How to get hormones and legally transition in Germany

Legally transitioning in Germany

For anyone who is transgender in Germany or who doesn’t identify with the gender they were assigned at birth, they might consider legally transitioning to have their actual gender better represented on their personal documents. To do this, there are a few things you’ll need to do. 

There are three different genders you can choose legally in Germany: “mänlich” (male), “weiblich” (female), and “divers” (technically considered diverse or other, but we personally like to call it gender non-conforming to include as many people as possible). Divers was the third gender option put into law in 2018 for those that didn’t fit into the standard two-gender model.

Requirements:

• You’ve lived with the name you want to legally change yours to for at least 3 years
• You have a diagnosis as transgender
• You have two psychologists who are willing to vouch for you
• You need to list your regular psychologist as a reference
• You need to send in the letter for a legal name change

Legally, for people who are non-binary, it might not be possible to change their legal name due to the decision made under XII ZB 383/19 that prohibits people who identify as non-binary trans* from changing their name under §45b (the law allowing people who are transgender to change their name legally). You can, however, still try by submitting your application to the German government with the second page of the letter linked in the list above that has been written by a non-profit organization. 

Extended ID for those who are transgender in Germany (Ergänzungsausweis)

The German Society for Transidentity and Intersexuality (Deutsche Gesellschaft für Transidentität und Intersexualität e.V.) has created an ID that allows someone to go by their preferred name and pronouns without being forced to out themselves if they haven’t yet changed their legal name or gender. You can see the ID and more information here. 

While this isn’t a legally binding document, it does help in certain situations, but this unfortunately also depends on the person receiving the ID. If someone requires another form of identification (i.e. student ID, passport, etc.), you’ll need to provide that to them.

Medically transitioning in Germany

While medical transition is not a requirement for identifying as trans*, it’s important to have the resources listed and in English for those who would like to get hormones or gender-affirming surgeries. 

The requirement is an Idikationsschreiben (Indication letter). For this, you’ll need around 6 months of therapy with 12/24 completed with at least 50 minutes per session with a qualified therapist who has a focus on gender identity. Sometimes, these letters are given out earlier depending on the therapist you’re seeing. You can ask online communities or local groups for those who are transgender in Germany for suggestions. 

What medical procedures are covered? (Public health insurance only)

HRT: After you have your Indikationsschreiben (Indication letter), you no longer need to go to therapy for any further procedures. You’ll be able to get a prescription for hormone replacement therapy (HRT) through an endocrinologist (make sure to get a letter from your general practitioner to recommend you to one). 

Bottom surgery: This is also covered by public health insurance, but along with an indication letter, you’ll also need to live as your actual gender for at least one year (at work, at home, at school, etc.). A cost overview from the clinic that will perform the surgery to be sent to your public health insurance provider. And sometimes, you’ll still be required to get two psychological evaluations, but it depends on the clinic. 

Hair removal: This will also be covered, but you need the indication letter and a cost overview to send to your public health insurance. 

Top surgery: This is covered by public health insurance, but you’ll need an indication letter, a cost overview, to live as your actual gender for at least one year, two years of HRT, and proof that after two years of HRT your cup size didn’t grow past an A.

For those wishing to have a mastectomy, the only regulation is an indication letter and an overview of costs. 

FFS, tracheal shave, vocal feminization surgery, shoulder blade shortening, and other surgeries: This is almost never covered by your health insurance, but you can try by putting together as much proof for the surgery as possible along with the overview of costs and a recommendation for the surgery by a licensed doctor or therapist. 

Each private health insurance is different and will decide which procedures are covered in individual cases. We recommend staying on the public healthcare system since switching back to public health insurance might be difficult.

An incredibly short overview of being trans* in Germany

Much of Germany’s literature on its own history of the trans* movement is focused on different political goals, which is hard to pull apart in a non-biased perspective. Instead, we can look objectively at the early 1990s when people began openly pushing for increased awareness for people who identify as transgender in Germany. Still, it was legal to be transgender and there were options available for those who wanted to transition since the 1978 Transsexuellen-Gesetz (TSG) or crudely translated The Transsexual Law. 

This law proved to cause major problems for people who identified as trans*, even if it did offer a bit of false hope. The law allowed people to transition both medically and legally under certain conditions. Two conditions were quite harsh and consisted of medical sterilization (or the proven inability to reproduce) and the second was that the person had to undergo surgery to change their gender. 

There are now people pushing for legal action to be taken against the German government for these requirements with the last two requirements only being changed as late as 2011, meaning anyone before this was directly impacted. 

After 2011, the conversation shifted from removing these two medical requirements to getting rid of the law completely as it categorizes being trans* as an illness. Political activists say that not all things that might need medical treatment are considered illnesses and list pregnancy as an example which the public healthcare system provides support for without the negative categorization. 

The process of going through two specialists to confirm that someone is trans* has also been criticized as highly humiliating with people needing to jump through hoops while also confronting their own dysphoria, as Humboldt University in Berlin noted in 2017 in a document to the federal government. 

A Self-ID law (a law that allows people who are trans* to identify as their actual gender and have access to healthcare without therapy or doctor approval) was brought before the German government in 2021 and was voted on with 186 voting yes and 452 voting no, which means that it will be a few years before the law is put to vote again under different political circumstances. The political parties currently advocating for Self-ID laws in Germany are the Greens, the FDP, the Linke, and the SPD. 

There are currently only a few countries with Self-ID laws in place: Argentina, Malta, Denmark, Luxemburg, Belgium, Ireland, Portugal, Iceland, New Zealand, Norway, Uruguay, and Switzerland. 

Interested in learning more? Our Pride series 2022 can be found on our blog under “Life in Germany.”