry, referring to section 23 of the Act, dismissed the applicant’s request for the alteration of the sex/gender marker on the birth register, holding that despite its requests to competent authorities it had not obtained “evidence of an actual change of sex (не прибави доказ со кој ќе утврди фактичка состојба која укажува на промена на полот)”. 18.  The applicant appealed against that decision. On 16 October 2015 the Ministry dismissed the appeal and upheld the decision of the Registry. 19.  On 11 November 2015 the applicant challenged the latter decision before the Administrative Court, arguing that section 23 of the Act did not specify any requirement for an alteration of the sex/gender marker in civil ‑ status documents. He furthermore submitted that the Registry had authority to administer civil-status records and accordingly to decide on the matter. The applicant also referred to the Court’s case-law on the matter. 20.  On 28 April 2017 the Administrative Court set aside the Ministry’s decision since it had failed to forward the case file. 21.  On 28 February 2018 the Registry rejected (отфрла) the applicant’s application for lack of jurisdiction (ненадлежност), holding that it did not concern the rectification of an error in an entry, but the alteration of the sex/gender marker in the civil status register. On 13 July 2018 the State Commission, which had become competent to decide such issues in second instance, upheld that decision. The proceedings before the Administrative Court are underway. 22.  The applicant submitted several reports from 2012 and 2016 in which psychologists had found that the protracted procedure in respect of seeking legal recognition of the applicant’s gender identity was having negative consequences on his psychosocial and mental health and everyday life.