In January 2026, the then-Federal Minister of Health, Nina Warken, tasked the Federal Joint Committee (G-BA) with regulating the provision of care for people with gender incongruence and gender dysphoria within the framework of outpatient, specialized medical care (ASV).
The move follows a 2023 ruling by the Federal Social Court (BSG), which could not establish a legal basis for the coverage of transition-related treatments by statutory health insurance. Since then, statutory health insurers have continued to cover the costs based on a recommendation by the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) — but only for binary transgender individuals.
Through the establishment of guidelines for the outpatient, specialized medical care (ASV), new framework conditions are to be created. The ongoing discussions are confidential. Based on publicly available information, one can nonetheless gauge which factors will matter for the future of transgender health care.
What is the ASV?
An ASV team is a consortium of qualified specialist physicians. For transition care, the fields of psychotherapy, endocrinology, urology, and/or gynecology may be involved.
ASV teams must follow strict guidelines; for example, the distance from the team’s practice to the location of the team leadership may be no more than 30 minutes. Particularly in large metropolitan areas, practices for psychotherapists and specialists are scarce and expensive, while in rural regions the distances are often greater. In addition, the G-BA requires proof of relevant qualifications and experience to participate in an ASV team.
Until now, all patients have been free to choose whether to have their condition treated by highly qualified ASV teams or by other practices. Whether this will also apply to transition treatments is not yet known.
A Process for the Decision
The G-BA engages with civil society organizations, but the content of the deliberations cannot be disclosed. The deliberations are expected to be completed in spring 2027.
Decisions reached are published by the G-BA on its website. They only take effect after the Federal Ministry of Health has reviewed them legally and published them in the Federal Gazette (Bundesanzeiger).
As soon as the decision is in force, eligible practices can form ASV teams to provide care for transgender people. That implies a organizational shift for these practices. Processing an application for participation can take up to two months.
A Great Responsibility
Transgender people constitute a very large patient group who often require lifelong medical support. The German Society for Trans*- and Inter*-gender Identity (dgti) estimates that transgender individuals make up about one percent of the population, roughly 750,000 people in Germany. Currently, there are about 600 changes of first name and gender entry every month under the Self-Determination Act.
Even if not all of them require medical or therapeutic support, dozens to hundreds of ASV teams would need to be formed to build capacities at this scale.
Legal Basis
The legal framework for the procedure is § 116b SGB V. Since its revision in 2012, the term “transsexualism” has been listed among “rare diseases and conditions with correspondingly low case numbers” for which outpatient, specialized medical care is planned. The mandate from the Federal Ministry of Health to the G-BA indicates that the upcoming guideline should also cover forms of gender incongruence or gender dysphoria not captured by the now outdated binary diagnosis.
Why “transsexualism” was included in the list of conditions for ASV in the 2011 legislative process cannot be traced today. In the predecessor law to “Outpatient Hospital Treatment,” there was no comparable term, and the documented Bundestag debates and legislative explanations do not explain the inclusion. Thus, it cannot be verified whether the assumptions made at that time remain tenable given current knowledge.
Alternative legal arrangements are conceivable. Plans by the governing coalition to enshrine a statutory entitlement to care for binary and non-binary trans people in law independently stalled when the coalition ended prematurely in November 2024.
Great Uncertainty for the Community
Without treatment options that are covered by health insurance, more patients would have to bear the costs of therapy sessions, diagnostic assessments, and specialist pre- and follow-up examinations.
A possible consequence is an uptick in so-called DIY hormone therapy with black-market preparations. At the same time, concerns are growing about stricter police action against this makeshift solution.
The G-BA’s room for maneuver is limited. Per the mandate from the Federal Ministry of Health, it must regulate ASV for the treatment of transgender people under § 116b SGB V — regardless of whether the structural prerequisites for such professional care at this scale exist.
Not publicly known are the substantive details that are likely critical for the community’s acceptance: for example, how transgender status will ultimately be diagnosed, whether already completed transitions will need to be re-evaluated, or which medical steps are planned in which cases.
Of particular importance will be the decision by statutory health insurers on whether they will continue to cover costs for treatments outside the ASV — and if so, on what legal basis. Otherwise, conditions like those in the United Kingdom with decades-long waiting times could ensue.
The GKV-Spitzenverband, as the umbrella body for statutory health insurers and a stakeholder in the G-BA deliberations, is also involved in the consultations. A spokesperson says that current care practices should continue until the new regulation is implemented. The stated goal is “a legally secure and quality-assured basis for care with clear eligibility criteria and a clearly defined scope of services for people with gender incongruence.” Whether this legal certainty will actually emerge or if further years of litigation will follow remains to be seen.
The most important questions are unlikely to be answered until the decision is published. Until then, transgender people must continue to worry about their care. A legally secure provision of care at a sufficient scale does not appear to be on the horizon.
