Transgender Health Care in Europe

Different European countries (Austria, France, Portugal, and Slovakia) have been selected to discuss transgender health care in the respective country. Confirmed speakers are:

Katharina Feil

Transgender healthcare in Austria
Title:
Transgender Health Care in Austria: Current Landscape, Challenges, and Future Directions 

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. 

Bio
Dr. Katharina Feil is a gynecologist and senior physician at the University Clinic for Gynecological Endocrinology and Reproductive Medicine in Innsbruck. She is the director of the Transgender Centre Innsbruck and, at the beginning of the year, established an Austria-wide network of professionals involved in the care of transgender people. As well as providing endocrinological care, she specializes in reproductive medicine and fertility preservation for transgender individuals. Her research focuses on the impact of GAHT on various aspects of quality of life in adults and adolescents, as well as its effect on different organ systems, such as bones and the vaginal mucosa.

Laetitia Martinerie & Clément Moreau

Transgender health care in France
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. 

Bio - Laetitia Martinerie
Laetitia Martinerie is a professor of pediatrics and works in the Department of Pediatric Endocrinology at Robert Debré Hospital in Paris, as well as at Paris Cité University. She established a multidisciplinary team (EPPAT) dedicated to supporting transgender and gender-diverse youth and currently leads the national network of pediatric endocrinologists providing care for transgender children that has recently published a consensus paper. 

She is also a member of Trajectoire Jeune Trans and Trans Santé France, two distinct organizations that bring together healthcare professionals and community associations representing transgender/gender diverse individuals and their families, with the aim of improving access to care and enhancing the quality of support provided. 

Bio - Clément Moreau

Clément Moreau (he/him) is a psychologist specializing in transgender health and neurodiversity. Clément primarily provides psychotherapy using a trans-affirmative approach for children, adolescents and their families, as well as adults. Drawing on his twelve years of experience in child and adolescent psychiatry and perinatal care, he’s been working in a private practice based in Ivry-sur-Seine, France, for the last fifteen years, and was the coordinator of the mental health division of the Espace Santé Trans association based in Paris, France. He is a trainer and supervisor on mental health and support for trans and non-binary people, espacially with the Institute for Trans Health in Montréal, Canada.

He is a member of the French Trans Health Network (Réseau de Santé Trans). As part of the Trajectoires Jeunes Trans platform, Clément is involved in research on supporting trans and autistic people.

Furthermore, Clément is a visiting lecturer at the University of Paris on the following themes: psychotherapy support for queer people, the role of the queer therapist through the prism of situated knowledge and the politicization of the therapeutic space, support for trans minors and their families.

Pedro Marques

Transgender health care in Potugal
In Portugal, specialized healthcare for transgender and gender diverse (TGD) children and adolescents is centralized in three main reference centres: Lisbon, Coimbra, and Oporto. These centres follow international best practice guidelines, aligned with the WPATH Standards of Care Version 8, to ensure safe and affirming care for TGD youth.

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.

Bio
Pedro Marques – Child and Adolescent Psychiatrist, working at the Child and Adolescent Psychiatry Department of the Local Health Unit of Santo António, Oporto, Portugal, providing specialized care in gender diversity during adolescence.

Barbora Vašečková

Transgender Healthcare in the Slovak Republic
Transgender healthcare in the Slovak Republic has a long history. It has been available since the 1970s in the former Czechoslovak Socialist Republic. The Czech and Slovak Federal Republics dissolved in December 1992. In the following period, both countries (Czechia and Slovakia) developed their transgender health care independently. This varied in terms of quality, accessibility and legal regulations.

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

Bio
Barbora Vašečková (she/her)

She works as a psychiatrist and sexologist at the Psychiatric Clinic of the Slovak Medical University and in the University hospital in Bratislava.

She was coordinating the working group of the Ministry of Health of the Slovak Republic for medical proposals for the legislation on legal gender recognition in Slovakia, and was one of the authors of Standard procedures for medical interventions during transition. She is the chairperson of the Section of sexology of the SLS Slovak Psychiatric Society, a member of board of the Slovak psychiatric association and of the Slovak Sexology Association.

She is active in the advocacy in the field of transgender health care. She initiated a statement by professional societies on the efforts of some members of parliament to ban legal gender change in Slovakia.