What is the approach across Europe to transgender identity?

What is the approach across Europe to transgender identity?
Copyright Bild von Carina Chen auf Pixabay
Copyright Bild von Carina Chen auf Pixabay
By Anne FleischmannLuke Hurst
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In many European countries, people who identify as transgender must have a mental health diagnosis to get their official records changed. This, according to Transgender Europe (TGEU), “violates the right of every person to determine their own gender identity.”


Germany’s first openly transgender politician has called for the abolition of the country’s Transsexuellengesetz ('transsexual law'), which she describes as degrading.

Tessa Ganserer, who sits in the Bavarian state parliament as a member of the Alliance 90/The Greens political party, has not yet had her gender change officially recognised.

The country's 1981 law stipulates those wanting to change their first name and gender must talk to psychologists and a judge.

"I do not think that any human being, any state and certainly any judge has the right to determine the sex of another human being," Ganserer told the DPA news agency.

In many European countries, people who identify as transgender must have a mental health diagnosis to get their official records changed.

This, according to Transgender Europe (TGEU), “violates the right of every person to determine their own gender identity.” The website warned a mandatory diagnosis “will further stigmatise, exclude and discriminate against people.”

Cianán Russell, a Senior Policy Officer from ILGA-Europe, an international LGBT association, told Euronews "forced medical and psychiatric exams can be classified as torture or inhuman treatment".

"As with all human rights violations, individual consequences vary from person to person, so it is not possible to provide a blanket answer to this question," they added. "However, the more important issue to note is that all forced medical and psychiatric exams represent a violation of the individual's fundamental human rights."

In Europe, 33 countries require a mental health diagnosis before identity documents can be adapted, which are shown on the below map in red.

Countries where this is not required are marked in blue and countries that do not offer reliable gender recognition procedures are shown in grey.

Two European examples

The United Kingdom

In the UK, people have to apply for a "Gender Recognition Certificate" which can be obtained by those over the age of 18 under three different scenarios and at a cost of £140 (€151).

Scenario 1: They must be diagnosed with gender dysphoria, which is defined as "a person having an unpleasant sense of their gender not matching the body into which they were born". They must have lived in their acquired gender for at least two years and intend to keep it for the rest of their lives.

This means that transgender people must, for example, prove with official documents such as a passport, driving licence or payslips that they have already changed their name.

Scenario 2: If they live in a protected marriage or protected civil partnership in England, Wales or Scotland, in addition to the above criteria, they must prove that they have lived in their acquired gender for six years.

Scenario 3: The third route holds if a person's acquired gender has been legally accepted in an "approved country or territory" and they have documents to prove it.


In Greece, a person can change their registered gender under the following conditions:

  • The person concerned must be 18 years old, otherwise, they need the consent of their parents.
  • If they are younger than 17 but older than 15 an additional interdisciplinary committee must agree to the change.
  • This committee must include a paediatric psychiatrist, a psychiatrist, an endocrinologist, a paediatric surgeon, a psychologist, a social worker and a paediatrician.
  • Furthermore, transgender people who wish to change their gender cannot be married.
  • A medical diagnosis of a person's mental health is not necessary in Greece but they must explain their reasons for the decision in person to a court.

An expensive change

Lukas lives in Germany and was registered as female at birth. He told Euronews about his experience of officially changing his name and gender.

First, he submitted an informal application to a court to estimate the cost of proceedings. He then had to make a downpayment and two independent psychological experts were appointed.


"The whole thing is very expensive," says Lukas. "Such a process costs approximately €4,000."

Legal aid is generally good he said but pointed out it is based on family income, so if someone's parents make enough money but don't agree with their child wanting to change gender, they most likely won't be able to afford the trial.

Those under 18 need the permission of their legal guardian. While in some German federal states or cities you can put forward your own experts, they are often determined by the court.

Ganserer did not go through the procedure to officially change her name and sex. "I will not stand before a judge to put up with the most intimate personal questions about my early childhood experiences, sexual preferences and partners so that he can decide for this state that I am the woman I have always been," she said.

In sessions of the Bavarian state parliament, the first name she was given at birth is displayed.


Being transgender no longer on WHO's list of 'mental illnesses'

The World Health Organisation (WHO) removed transgender health issues from its list of mental illnesses in 2018 — a move welcomed by the transgender community.

It is now called "gender incongruence" and was reassigned to a new category: Category 17 — conditions related to sexual health, which also includes paedophilia and exhibitionism.

The new categorization is a "possible model for all those who talk about transsexual bodies in the same breath as paedophiles," activist Sarah Unger wrote in an article in German daily Tagesspiegel.

"It will take years for this new version of the International Classification of Diseases (ICD-11) to be implemented globally, with some countries, such as the USA, indicating that they have no short-term intention to implement the new system," Russell said.

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