Gender Care in Germany
Germany presents a striking tension. In legal terms, the country opted for self-identification in 2024 through the Selbstbestimmungsgesetz, one of Europe's most liberal laws. At the same time, critical voices are growing in the medical field: a controversial new guideline, criticism from professional associations and a statement by the European Academy of Paediatrics are fuelling the debate about a more cautious, evidence-based approach to paediatric gender care. The developments are therefore moving in opposite directions.
Selbstbestimmungsgesetz (SBGG, 2024)
The Selbstbestimmungsgesetz entered into force on 1 November 2024. It allows adults and young people aged fourteen and over to change their legal sex through a simple declaration at the civil registry, without a medical assessment or court involvement. For those under eighteen, the consent of a parent or, in the event of disagreement, a family court is required. The law replaced the Transsexuellengesetz of 1980, which did require medical reports.
The law came under strong criticism from the outset. Feminist groups, lawyers, paediatricians and parents pointed to risks for sex-based facilities and provisions (women's shelters, sporting events, prisons) and to the consequences for minors who have their legal sex registered during an impulsive phase. It was also noted that the law goes much further than in countries that are now tightening their medical policies. In 2026, Germany's justice ministers and a UN special rapporteur called for the self-identification law to be tightened, and the AfD submitted a motion to repeal the law. Experiences with self-identification in other countries are described at transbeleid.nl.
Medical care: new S2k guideline in 2025
Critical voices are growing in Germany's medical field. In 2025, a new guideline for children and young people was added to the register of the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), prepared for Germany, Austria and Switzerland. It had been announced as an S3 guideline, the highest level, but appeared as an S2k guideline: based on consensus among experts rather than a systematic assessment of the evidence. The guideline calls for extensive multidisciplinary diagnostics and attention to comorbid conditions (autism, trauma, depression, eating disorders), but leaves open the possibility of puberty blockers and cross-sex hormones for minors following an individual assessment. It therefore does not go as far as the Scandinavian countries or the UK, and has been criticised by doctors who consider the evidence too weak.
A group of German paediatricians, psychiatrists and scientists has publicly called for a formal evidence review modelled on the UK example. In 2024, the European Academy of Paediatrics published a statement that is also widely cited in Germany; the text is available through Frontiers in Pediatrics. It advocates caution regarding hormonal interventions and is consistent with the findings of the Cass Review.
Healthcare providers and waiting times
Germany has a relatively large number of gender care centres, including university clinics in Hamburg (UKE), Munich, Frankfurt and Berlin. Hamburg's UKE was a leading provider of paediatric gender care for a long time and now follows the new S2k guideline. Waiting times vary considerably by region and have also risen sharply in Germany due to increasing demand. As elsewhere, the demographic composition of patients has changed: significantly more adolescent girls, often with comorbid mental health problems. German insurance data also shows that the diagnosis of gender dysphoria in young people is not very stable. The parent group TransTeens Sorge Berechtigt is calling for caution.
Reimbursement
Gender-affirming treatments are covered by statutory health insurance (GKV) provided that the diagnostic criteria are met. Patients submit an application to their insurer; applications may be rejected, and such decisions can be challenged in court. Whether the new S2k guideline will eventually lead to more restrictive reimbursement of puberty blockers for minors is currently under discussion.