Transitioning in Berlin
Medical, legal, and social resources for your gender journey
So you´re considering taking off on a journey of exploring, changing, or affirming your gender identity: Congratulations! Adventure and new experiences await you.
If, however, you are arriving in Berlin from another country, if your residence status in Germany is precarious, and/or if German isn’t your first language, you may find it challenging to even get started. You may be finding it difficult to orient yourself and access the gender-affirming medical, legal, and social resources that you need.
This brochure is intended to provide you and other trans*, intersex* and non-binary people (we use the acronym TIN* for short) with a condensed overview of some of the topics that might concern you as a TIN* person on a gender journey: namely, finding TIN*-friendly health providers, accessing gender confirmation („transition-related“) medical procedures, and legal gender recognition. These are broad subjects that are beyond the scope of this brochure to cover in detail, but we hope that the information and resources provided in this brochure will help you figure out where you can do further research on your own or get the help you need at one of the many LGBT*I*[1] or TIN* organizations and community groups in Berlin.
In developing this brief guide, we have tried to consider how individual gender journeys are affected by a variety of factors, including (but not limited to) residency status, income level, discrimination, and mental and physical conditions, and to provide suggestions that take into account a variety of lived experiences where we can.
Have we overlooked something? Or have you been traveling along your path for a while now and have encountered hidden treasures and magical helpers along the way that we should know about? Or do you have other suggestions for improving this guide? We would love to receive your feedback. Write to us here: beratung@queer-leben.de.
The counselling team at the Inter*Trans* Counselling Center (Inter*Trans*Beratung) at the Schwulenberatung Berlin wishes you eine gute Reise!
General information about accessing health care in Germany
When you arrive in Germany, you may be uninsured, be partially insured via the European Health Insurance Card (EHIC)[2] or an emergency insurance plan in your home country, or have temporary health insurance such as traveller’s insurance or „expat“ insurance (insurance intended to cover you for a temporary stay for up to 5 years). It’s important to know that, if you want to stay in Germany or visit for longer than a few months, you are required by law to have full health insurance coverage.[3] Being uninsured can incur financial penalties that you may be required to pay when you do apply for health insurance and being inadequately insured may affect your ability to renew your residence permit.[4] And above all, if you intend to access any medical or psychological support along your gender journey, health insurance can make paying for it all much easier! For more general resources about accessing health insurance, see the supplementary flyer or digital PDF, “Your gender journey: Further support”.
If you have tried to get health insurance but have been unable to access sufficient coverage due to income, employment or residency status, or other factors, there are independent insurance brokers—whose services are free, as they work on commission– and community organizations who may be able to help (see below under „Resources: Social Services and Counselling“).
It may be, however, that you have a precarious residency status or be in the process of applying for asylum, and thus only have access to emergency health care and very limited access to TIN*-related health services. Or you may be unable to access any of the insurance options available to you for financial reasons. In these cases, we would suggest contacting a community organization experienced with counselling people about how to access social services and benefits, and with helping TIN* refugees, asylum seekers, or uninsured people (see below under „Resources: Social Services and Counselling“).
Finding TIN*-friendly general health care providers
Once you have health insurance, your next step may be to search for health care providers who are TIN*-friendly. In addition to contacting one or more of the community organizations listed under „Resources: Social Services and Counselling“ for suggestions of TIN*-friendly providers, you may try doing some research of your own in the physician directories that consider LGBT*I* and/or TIN* health care needs (see below under “Resources: Physician Directories”).
You might also consider contacting or dropping by one of the spaces that focus on the specific health care needs of LGBT*I* and TIN* people, or where LGBT*I*/TIN* people are a primary target group (see below under “Resources: Health Centers”).
Medical gender confirmation („transitioning“)
Details about accessing health care services related to gender confirmation, such as hormone therapy, speech therapy, hair removal or surgeries, are discussed below. Public health insurance providers are required to cover a basic catalogue of TIN* health care services, but in order to obtain insurance coverage for these services, your insurance provider will require you to fulfil certain requirements and obtain letters of support from various health care providers. Insurance providers may vary in terms of the additional services they cover or the exact documentation they require for accessing services, so in case of doubt, you’ll want to contact your insurer directly.
Accessing hormone therapy and medical gender confirmation procedures in Germany such as genital surgery (geschlechtsangleichende Operation), „chest surgery“ (Mastektomie), and breast augmentation (Brustaufbau) requires obtaining a diagnosis of „transsexualism“ from a psychotherapist.[5] In addition, for genital surgeries to be covered by public health insurance, you may be asked to submit other supplementary documentation from urologists, endocrinologists, and the surgeon performing the procedure. Access to hormone therapy and/or gender confirmation surgeries on the basis of the „informed consent“ of the patient is not widely available in Germany at this time.
If you identify as intersex and wish to undertake medical procedures related to confirming your gender identity, please note that, although specific treatment guidelines for intersex people do exist[6], many intersex people choose to use the more established application processes intended for people identifying as trans*/non-binary to apply for coverage.
Note: For some services and medications covered by health insurance (for example, speech therapy, hormones, hospital stays), you will still be asked for a small co-payment. If you are low-income and/or chronically ill, you can apply to your insurance company for reimbursement or waiver of some or all of these fees (called applying for a Zuzahlungsbefreiung).
Hormone therapy:
A general practitioner/family doctor (Hausarzt*Hausärztin[7]) or specialists such as an endocrinologist (Endokrinolog*in) or gynecologist (Frauenarzt*Frauenärztin) can prescribe hormones and monitor hormone therapy. In the majority of cases, your health care provider will tell you that you need to get a treatment recommendation (called an Indikation) from a psychotherapist or psychiatric psychotherapist that includes a diagnosis of transsexuality or gender dysphoria/incongruence and recommends hormone therapy (see below in this section under “Resources: Psychotherapy“ for more details on how to find a therapist).
Once you have this letter, your medical care provider will do some initial bloodwork to make sure that you have no underlying health conditions and, if all is well, start you on hormone therapy (testosterone when masculinizing effects are desired, estrogen and/or androgen blockers when feminizing effects are desired). Usually you will need to see the medical provider prescribing you hormones at least every 3 months in the first year to check your progress and adjust your dosages if needed, and every 6-12 months after that.
Note that is not necessary to make an application to your health insurance company in order to start hormone therapy. Once the need for hormone therapy has been established via a confirmed diagnosis from a mental health professional, hormones are treated just like any other medication and can be administered by your doctor without pre-approval by your insurance company.
Gender confirmation surgeries:
If you know that you want to have a gender confirmation surgery such as chest surgery, genital surgery, breast augmentation, or another procedure, you can begin by researching surgeons who offer the procedure(s) and make appointment(s) for an initial consultation (Vorgespräch). To find medical providers, you can use the search platforms provided at the end of this brochure (under „Resources: Physician Directories” or go to a counselling service (under “Resources: Social Services and Counselling”) for suggestions.
At your initial consultation, you can ask questions about the procedure, obtain documentation about the proposed procedure and the surgery prognosis, and get a recommendation for the procedure (somatische Indikation) which you would then submit to your health insurance company as part of your application for coverage of costs. In addition to this documentation, public health insurance companies following recent treatment guidelines generally require an application for gender confirmation surgeries to provide documentation of 6 months of therapy (12 months for genital surgeries), proof that you have lived in your current gender role for at least 12 months (the so-called “real-life test”) and confirmation that you are not intersex (this can be done via a written confirmation from your general practitioner or via a chromosomal analysis). Proof of current hormone therapy is no longer required for genital surgery or breast removal (“chest surgery”), but for breast augmentation or facial feminization you must supply written confirmation from your medical provider that you have been undergoing hormone therapy for at least two years. Required supplementary documentation can vary according to the procedure you are applying for (such as letters from a gynecologist or urologist in the case of genital surgery) and sometimes includes a personal statement (biografischer Bericht or persönliche Stellungnahme) as well.
Your health insurance is required by law to give you a decision on your application within three weeks of receiving a complete application, or within 5 weeks if they have to forward it to an oversight body (Medizinischer Dienst) for additional processing. If they don’t reply within that deadline, your application qualifies as approved (called a Genehmigungsfiktion). If you have difficulty getting the costs for a procedure covered, you can try contacting one of the legal aid resources listed at the end of this brochure (“Resources: Legal Aid”).
Psychotherapy and counselling:
Most medical providers and public health insurance companies in Germany still follow the treatment guidelines that foresee 6 months of psychotherapy (or at least 12 therapy sessions) before a recommendation for hormone therapy can be made and before you can be approved for further medical interventions. For this reason, and because it can be helpful to have some room to reflect upon your gender journey as you’re going through it, it pays to put some time and effort into finding a suitable therapist.
Psychotherapy is covered by the German public health insurance system, with some limitations and when certain requirements are met. For psychotherapy, you’ll want to go (in most cases) to a state-licensed psychotherapist (Psychologische*r Psychotherapeut*in) working in one of the therapeutic modalities covered by public health insurance: behavioral therapy (Verhaltenstherapie), psychodynamic psychology (Tiefenpsychologische Psychotherapie), psychoanalysis (Psychoanalyse) or systemic therapy (Systemische Therapie). If you think you may need psychotropic medication, you will need to see a psychiatrist, as psychotherapists without a medical license cannot prescribe medication.
Psychotherapists are divided into those who can bill public insurance directly (called having a Kassensitz) and those who cannot.[8] If your psychotherapist of choice can’t bill public insurance directly, you can ask them about the possibility of submitting an application for reimbursement to your health insurance company (this procedure is called a Kostenerstattungsverfahren). Not all psychotherapists are willing to do this, as a Kostenerstattungsverfahren can be time- and labor-intensive and is not possible with every health insurance company. Healing practitioners (Heilpraktiker*innen) also can offer therapy within certain legal limitations; however, they can’t make formal diagnoses, nor can they receive payment through your public insurance plan (except if you’ve bought supplementary insurance), so you would have to pay them privately.
If you think you need therapy or an Indikation in order to access further gender confirmation procedures, but you haven’t yet found a psychotherapist, you can contact your health insurance company and ask them to give you an appointment during the consulting hours (psychologische Sprechstunde) of a psychotherapist near you. It’s important to realize, however, that this therapist will be assigned to you randomly and may have no special experience with TIN* clients. They will, however, meet with you and can then give you a recommendation for further treatment (called the PTV 11 form). If you think you may need to use the Kostenerstattungsverfahren and/or if you feel you urgently need therapy, you can ask them to make note of this on your PVT form (Vermerk der Dringlichkeit).
Some search engines you can use to look for a therapist are noted below (under “Resources: Psychotherapy”). You can also contact social services organizations („Resources: Social Services and Counselling”) for suggestions of psychotherapists or to advise you if you are having trouble paying for your therapy.
Once you have found a therapist with whom you think you want to work, you can meet with them for up to five sessions before they will need to make a preliminary diagnosis and submit an application for coverage to your health insurance company. These initial five appointments give both of you the chance to get to know each other and figure out if it’s a good fit. Usually psychotherapists will want to see you for at least a few sessions before they will be willing to write a letter of support for hormone therapy. Some general practitioners/endos/therapists insist that this letter be based on a psychotherapy of six months, as recommended in medical guidelines. A very few endocrinologists/GPs are willing to accept a letter written on an „informed consent“[9] basis from a therapist or counsellor working in a community counselling center.
Community counselling centers (see under “Resources: Social Services and Counselling”) can provide short-term individual, relationship, family, and professional counselling, usually between five to ten sessions, and can be very helpful if you need advice and support in your gender journey. These centers are not, however, generally able to provide either long-term therapy or emergency care.
Speech therapy:
Speech therapy (Logopädie) is covered by public health insurance but requires a treatment prescription (“Heilmittelverordnung“) from a doctor. The prescription usually covers an initial consultation and then ten sessions, with a possible renewal of the prescription for an additional ten sessions. General practitioners (Hausärzt*innen), neurologists (Neurolog*innen), and throat, nose, and ear doctors (Hals-Nasen-Ohrenärzt*innen, or HNO) can write these prescriptions for treatment. You may need a referral from your general practitioner, and you will be required to pay 10% of the costs of the treatment as a co-pay.
Hair removal:
Hair removal (Epilation) via laser is technically covered as part of gender-confirming related health care. Public health insurance companies, however, generally require it to be done under medical supervision, and there is a shortage of medical providers for this procedure. If you decide to pursue coverage through your health insurance company, you can contact one of the counselling services (“Resources: Social Services and Counselling”) for suggestions of medical providers and cosmetic studios familiar with this application process.
Legal gender confirmation Changing one’s name and gender marker:
In Germany, the legal procedure for changing one’s name and gender marker (Personenstand) as part of a gender confirmation process („transition“) is outlined in the so-called Transsexual Law (Transsexuellengesetz, or TSG).[10] All German citizens, stateless residents of Germany, asylum holders or refugees resident in Germany, and non-German citizens holding a renewable or permanent residency permit whose home countries have no law comparable to the TSG (see below, “Using the TSG as a non-German Citizen”) are eligible to use the law to change their name and/or gender marker.
Please note that the current coalition government in Germany has committed to reforming this law; however, at the time this brochure is being written (March 2022), no reform has yet occurred. Also please note that the TSG in its current form describes a legal process, not a medical one; you are not required to undergo any medical procedures in order to make an application for recognition of your chosen name and gender.
According to the current TSG, you have the option to change your gender marker to “male” or “female”. It is also possible to change one’s gender marker to “diverse” (divers)[11] or leave the entry blank (ohne Eintrag), but access to these last two options is regulated by a different law, the §45b Civil Status Law (§ 45b Personenstandgesetz).[12] More information about using this law is provided below (“Using the §45b Civil Status Law”).
If your chosen name is very inventive or is commonly associated with the gender “opposite” to the gender marker for which you have applied, you may be asked to provide proof that the name exists and is used as a gender neutral or “unisex” name (i.e., in other languages/countries). For suggestions about how you can do this, you may want to consult one of the counselling organizations listed in this brochure.
To change your name and/or gender marker according to the TSG, you first write a letter to your district court (Amtsgericht, in Berlin the Amtsgericht Schöneberg) making this request. If the court recognizes your right to use the TSG, two independent psychological evaluators (Gutachter*innen) will be assigned to assess you and write a report (Gutachten) that positively or negatively evaluates your application. In your initial letter to the court, you can also request that specific evaluators be assigned to you. If you don’t know whom to request, you can contact the TIN*-specific community counselling organizations listed at the end of this brochure.
Once your evaluators have been confirmed by the court, they will arrange to meet with you (usually between 2-4 times) to speak with you about your biography, how long you have identified as your current gender (at least 3 years), and whether you can confirm that your gender identity is unlikely to change in the future. The report they write, along with their positive or negative assessment of your application, will then be sent to the court. You will be invited to a final interview with a judge, after which a decision will be reached about whether to approve or deny your application. If your application is denied, or if it is approved but you change your mind, you have one month grace period to challenge the court’s decision (called doing a Widerspruch). Although many people find this process to be stressful and pathologizing, it’s also good to know that well over 90% over applications for legal gender confirmation are approved, so don’t let it stress you out too much!
You should expect to receive a bill from the court for at least 1,500 to 3,000 Euros depending on how many appointments your evaluators require and how much they charge in fees. For this reason, t is always worth it to ask potential evaluators for the approximate number of appointments and fees involved in advance, before you ask the court to contract them. Also good to know: If you are low or no-income, you can apply to have the legal costs of this process partially or entirely waived (Verfahrenshilfe, formerly known as Prozesskostenhilfe). In order to apply for Verfahrenshilfe, you need to fill out an application for coverage of these costs (available on the district court website) and send in proof of income.
The process of legal gender confirmation varies in terms of the time it takes (how quickly the court responds, how quickly your evaluators make appointments, how quickly they produce their assessments, etc.), but usually takes about six months for German citizens. Once you have your court-ordered name/gender marker change document in hand, you can begin changing your personal documentation (registration, residency permit, driver’s license, health insurance card, etc.).
Using the Transsexual Law as a non-German citizen:
If you are not a German citizen and not a recognized stateless person, asylum holder, or refugee, it is still possible under certain circumstances to use the TSG to change your legal name and gender marker; however, if you don’t hold German citizenship, you will need to explain why you are claiming the right to use the TSG.
You must be able to prove that the country in which you hold citizenship does not have a legal procedure comparable to the TSG that you can use, or that the procedure required by your home country would subject you to undue hardship (for instance, require you to move back to your home country to establish residency, require you to undergo forced sterilization, etc.). If the country in which you hold citizenship does have a comparable procedure to the TSG that it is possible for you to use, then you need to complete a legal gender recognition in that country.
Using the Transsexual Law as an intersex person:
If you identify as intersex, it is still possible to use the TSG to correct your name and gender marker if you identify as (or at least want to be documented as) “male” or “female”. If you have a formal diagnosis of an intersex “condition” and/or want to erase your gender marker or correct it to “diverse”, you might also consider using another legal process based upon another law, §45b Personenstandsgesetz (see below, “Using the §45b Personenstandsgesetz”).
Using the TSG as an applicant for asylum:
When applying for a name and/or gender marker change as an asylum applicant or refugee, you can make a note of and provide proof of your status as an asylum applicant/refugee and, if needed, also apply for translation services. Please note that asylum applicants and refugees are still required to submit a birth certificate, despite the difficulty many have in obtaining such a document.
Using the §45b Civil Status Law:
The law described under the §45b Civil Status Law (Personenstandgesetz, referred to from here on as §45b PStG) stipulates that people who have “variations in sexual development” (Varianten der Geschlechtsentwicklung) can correct their gender marker to “diverse” or delete it altogether. This option is also open to permanent residents, non-permanent residents whose home countries do not have a comparable law, holders of a renewable visa who are resident in Germany, asylum holders, stateless persons, or refugees resident in Germany, and those who hold a blue EU card.[13] To make an application under this law, one submits a written request along with a letter from a doctor stating that “variations in sexual development” are present or— in exceptional circumstances— a written personal affidavit, to any civil registry office (Standesamt).[14]
Currently, how §45b PStG should be interpreted and implemented in practice is under debate. The original court decision establishing §45b PStG[15] emphasized that gender identity rather than physical characteristics determines a person’s sex, and since the law was implemented in 2018, some people who did not have a medically diagnosed intersex “condition” but did not want to choose either of the binary options of “male” or “female” as foreseen in the TSG have been able to use the law to erase or correct their gender marker to “diverse”. Subsequent court battles have taken place, however, over whether use of this law should be limited to those able to provide written confirmation of a medically diagnosed intersex “condition”, or whether the meaning and applicability of the term “variations in sexual development” can be more broadly interpreted, and the legal situation is currently unclear.[16] Recently, civil registry offices have increasingly demanded documentation of a formal medical diagnosis of an intersex “condition”, so that people without such documentation trying to use the §45b PStG to correct their gender marker have often been unsuccessful. For more up-to-date information about §45b PStG and intersex or non-binary identity, you can consult one of the counselling organisations listed at the end of this brochure.
Supplementary personal identification (“Ergänzungsausweis”):
The supplementary personal identification (Ergänzungsausweis)[17] was developed by a TIN* activist organization, the Deutsche Gesellschaft für Transidentität und Intersexualität e.V. (DGTI), to help TIN* people advocate for themselves and avoid discrimination when they are unable to obtain a personal identification document that reflects their gender identity, or who have applied for but not yet received such documentation. The ID does not replace a state-issued personal ID, and cannot be used to change your name or gender marker on many forms of official documentation. It can, however, help you use your new name and gender marker in some less formal situations or help you prove that you are who you say you are, in case your state-issued ID doesn’t match your current identity or appearance or you just don’t want to use it. For details on how to obtain an Ergänzungsausweis, see the website of the DGTI listed under “Resources: TIN* Advocacy and Activism” below.[18]
Resources
Key to abbreviations:
EN= English; GR= German; LGBT*I*= lesbian, gay, bi, trans*, intersex*; TIN*= trans*, intersex, non-binary; BIPOC= Black, indigenous, person of color; FLINT*= German acronym for women, lesbian, intersex, non-binary, trans*
Physician directories:
Queermed Deutschland, https://queermed-deutschland.de/ (GR, LGBT*I*)
Gynformation, https://gynformation.de/en (EN/GR, general, run by a queer feminist collective)
TransDB, https://transdb.de/ (DE, focus on trans*related health care services)
Roter Stöckelschuh, https://roterstoeckelschuh.de/ (GR, focus on sex workers)
Jameda, https://www.jameda.de/ (GR, general)
Health centers:
Checkpoint Berlin, https://checkpoint-bln.de/en/ (EN/GR/Arabic/Farsi/Russian/Spanish, LGBT*I*, “TIN* Day“ 1x/month)
Casa Kùa, https://casa-kua.com (EN/GR, TIN*, BIPOC-focused)
Heile Hause, https://heilehaus-berlin.de/en/ (EN/GR/Arabic/Farsi/Spanish/French, general, focus on socially disadvantaged people)
Berliner AIDS-Hilfe, https://www.berlin-aidshilfe.de/# (EN/GR/multiple, general, focus on those affected by HIV/AIDS)
Psychotherapy:
Association of Counselors and Therapists (ACT) Berlin, https://www.actberlin.info/therapist-directory.html
(EN, general)
Angloinfo Berlin, https://www.angloinfo.com/berlin/directory/berlin-counselling-therapists-477 (EN, general)
It’s Complicated, https://complicated.life/en/find-a-therapist (EN/GR, general)
Stillpoint, https://www.stillpointspaces.com/find-a-counsellor/ (EN/GR, general)
Therapie.de, www.therapie.de (GR, general)
Kassenärztliche Vereinigung Berlin, https://www.kvberlin.de/fuer-patienten/arzt-und-psychotherapeutensuche (GR, general)
Doctolib, https://www.doctolib.de/psychiatrie-und-psychotherapie/berlin (GR, general)
Social services and counselling:
Inter*Trans*Beratungsstelle (Inter*Trans* Counselling Center, project of Schwulenberatung Berlin), https://schwulenberatungberlin.de/queer-leben-en/ (GR/EN/multiple, TIN*)
Schwulenberatung Berlin, https://schwulenberatungberlin.de/ (GR/EN/multiple, LGBT*I*)
Café Kuchus (project of Schwulenberatung Berlin), https://schwulenberatungberlin.de/queer-refugees-en/ (GR/EN/multiple, LGBT*I*, focus on queer refugees)
Fachstelle LSBT*I*, Altern und Pflege (Center for LGBT*I*, Aging and Care, project of Schwulenberatung Berlin), https://schwulenberatungberlin.de/wir-helfen/fachstelle-lsbti-altern-und-pflege/ (GR/EN/multiple, LGBT*I*, focus on older people and nursing services)
Trans*Inter*Queer e.V., http://www.transinterqueer.org/ (GR/EN/Spanish, TIN*)
Lesbenberatung, https://lesbenberatung-berlin.de/en/start-english (GR/EN/multiple, FLINT*)
GLADT, https://gladt.de/ (GR/TU/EN/multiple, LGBT*I*, focus on BIPOC)
Lambda e.V., https://www.lambda-bb.de/ (GR, LGBT*I*, focus on queer youth up to age 27)
Sonntagsclub e.V., https://www.sonntags-club.de/international/englisch.php (GR/EN/multiple, LGBT*I*)
Clearingstelle der Berliner Stadtmission, https://www.berliner-stadtmission.de/clearingstelle (GR/EN/multiple, general, focus on people without health insurance)
Legal aid:
Dunkel Richter Rechtsanwält*innen, https://dunkelrichter.de/ (GR/EN, LGBT*I*)
Bedenk & Dr. Heun Rechtsanwälte, https://www.bedenk-heun.de/ (GR/EN/Spanish, general, specialized in serving TIN* clientele)
TIN* Advocacy and Activism:
Trans*Inter*Queer, http://www.transinterqueer.org/ (GR/EN, TIN*)
IVIM/OII Deutschland, https://oiigermany.org/ (GR, focused on intersex* people)
Bundesverband Trans*, https://www.bundesverband-trans.de/ (GR/EN, TIN*)
Deutsche Gesellschaft für Transidentität und Intersexualität e.V. (dgti), https://dgti.org/ (GR, TIN*)
[1] Abbreviation for “lesbian, gay, bisexual, trans*, and intersex*
[2] Insurance coverage via the EHIC of planned and unplanned medical procedures is explained here: https://www.eu-patienten.de/de/behandlung_deutschland/behandlung_in_deutschland_1.jsp
[3] https://www.germany-visa.org/insurances-germany/health-insurance/
[4] https://www.howtogermany.com/pages/healthinsurance.html
[5] More commonly known as “transsexuality”, this diagnosis is coded as F 64.0 in the International Classification of Diseases (ICD-10), the medical standards of care used in Germany, which insurance companies use to make decisions about insurance coverage. A new version of the ICD, ICD-11, has been published, in which “transsexualism“ as a mental health diagnosis no longer exists and “gender incongruence” appears instead as a diagnosis within the section “Conditions related to sexual health”. The ICD-11, however, will only begin to be implemented in Germany after 2022, and the implementation process will be gradual (see https://icd.who.int/en). Updated guidelines for insurance evaluators that take this new diagnostic criteria into account have been published (see https://md-bund.de/fileadmin/dokumente/Publikationen/GKV/Begutachtungsgrundlagen_GKV/BGA_Transsexualismus_201113.pdf), as well as updated treatment recommendations for service providers (see Geschlechtsinkongruenz, Geschlechtsdysphorie und Trans-Gesundheit: S3-Leitlinie zur Diagnostik, Beratung und Behandlung published by the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V., under this link: https://www.awmf.org/leitlinien/detail/ll/138-001.html). The information provided in this brochure attempts to reflect these current standards.
[6] https://www.aem-online.de/fileadmin/user_upload/Publikationen/S2k_Geschlechtsentwicklung-Varianten_2016-08_01_1_.pdf
[7] In recent years, the use of an asterisk (*) or a colon (:) has been used in German to denote a space within typically gendered words for non-binary identities beyond “male” and “female”. These punctuation marks are, however, not normally used in dictionaries, so that you may have to use a different, gendered ending (for instance, “Endokrinologe” instead of “Endokrinolog*in”) if you look up any of these terms.
[8] The German system governing licensing and billing for psychotherapy can be confusing. The important thing to remember is that having education or training in psychotherapy does not equal having a state license or contract with the public health system. This means that when you search for a therapist, you will want to not only research a therapist’s qualifications, but also how she*he is licensed and how she*he can receive payment.
[9] In this context, “informed consent” means that the person receiving medical treatment states that she*he has been informed by the medical practitioner about the purpose, process, and possible risks of the treatment, that she*he is of sound mind and able to make decisions about her*his own medical care, and that she*he agrees to the treatment in question and takes responsibility for all possible consequences of this decision.
[10] https://www.gesetze-im-internet.de/tsg/
[11] This term refers to identities beyond or besides “male” and “female”.
[12] https://www.gesetze-im-internet.de/pstg/__45b.html
[13] https://www.gesetze-im-internet.de/pstg/__45b.html
[14] https://www.antidiskriminierungsstelle.de/DE/ueber-diskriminierung/diskriminierungsmerkmale/geschlecht-und-geschlechtsidentitaet/dritte-option/dritte-option-node.html;jsessionid=38DDB601C0950FA4007691539B5D3694.intranet221
[15] https://www.bundesverfassungsgericht.de/SharedDocs/Entscheidungen/DE/2017/10/rs20171010_1bvr201916.html
[16] See the decision of the Oberlandesgericht Düsseldorf from 11.06.19 (https://openjur.de/u/2193311.html), and the subsequent national court decision from 22.4.20 (http://juris.bundesgerichtshof.de/cgi-bin/rechtsprechung/document.py?Gericht=bgh&Art=en&az=XII%20ZB%20383/19&nr=106062).
[18] Information on the Ergänzungsausweis in English can be found on https://nonbinary.berlin/blog/ergaenzungsausweis/
