This is a very lengthy post about how I finally got HRT in germany, why I didn’t initally plan to do it immediatly, what kind of problems did arise on the way and the mess that I’m now left with afterwards.

How to HRT in Germany

First up will be a brief description about how this process usually works in germany, in general.

  1. Aquire a diagnosis in form of indication for hormone replacement theraphy by a theraphist or psychatrist.
    There isn’t really a standard on how to write this document, but experienced mental health professionals can usually write this up after one or two sessions with them.

  2. Find a doctor that prescribes you HRT and can take care of your bloodlevels to adjust your dosis properly.
    Usually any doctor can prescribe you HRT without getting into trouble, but as your bloodlevels need to get checked regularly, it makes a lot of sense to consult a specialist for hormones (an endocrinogist) for this matter.

  3. (Optional) As an MtF patient, your insurance should cover a sperm-cryopreservation as well.
    If you’d like to have children at some point, this is probably easier to do than adopting a child later on. So if insurance covers it, why not. Well, this step has caused most problems for me, you’ll read more about it later.

  4. Receive a recipe!
    Yay, you have done it, you are now getting HRT in germany!!

Diagnosis

So the first step is usually finding a therapist that will write you an indication in a timely manner. Not all therapists know how to avoid gatekeeping you though and some of them don’t even know anything about the subject. So it makes a lot of sense to ask your local trans-self-support group for some advice on which ones to avoid and where you can get an indication easily.

As for me, I already had a great theraphist at the time. After some initial confusion about the topic – I was the first trans-patient for them – they said, they’d write me an indication. They were really excited to help me out and they did also gender me correctly without me even bringing it up myself. There was also a lot of time to write the indication for her for reasons you’ll later read about.

Finding an Endocrinologist

Finding an endocrinologist was probably the 2nd hardest thing about this journey. Already being connected to the local self-support-group, I was told two places in my city – let’s call them place 1 and place 2 – that were able to do hormone replacement theraphy.

I immediatly tried to make an appointment at place 2, because every said that they were far better than place 1 and most of the trans-woman in my city are there.

Unfortunatly, the hormone-doctor situation in my city has become pretty bad around that time. Some places closed only to privately insured patients, some closed all together. So there was really only one place left that was not part of a hospital, that’s place 1.

Therefore, after calling place 2 for two weeks and not being able to get through, I decided to go there in person to make an appointment. It was close to my home anyways. Well, I got an appointment, but it was for April 2025.

Mind you, it was April 2024 when I went there. I would have problably not made it through until April 2025, so I also made an appointment at place 1 to get anything unti the good place has an appointment for me. The appointment I got at place 1 was in September 2024, so that’s also a 5 month wait time.

I wasn’t even really sure if I’d want to actually do HRT at that point, I wanted to talk to a doctor first and foremost. But this experience alone was such a frustrating one and it shows that our local insurance is not really doing a great job at supplying this city with enough health-care-services.

I told myself ot chill down a bit, after all the most stressful part of the semester was to come up. And after that I had planned two amazing holidays where I could relax myself from the matter.

Experience at Place 1

People had already told me a lot of bad stuff about this place, hence why I wanted to avoid it. But any HRT is better than none until the time I could find a better doctor. Also, they’d just prescribe you the medications at the reception once you’d get them and you essentially do what you want from that point onwards. Not all too bad, as that allows me to choose a better dosage from the start myself.

Well, the badness did arise as my name was called uppon waiting in the waiting room. I was dressed femme, I even did eye-makeup on that day and yet the doctor that was responsible for me still called me “mister lastname” when they went to pick me up at the waiting room.

Not up to a great start. But it wouldn’t get better from there:

She essentially just explained that we’re only taking baseline blood levels today and I should come back when I have an indication.

I told her I already have an indication, she looked for about 3 seconds, handed it back to me and said that I should get one from a psychiatrist. My theraphist, mind you, is a psychiastrist.

She also handed me a handout about the effects of HRT (MtF) which talked about voice changes. So the handout I got actually contained false information. That should give you an indication at how little these people there cared about transgender patients.

The sperm-cryopreservation that should be covered by my insurance wasn’t even mentioned, let alone the fact that I’ll get infertile from the medication.

Blood levels were taken and I got told to come back when I have a indication.

Aftermath of Place 1

After two weeks I went there again, asked for the blood test results, which were just about ready. I got told that something is wrong with my blood levels and that I should do another test. For which I got an appointment at the laboratory at the end of fucking october.

Well, not much I could do about that.

I then also asked for a transferral thingy for a sperm-cryopreservation. The person at the counter was a bit confused at first but in the end I got what I needed, to get this covered by my insurance.

I wasn’t planning to start HRT there after that initial experience, but I still told them I now have a new indication now and the person at the counter scanned that. Just in time for this disaster, a friend told me about a place 3 that now also does HRT here, and I was about to make an apointment there as well.

Finding a place that does sperm-cryopreservation

This was by far the hardest part.

So, I found out that there’s two places in my city that do that. Let’s call them cryo place 1 and cryo place 2.

I first called cryo place 1, asked for an appointment because I got a transferral thingy, and got told that they don’t cover that with insurance in my case. I still made an appointment and thought I could deal with the fact that they don’t know how to cover my case by insurance later.

After three exhausting calls and a lot of discussion on the phone, I had to cancel the appointment, because I couldn’t provide what they wanted from my insurance and hormone doctor and the price that I would have to pay on my own was simply put more than I could possibly afford.

During those phonecalls I also got told that this isn’t a treatment that makes infertile and therefor I had to pay myself, absolute bullshit. Peak gatekeeping.

There was a chance that I could get it back from my insurance, but that was very risky and I would have to go into debt, to do that.

Completely insance if you’ll take into account what my insurance had to say to that. We’ll cover that later, in chronolocial order.

Experience at Place 3

Place 3 did have an appointment after about 2 months for me, which they already considered a long waiting time, but in my opinion it was worth the wait. A new doctor would be more motivated to do this and there was more room for discussion, is what I hoped.

I was very delighted after getting called “miss” after signing up at the reception. They told me that their IT system isn’t capably of noting another name and gender than what is on my electronic insurance card. They continued to gender me right though and every instance apologized about it, very heartwarming.

The doctor there took a whole 30 minutes to talk to me on an insanely busy day. The first thing she brought up was that I’ll get infertile.

I then told her the whole story I had encountered until now and asked if she could help me with the an indication that says that I’ll get infertile from it. She said she couldn’t write anything specific for that, but that the letter that I’ll receive from her will explain that my medication makes me infertile anyways.

She also didn’t know how this should get covered by insurance. I then explained to her, what I had found up until then.

All in all that was a great experience. She said I should call or come back again when I have figured the sperm-cryopreservation out and then I’ll get a precription.

Asking the Insurance Part 1

Now after all those difficulties asking doctors about a kryo-preservervation that is covered by insurance, I wanted to ask my insurance what they had to say about that.

I got told that they do cover it normally and I would not need anything special for the doctor. I should talk to the doctor again and convince them, is what they said.

I also didn’t get anything in form of a signed piece of paper, that place 1 asked for.

Very frustrating overall and not helpfull at all.

Mind you, that was before my name was legally changed and everything with deadname. Very hard to do, very draughtful.

When saying goodbye the person talking to me was very kind though, gendered me right and even looked up information on hair removal in their system because I mentioned that.

People there are very nice, if you are nice to them.

Visit at the Gynecologist

I somehow magically got an appointment at a gynecologist by knowing someone in my city. They did know the chef-doctor of cryo place 1 and had a lot more knowledge about this whole cryopreservervation thing.

I got told that this place has proportionally a high number of trans-people which makes sense since her own child is trans aswell!

She was also able to print out yet another transferral-document for me to try getting cryopreservation covered.

In the end she wrote an application to get the costs of cryopreserveration covered by my insurance for me, so that I could get the money back that I would have to pay for this process privately.

At that point I already had made an appointment at cryo place 2, which was significantly less expensive. They were surprised that something like this can be covered by insurance, but after enough reassurance and begging from my side – I was in a lot of mental pain at that point, mind you – they actually said they’d try to cover it by insurance.

Asking the insurance Part 2

Now yet again for another visit at the insurance, this time with the application to get something covered that doesn’t require an application. But chef-doctor of cryo place 1 told so.

This time they actually had some other documents that they gave me about some sentence that insurance had to cover cryopreservation for trans patients (MtF)

So they themselves said they have to cover it, but did now give me anything that would legally help the doctors to get it covered by them.

Insanely frustrating but yet they gendered me right and were pretty kind.

I don’t get why they can’t give me a signed document that says that they’ll cover something that they have to cover anyways, but well. This is germany after all and things like that are very complicated.

Cryo Appointment at Cryo Place 2

It was finally time. This time nobody could stop me. My name and gender have already been legally changed, so I even got the documents for woman to fill out after signing up at the reception. I knew I could barely afford paying for it myself, so I was definitly going to do it, even if they don’t cover it.

After talking to the doctor, hopes were very high, because they told me they can probably cover the freezing step by insurance themselves.

Very cool!

But my hopes got destroyed again after they told me that the laboratory can’t do sperm cryo-preservations today, because the person doing it usually wasn’t there.

Uuuuuugh. That was sooo bad.

At least I got an appointment early in the morning right the next monday.

Mind you, I haven’t been doing “it” for a while, since that helps with sample quality and was relatively on edge at that point. At least I would spend the weekend at a friends place in another city, so I would be well distracted until then.

2nd Cryp Appointment

I did it. I went there. I gave off a sample. I went there again after an hour.

Quality was good, amount was good. Everything was set.

I could start HRT that day. It was truly a relieving day.

I couldn’t even be actually happy about it, since the exhaustion from the past few months settled in.

Finally I was able to start living again. I wasn’t in functional-mode anymore.

The doctor there even told me, they can for sure cover the freezing process by insurance, but not the recurring storage cost. And they gave me a “fitting” form to give to my endocrinologist to fill out for them to get it covered.

Great!!

Aftermath

As expected I received a bill for the storage costs that I should be able to get back from my insurance.

But after some time, another bill came in for the blood test that was made in order to test for STDs (sexually transmittable diseases) that had to be made for the record.

The endocrinologist also said that they cannot fill out the form that I have sent them for the matter. I suspected that but did send it to them anyways.

Three matters that didn’t work out and made me very very annoyed. I therefore wrote a lenghty mail to the cryo place, asking about all of them.

Luckily, a very friendly lady called me a few days later and had an answer to all of my issues.

  1. They can’t cover storage costs for any patients.
    It is usually a thing patients have to pay themselves and get back from the insurance. Apparently only a smal number of storage places can make insurance pay for it directly.

  2. I don’t have to pay the bill for getting STDs checked!
    That was a mistake from their side, they have talked to the laboratory that sent me the bill and they could make insurance pay for it.
    At that point I had already sent them money though, so I made steps to get it back.

  3. I got the wrong form!
    Apparently the doctor taking care of me had no idea about the matter of transgender (MtF) people. I then received the correct one after a few days.
    This one, the endocrinologist could sign and after sending it back to the cryo place, I got a “nice, perfect!”

Phew!

What a hell of a ride. But in the end it was worth it. We now have a place in this city that knows how to cover sperm cryo-preservation in case of MtF hormone treatment. Yay!

Only catch is that you’ll have to do a bi-yearly turnus of sending your insurance a bill and hoping that you can get the money back.

I have HRT now. I feel like I’m not wasting time anymore.

As of finishing this off (2025-01-01T20:22:42+01:00) I have already started noticing effects of it.

I feel more like I am myself now. I can actually look into a mirror naked and think: “I love my body!” I never though that would be possible anymore.

What a relief, what a ride to get there.

If you are on your journet to aquire HRT in germany and need help, reach out to me! I would love to help you, because I know how frustrating it can be.

Don’t stop fighting for your right to get a treatment!

Love,
Lucy