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Access to gender-affirming procedures

What do I need to do to get a prescription or funding for hormones, surgery or other gender-affirmingtreatments?

In order to undergo gender-affirming procedures in Germany, first you need to be diagnosed with F 64.0 (until puberty: F 64.2) by a medical practitioner or a psychotherapist. A step by step guide for having your costs covered by a health insurance company is laid out in the German Health Insurance Medical Service (MDS). The guidelines require, among other things, 12 months of psychotherapy (for hormone or epilation treatment) and/or 18 months (for surgery) that ends with a treatment recommendation. In addition, the desired gender role must be tested in all areas of life (also called: “everyday life test”). Sometimes, medical practitioners prescribe hormone specimen without a written assessment by a therapist, including “puberty blockers” for young people.

Getting through the assessment process successfully

The costs coverage process is lengthy, complex and inconsistent as we roughly illustrated in the above picture. So, do contact your local counselling centre early on as they know the current practice in their respective regions and can help you with some tips.

The healthcare provision for transsexual, trans* and/or non-binary people is currently undergoing a major overhaul. New medical guidelines as well as a revised diagnosis by the World Health Organisation (WHO) will make it more needs-oriented and less discriminatory.

The MDS guidelines, however, are still based on a scientifically obsolete understanding of what being trans* is. Critique is directed, among other things, against the mandatory “everyday life test” that puts people choosing a physical transition at high risk, and also has a narrow view of what constitutes a “real” trans* person.

So, if possible, choose a medical practitioner and therapist who has the relevant experience and will use his/her scope for action to work with you towards a self-determined and needs-oriented approach: They will bear in mind potential risks of discrimination when preparing with you for the “everyday life test” and will not treat your gender identity like an illness. Instead they will focus on your needs and concerns during therapy.

Overcoming other obstacles

Some people still have to overcome other obstacles on their way to gender-affirming treatment:

  • Often people with mental illness or cognitive limitations are not taken seriously in the way they feel about their gender identity and their wish to transition. Also, they tend to be vulnerable and more dependent on the support of others. Whether a trans* person has access to the procedures he/she is entitled to depends first and foremost on the professionalism of the relevant specialists and the commitment of family and friends.

  • Those in pending asylum proceedings are entitled to acute treatment in Germany. In most cases they are granted a (continuation of the) hormone therapy.

  • Physical transitions also have ancillary expenses that not everyone can afford. Sometimes, the Job Centre will, upon request, pay for new clothing or binders (auxiliary for a flat breast).

Under such difficult conditions, it is particularly advisable to seek advice and support from counselling centres.