Trans in the Medical System

Not every trans or non-binary person needs or wants medical services to change their own body. Whether and to what extent young trans and non-binary people make use of these services is entirely up to them.

Only the person in question can determine what feels good and right for their individual situation. For some people, comparatively easy-to-obtain aids already bring euphoria and relief. Other people strive for medically-induced solutions to align their external appearance with their gender identity.

The young trans or non-binary person in your care may have already thought very long and thoroughly about possible medical steps. Or they may be faced with seemingly unmanageable difficulties and, because of this, may entrust you with this information.

The use of medical services, what kind and to what extent, should not be important at first. Instead, it is of great importance to create a supportive environment for trans and non-binary children and teens to access health carefree of fear and discrimination. In this regard, you as a caregiver or family member can provide critical support in everyday life.

Being mindful and reducing personal fears

You might be worried about the young trans person close to you. You might be afraid that irreversible decisions happen rashly and prematurely. Or you have a hard time letting your child or young family member take responsibility for their own physical and mental health.

Don’t be ashamed of your worries and fears. But don’t make the mistake to unload your stress and anxiety on the young trans or non-binary person in your care. Talking to health insurance representatives and doctors usually already poses a great challenge for them. Try to connect with your own negative emotions. Talk to people who have shared similar experiences. More information on taking care of your own emotional response can be found here. 

Having your support as an ally when dealing with health care and doctors, can be of immense value to a young trans or non-binary person.

Non-medical tools

The young person may (also) want to make use of non-medical tools that can alleviate body-related dysphoria and/or enhance their own well-being, for example by changing their clothes or experimenting with makeup.

In other areas, your child or family member may need more support: good quality binders, packers, or chest pads are often expensive or only available in specialised stores and online shops.

The cost of certain equipment, such as breast binders or epitheses, may in some circumstances be covered by health insurance. A little practice is sometimes necessary when using it. More information on tucking and binding can be found here: (only in German language) 

Keeping their personal boundaries and privacy in mind, you can offer the trans or non-binary person in your care assistance in researching or obtaining the appropriate materials.

Diagnoses and treatment guidelines

Trans and non-binary people often face discrimination in the health care system as well. To this day, trans people in Germany are still diagnosed with “transsexualism” and “gender identity disorder”. 

Fortunately, this outdated and pathologizing diagnosis could soon become a matter of the past: the diagnostic classification system, called ICD, has already been revised to this end. With the release of ICD-11 (the 11th version of the WHO's International Statistical Classification of Diseases and Health Problems) in January 2022, long overdue updates have been made: the pathologizing classifications were replaced by the diagnosis of ”Gender Incongruence” (i.e. the permanent lack of congruence between assigned sex and gender identity). 

Correspondingly, the diagnosis for children and adolescents in ICD-11 has also been updated to “Gender incongruence of childhood”.

However, there is still a long way to go before the ICD-11 is introduced in Germany. A concrete date has not yet been set.3 Nevertheless, these new developments are another important step towards destigmatisation of trans and non-binary people. 

An important document for the enforcement of a proper and fair treatment of trans and non-binary patients in childhood and adolescence is the so-called S3 guideline Gender Dysphoria in Childhood and Adolescence, Diagnosis and Treatment of the Association of the Scientific Medical Societies (AWMF).4 It contains, for example, recommendations for the treatment of trans-specific health issues. 
Adult trans people can refer to the S3 guideline Gender Incongruence, Gender Dysphoria and Trans Health.6. The German Trans Association (BVT*) has created a guide (German only) for everyone seeking treatment.

On the one hand, the guidelines are an orientation for health care personnel and, on the other hand, a tool in the hands of patients and their families for asserting claims and demands from the health insurance. The guideline for children and adolescents is currently being revised.

Overview of trans-specific medical services

Complementary psychotherapy

The purpose of complementary therapy is to help establish diagnoses and indications for possible upcoming hormone therapies and surgeries.4
These are currently necessary in order to later apply for coverage of the costs of additional surgeries by the health insurance.

A good therapist supports trans patients respectfully and informs them about different treatment options and possible consequences. If desired, the patients are given a safe space to test and reflect on their own (gender) identity. A therapist can also offer support in dealing with the social environment, for example with family, friends or school. 

The costs for this therapy are covered, provided that it is carried out by a therapist who is registered with a health insurance (owns a “Kassensitz”).

Medical equipment

Medical equipment includes, for example, binders (medical compression shirts), or breast and genital epitheses.

Hormone therapy

These types of treatments include estrogen and testosterone therapies and hormone blockers (puberty blockers).

Gender reassignment surgery

Epilation (body hair removal) 

Speech therapy (voice therapy)

Health and prevention

Access to good health care is often fraught with barriers and obstacles for trans people. Feelings of shame, negative past experiences or fear of misgendering or other discrimination can cause trans children and adolescents not to attend important appointments or examinations.

In order to provide initial support for a self-confident and responsible approach to one's own health, the organisation LaKo Trans* NRW has published the brochure Vorsorge und Trans* Gesundheit by trans people for trans people, which is available in German.

It contains information on common routine and preventive examinations as well as tips for a stress-free before, during and after.

Medical care for trans people without German citizenship

Every person with a German residence permit also has access to legal health insurance in Germany. In theory, they are entitled to the same medical treatment that people with German citizenship are entitled to.

If an asylum procedure has not yet been completed or if an asylum application has been rejected, medical care is only covered to a limited extent. Counselling services or a therapy place, for example, can be sought out in such cases. This means, however, that for young trans and non-binary people in the asylum seeking process, hormone treatment or other health services might only be paid for under certain circumstances. 

Counselling centres for queer people with refugee and/or migration background can provide further support:

Working together to achieve better care for young trans and non-binary people 

By familiarising yourself with the options offered by the German medical system, you can be a valuable asset to trans and non-binary people in your community. 

It is important to listen to the needs of each individual person and to create safe spaces for trying things out, reflecting and - if needed – sharing experiences. 

Contacting queer communities or a queer*- or trans-specific counselling centre can also be helpful.