Current Legal Situation for
Transgender People in Germany
Information for Your Journey!
The legal situation for transgender people in Germany has fundamentally changed in recent years. Both the change of first name and gender marker under the Self-Determination Act, as well as the coverage of gender-affirming medical measures by health insurance companies, are subject to clear but separate legal regulations.
For those affected, it is important to know which steps are legally required, which medical requirements apply, and how application and review procedures correctly proceed. On this page, we provide an understandable overview of the current legal situation for transgender people.
What is an assessment needed for?
Change of first name and gender marker – the current legal situation
Since November 1, 2024, the Self-Determination Act has been in effect in Germany. This replaced the former Transsexuals Act. For changing the first name and gender marker, assessments, medical certificates, and court proceedings are no longer required.
The change is now made through a personal declaration at the responsible registry office. After a legally prescribed reflection period, the new first name and the desired gender marker are officially registered. The sole basis is the self-determination of the person concerned.
The distinction between legal recognition and medical measures is important:
For hormonal or surgical treatments, medical indications are still required. However, these have no influence on the change of first name or gender marker and are legally completely separate from it.
How many assessments do you need?
Coverage of gender-affirming surgeries by health insurance
Many transgender patients wonder under what conditions the health insurance covers the costs for gender-affirming surgeries. In Germany, cost coverage is not done through a court procedure, but on the basis of a medical indication.
The prerequisite for the coverage of a gender-affirming surgery (e.g., breast surgery, genital reassignment, or feminizing or masculinizing procedures) is usually a detailed indication letter. This is issued by a licensed psychotherapist, a psychotherapist, or a specialist practitioner and justifies the medical necessity of the planned surgery. This is usually preceded by long-term psychotherapeutic support.
In addition, medical statements, including those from the operating specialist, are included in the application for cost coverage. The statutory health insurance can forward the documents to the Medical Service (MD) for review. Any assessment is carried out there internally – additional assessments usually do not need to be obtained by the patients themselves.
Important to know: The change of first name and gender marker under the Self-Determination Act is not a prerequisite for the coverage of medical measures. Legal recognition and medical treatment are completely separate procedures.
In our clinic, we provide comprehensive support in preparing the application for cost coverage, compiling all required documents, and accompany you transparently through the entire process.
Where do I find an assessor?
Our special added value for our patients
A particular advantage of the Praxisklinik am Rosengarten is the close cooperation with an experienced psychological assessor. Our patients benefit from the fact that necessary psychological statements and indication letters can be created in a structured, professionally sound manner and in close coordination with our medical team. This creates clear processes, short paths, and maximum planning security – especially within the framework of cost coverage procedures with health insurance companies.
Psychological Assessments
& Indication
Cooperation with Dr. Franckenstein
For psychological assessment and medical indication in the context of gender-affirming treatments, we work closely with Dr. Franckenstein.
The cooperation ensures a professionally sound, legally secure, and guideline-oriented creation of psychological statements, as required, among other things, for cost coverage procedures with health insurance companies.
Dr. Sherine Franckenstein
Dr. Franckenstein holds degrees in psychology as well as business administration, thereby combining clinical-psychological expertise with a structured, process-oriented understanding of complex medical and administrative procedures. The advanced training as a psychological psychotherapist as well as the additional qualification as a psychological expert form the basis for methodologically sound diagnostics and reliable assessment creation.
In the course of her doctorate in psychological methodology, Dr. Franckenstein deepened her scientific competence, particularly in differentiated diagnostic findings, diagnostic classification, and the comprehensible justification of psychological evaluations. This profile is complemented by the qualification as a trauma therapist (DeGPT), whereby even complex psychological stress situations can be taken into account in a professionally precise and sensitive manner.
In addition to clinical work, Dr. Franckenstein is regularly active in university and professional teaching. The continuous teaching assignments ensure that psychological assessments and indication letters are always created in accordance with the current state of science, jurisprudence, and guidelines.
Through the cooperation with Dr. Franckenstein, we ensure that psychological assessments and indication letters for gender-affirming surgeries meet both the medical requirements and the formal expectations of health insurance companies and the Medical Service. This creates transparency, planning security, and a reliable basis for further medical decisions.
Frequently asked questions about The Transgender Assessment
We are happy to answer your questions here about the current legal situation, cost coverage, and application.
As a rule, yes. Each gender-affirming measure must be applied for and justified individually. However, your therapist can often build on the existing progress report and supplement it with the specific indication for the new procedure (e.g. correction of the body contour or breast reconstruction).
Yes. You will receive a detailed surgical information letter (doctor's letter) from us, which explains exactly why the surgery is medically necessary. We know which wordings the MDK pays attention to.
According to the current BGA guidelines (assessment guidelines), hormone therapy is not a mandatory prerequisite for a mastectomy, provided that the medical necessity can be justified in another way. However, many MD assessors like to see hormonal pretreatment as part of the "everyday life test". We will advise you in a personal consultation on how best to document your individual path.
That depends on your insurance status. Private health insurance providers often cover the costs without any problems, depending on the tariff. For those with statutory insurance, coverage of costs in a purely private clinic is usually only possible through the cost reimbursement system (according to § 13 para. 3 SGB V), if no comparable treatment is available in a contracted clinic in a timely manner. We are happy to inform you about the options at our clinic.
The "Big 5":
- Indication letter & progress report (therapist)
- Gynecological/Urological exclusion findings (intersexuality ruled out)
- Endocrinological findings (hormones, if applicable)
- Trans curriculum vitae (personally written)
- Our surgical certificate
That depends on the effort and the method. After the consultation, we will create a binding complete offer for you, so that you have planning security.
A rejection is, first of all, no reason to despair. You have the right to file a written objection within one month. Often, the insurance funds merely request further details or specific wording in the reports. In this case, we are happy to support you with a medical statement to once again substantiate the necessity of the procedure.
In Germany, statutory health insurance funds (GKV) generally cover the costs of gender-affirming surgeries that are deemed medically necessary in cases of diagnosed gender dysphoria. These usually include mastectomy, breast augmentation (under certain conditions), as well as gender-affirming genital surgeries. Treatments such as facial feminization surgery (FFS) or permanent hair removal are often decided on a case-by-case basis.
For a complete application to the Medical Service (MD), you usually need:
- A specialist psychiatric or psychotherapeutic indication (confirmation of the diagnosis and necessity of the surgery).
- A detailed psychiatric/psychotherapeutic progress report.
- The surgeon's findings report (which you will receive after your consultation with us).
- A findings report from your endocrinologist (hormone status).
- A trans-identity CV (this is still requested by some insurance companies, but is legally disputed).
Once your application has been received by the health insurance company, it usually has three weeks to make a decision. If the Medical Service (MD) is called in for an assessment, the deadline is extended to five weeks. We recommend always sending the application by registered mail so that you have proof of when it was received.
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Get non-binding advice about the transgender assessment now. We clarify all open questions and talk about your desired change.
Completely without pressure, completely non-binding, and above all on equal footing and without prejudice!