Transgender Health Care in Europe

Speaker: 

Katharina Feil, Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, Innsbruck, Austria 

Abstract:
This presentation provides an overview of the current state of transgender healthcare in Austria, highlighting recent developments, ongoing challenges, and future opportunities to improve care quality and accessibility. The country has made significant progress in establishing multidisciplinary care models and improving legal frameworks that support transgender individuals. Nevertheless, barriers such as regional disparities in service availability, a lack of specialised training for healthcare professionals, and social stigma still impact the provision of timely and affirming care. 

This talk will outline the structure of transgender healthcare services, including hormone therapy, mental health support and surgical interventions. By sharing Austria’s experience, it aims to contribute to the broader European dialogue on optimising transgender healthcare and fostering collaboration across countries, and to “cut through the noise” and deliver evidence-driven, person-centred care. 

Support for transgender / gender diverse people in France began in the late 1970s for adults, but it was not until 2013 that care for minors was initiated. This support has gradually been organized over the past 10 years through a network, in close collaboration between the various professionals working with young people and their families, as well as associations of concerned persons and parents. 

Despite controversies and political pressure, this network continues to develop and can now rely on a consensus paper published under the auspices of the French Society of Pediatric Endocrinology and Diabetology and supported by the French Pediatric Society. 

The High Authority for Health is about to publish guidelines for supporting adults and is expected to launch a working group to develop recommendations for minors soon. 

In 2021, the Unit for Gender and Sexuality (UGS) was established at the Local Health Unit of Santo António, in Oporto. The Child and Adolescent Psychiatry Department of this hospital is an integral part of this unit, offering comprehensive mental health assessment and care for TGD adolescents. Following a model similar to the Dutch Protocol, the evaluation process includes multiple individual and family consultations with a child and adolescent psychiatrist, as well as psychological assessments covering cognitive and emotional dimensions. All cases are reviewed by a multidisciplinary team -including psychiatrists, psychologists, paediatric endocrinologists, and social workers- before any medical intervention is considered.

This presentation will also include caseload data from the UGS on children and adolescents referred to child and adolescent psychiatry for gender identity-related concerns since 2018, reflecting the evolving needs and care pathways within one of the national reference centres for gender-affirming care in Portugal.

In Slovakia, transgender health care is traditionally decentralized, with only a few institutions or providers offering care. The main problems identified both by health care providers and transgender clients are the lack of services, long waiting times and limited care, where some procedures are not available, not covered by health insurance, or both.

The situation in Slovakia continues to change. Since 2019 the main aims of medical professionals has been to modernize medical guidance for transition in the light of scientific research and to abolish the requirement imposed on transgender persons to undergo sterilization before being allowed to change their registered first name and gender. This process was led by professionals from Slovak Psychiatric and Slovak Sexology Associations. National Standards for Health Care for assistance with medical transition were created based on international standards from other European countries and WPATH Standards of Care. Currently these standards are not officially supported by state institutions.

Another problem for transgender people in Slovakia is legal gender recognition. Currently the offices of the Central register refuse to provide legal gender recognition for most applicants.

The presentation discusses current practices in the provision of transgender healthcare with overlap to socio-political situation, including the roles of not only of health care providers, but also active non-governmental organizations.

Keywords: Transgender Healthcare in Slovak Republic, Legal Gender Reassignment, Standards of Care, Legal Transition