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Gender care in Germany

Germany shows a striking tension. On the legal side the country chose self-identification via the Selbstbestimmungsgesetz in 2024, one of the most liberal laws in Europe. On the medical side, critical voices are growing at the same time: a new S3 guideline, criticism from professional associations and alignment with the European Academy of Paediatrics push German paediatric gender care towards a more cautious, evidence-based approach. The developments thereby run at cross-purposes.

Selbstbestimmungsgesetz (SBGG, 2024)

On 1 November 2024 the Selbstbestimmungsgesetz came into force. It enables adults and young people from age fourteen to change their legal sex via a simple notification at the civil registry, without medical assessment and without judicial intervention. For minors under eighteen consent of parents or, in case of disagreement, of a family judge is required. The law replaced the Transsexuellengesetz of 1980, which did require medical reports.

The law received considerable criticism from its introduction. Feminist groups, lawyers, paediatricians and parents pointed to risks for sex-based provisions (women's shelters, sports competitions, prisons) and to the consequences for minors who register a changed legal sex at an impulsive stage. It was also noted that the law goes much further than in countries that are now actively tightening their medical policy.

Medical care: new S3 guideline 2025

On the medical side, critical voices are growing in Germany. In 2025 a new S3 guideline appeared from the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). The guideline emphasises extensive multidisciplinary diagnostics, the systematic exclusion of co-morbid problems (autism, trauma, depression, eating disorders), restraint with puberty blockers and cross-sex hormones in minors, and the importance of psychotherapeutic support. The guideline is thereby considerably more cautious than earlier German recommendations, though it does not yet go as far as the Scandinavian countries or the UK.

A group of German paediatricians, psychiatrists and scientists has publicly called for a formal evidence evaluation along British lines. The European Academy of Paediatrics published a statement in 2024 that is widely cited in Germany too; the text is available via Frontiers in Pediatrics. It argues for restraint in hormonal interventions and aligns with the findings of the Cass Review.

Care providers and waiting times

Germany has a relatively large number of gender care centres, including university clinics in Hamburg (UKE), Munich, Frankfurt and Berlin. The Hamburg UKE was long a leading centre for paediatric gender care and now applies the new S3 guideline. Waiting times vary widely by region and have also risen considerably in Germany due to rising demand. As elsewhere, the demographic composition of patients has changed: substantially more adolescent girls, often with co-morbid psychological problems.

Reimbursement

Gender-affirming treatments are reimbursed by the gesetzliche Krankenversicherung (GKV) provided diagnostic criteria are met. Patients submit an application to their insurer; rejections occur and can be challenged in court. Whether the new S3 guideline will in time lead to more restrained reimbursement of puberty blockers in minors is currently being discussed.