Trans Survival Guide
or, how to survive as a trans person in the Czech republic
If you know you are trans, this page is for you. It will lead to irreversible changes. You have to be sure, because if you change your mind - even if you later figure out that you are indeed trans - the Czech system doesn't really account for uncertainty. It could be too late and you could be denied medical care.
Note for people who are not Czech citizens: to receive healthcare and start the transition in the Czech Republic, you have to pay into the public health insurance in the Czech Republic. If you don't have Czech citizenship or residency (yet), you will have to be employed by any Czech employer, which will deduct the health insurance from your salary. Once you are employed and receive your health insurance card, you are entitled to full healthcare, including transition, in the Czech Republic.
Almost everything on this page relates to binary trans people. If you feel that you don't fit into one of these two roles, things will be more complex for you. The Czech Republic currently doesn't recognize any other identity than the binary genders of male/man or female/woman. If you decide that you want to take some steps to change your body (HRT, mastectomy, etc) then it will most likely be necessary to convince the doctors that you are trans and want to live as a binary gender.
This could very well change in the next few years, when our country will be forced to adopt the new version of the diagnostic manual, ICD-11.
First of all you need to choose a sexologist who you'll be visiting. It is not an easy task since the situation is not ideal anywhere. Distance and surcharges may play a role. It is also possible that the sexologist of your choosing won't be taking on new patient at that time. It is important to remember that everyone will have a different experience and what is written here might not necessarily apply to your experience. However, it is still a solid list that correlates with the experiences of most trans people.
While there is a bit of freedom in the individual approach taken by each sexologist, nonetheless some things are the same. Trans feminine people will unfortunately experience a completely unnecessary examination of genitalia. This practice may be traumatizing and cannot be refused if you wish to proceed with your official transition. The only possibility that comes to mind is to say that you already went through that examination at a different sexology, and with a bit of luck you might just avoid it. Trans masculine people here will experience a gynecologist exam.
Another problem might be the so called "real life test" (a practice so barbaric that it should be banned). It consists of “trying out” the transition socially without medical transition. When you "prove" that you're really trans, they can finally prescribe you hormones. This practice can realistically lead some people to suicide. Due to the societal requirements of looks and also due to biology this greatly concerns trans feminine people; but that doesn't mean that trans masculine people have it easy. If you encounter this practice, we suggest finding a different sexologist.
Even worse is an arousal test. For trans feminine people it involves using penile plethysmography, and for trans masculine people it means vaginal photoplethysmography. The principle is the same - a device will be put on your genitals and you'll be shown erotic pictures and the device is supposed to measure arousal. The fact that sexuality and gender are two different unconnected things doesn't matter here. According to this highly subjective and humiliating method you can be denied the access to further care. Again we suggest changing the sexologist at this point.
The rest is not so bad. You have to be certain in your gender identity. Your looks and behavior have to be as stereotypical as it gets. If you are non-binary and want hormones, you will have to present as either a binary trans man or a binary trans woman.
MUDr. Pavel Turčan - contact CZ - Olomouc
The best the Czech sexology can offer. Doesn't fully admit the discrimination on different levels throughout the system and the complex access to trans healthcare in Czech Republic. On the other hand he doesn't require or force people into SRS (sex reassignment surgery), is progressive about law changes (abandoning the required sterilization, allowing same sex marriage), and also all hormones are free without co-pays. Also offers the natural progesterone for trans feminine people (as opposed to the synthetic version or no progesterone at all). There is no surcharge if you take hormones from him directly.
MUDr. Luděk Fiala, Ph.D., MBA - contact CZ - FN Plzeň
Very competent sexologist, likes to chat about various topics besides just trans issues. Upon first visit, you might be under the impression that he's not so friendly, but don't be discouraged. Mr. Fiala works for the sexology in Pilsen and Prague, so he is very busy. He will describe the whole transition in great detail, and the whole process is very swift. Contact is only possible by phone during the office hours so you might not get an answer if you write an email. As always, you have to be sure by your gender identity, otherwise some questions may throw you off balance and lengthen the period before you get HRT. Sometimes there is and sometimes there isn't a surcharge for hormones.
MUDr. Petra Vrzáčková - contact CZ - Praha
Just for her progressive opinions in this CZ article she deserves our recommendation despite us not having any experience with her directly.
Not enough experience:
MUDr. Hana Fifková - Prague
She doesn't accept that non-binary people exist CZ and generally her opinions towards gender and upbringing are strongly conservative.
MUDr. Ivo Procházka CSc. - VFN Prague
His approach is backwards and doesn't align with current findings. For example the fact that as a trans person you must actively consume trans topics in literature, movies, etc. Furthermore he doesn't recognize cyber bullying as a form of bullying.
MUDr. Petra Sejbalová - FN Brno
She is transphobic and has a strong hatred towards trans people. They demand a real life test CZ and other horrible practices. Try to avoid this place.
MUDr. Helena Reguli - Brno
She has a strict approach which she uses to get straight to the topic without any detours. This can be uncomfortable and some questions she asks are very unpleasant. For example when asking about your weight/body, where she follows the BMI values and doesn't hesitate to voice her opinion. We do not recommend her especially to people who struggle with self-image or an eating disorder. Her opinions on non-binary people are unknown to us at this time.
This is the most degrading, unnecessary and discriminatory part. In an ideal world there would be only one recommendation - "Be honest." - but unfortunately we do not live in such a world, and being honest can harm you a lot. In the end what you say is up to you, here we simply describe what's ahead of you and what the psychologists want to hear. If you want to proceed with your transition officially, this is unfortunately required. Don't let this scary introduction keep you from going through with it, since one bad day is better than a bad life.
Specifically Raven's Progressive Matrices. There's not much to be afraid of. It is unnecessary and degrading, but unfortunately required. You will get a paper and your job will be to find the next geometric shape that fits into a given series. You do not need any previous knowledge.
Test, which shouldn't be repeated more than once in a lifetime (or at least once per 15 years), or it completely loses its purpose. Here it can be more dangerous to know more about the test. The rating tables are secret and it's very difficult to gain access to them. Of course you can find information on the internet, but if your psychologist judges it differently, it could severely harm you.
Drawing of figures
The most pointless but thankfully the easiest and fastest part. If you are trans feminine, first draw a stereotypical and a happy woman (dress, long hair, jewelry). Then draw a stereotypical and a sad man (muscles, short hair). If you are trans masculine, do it the other way around (happy man, sad woman). It is possible that some psychologists are a little more progressive here, but it is up to you if you are willing to risk it.
Saying the most stereotypical things is going to give you the best results. If you are trans feminine, you can say you played with dolls as a young boy and subconsciously wanted to fulfill the feminine role. Perhaps if you did something feminine, your parents reprimanded you. Similarly for trans masculine people - as a little girl you played with cars/roleplayed soldiers.
Here it's best to not think about it too much, but to prepare beforehand. It is extremely degrading, unnecessary and just like the other tests, it doesn't say anything about your gender, but unfortunately our current system demands it. We will provide an example for what a trans feminine person should say. Swapping the words for a trans masculine person should be easy enough. Say you already had sex and when you masturbate you imagine that you are a woman having sex with men. When you have sex, it's always anal and you are the submissive one. You don't think about your penis because it causes you a great deal of suffering and you would rather not have it.
Specifically Minnesota Multiphasic Personality Inventory, but unfortunately we don't know which version exactly. Here it's very important to be consistent in your answers. Some questions repeat or are just phrased differently. It is not difficult, just takes a very long time to answer more than 500 questions.
They will ask you about your mental health. Of course we know that the majority of trans people go through a lot, for instance depression or anxiety, which might or might not be connected to the fact that they're trans. The experience of trans people in Czech Republic is unfortunately such that it's better not to mention such issues. The psychologists that evaluate trans people can deny you further care in case if you admit to having mental health issues and may require you to treat them before continuing in the transition process. No one cares that these problems might be caused by not being allowed to transition.
In any case we suggest treating all problems at the same time, in other words don't wait to treat your (for example) depression until after you start the transition, rather visit a mental health professional ideally before visiting a sexology. If you decide to talk with the psychologist about your mental health, then it's good to also mention that you are already working on it and that thanks to that you already have a safety net and your mental health is improving.
The result of this evaluation should be the F64.0 diagnosis as described in ICD-10. In the newer ICD-11 a similar diagnosis should be under the code HA60. If your diagnosis has any other code than F64.0, ask your psychologist why isn't it like that, because in the future this could cause problems. This diagnosis is naturally very problematic, because it directly contradicts the concept of self-identification. This inappropriate approach thus leaves the power of determining your identity in the hands of the psychologist, who cannot ever know how you feel inside, and even less then make the decision whether you are trans or not.
MUDr. Martin Plotz - Otrokovice
Sent here by: MUDr. Turčan
We don't have any concrete experiences, however so far he seems like the least bad.
MUDr. Petr Weiss - Praha
Sent here by: MUDR. Fifková, MUDr. Vrzáčková, MUDr. Procházka CSc.
Not recommended at all. He doesn't recognize bisexuality. We unfortunately don't have more experiences and tips, but the fact that all trans people complain about him, says a lot.
MUDr. Jana Černá - Plzeň
Sent here by: MUDr. Fiala, Ph.D., MBA
She follows the aforementioned steps completely and you can't discuss anything with her. We recommend not to mention mental health issues, it could lead to the denial of the much needed care. She will ask you about your sexuality in great detail.
PhDr. Adam Suchý - Prostějov
Sent here by: MUDr. Turčan
He is not against non-binary people. If you have depression or other issues, there's a very high chance you'll be denied the required diagnosis.
There are a few more possibilities for trans feminine people. In the beginning you'll either take 2x1mg of Estrofem, which is upped after a month to 2x2mg (surcharge around 0–100 CZK), or you can get estrogen injections—Neofollin (surcharge around 60 CZK for 5 ampules). Another alternative is a dermal application, most likely Estrahexal (surcharge around 200 CZK), but we don't have any experience with its efficiency. Along with that you'll take Androcur (usually without surcharge, but they might want you to pay the full price of 650 CZK), where the dosage may differ greatly based on your testosterone level. Common dosages are anywhere from 12.5mg to 100mg daily. Alternatives to Androcur include products based on spironolactone (diuretic, causes frequent urination) and bicalutamide (expensive), it's unlikely you'll use them, you can ask about them if you experience side effects on Androcur. Better sexologists also offer progesterone, either the natural form or the synthetic one. The natural form is Gynprodyl (usually without surcharge), the synthetic form is Provera (surcharge around 50 CZK). From personal experience we can recommend the natural form.
Trans masculine people used to start taking testosterone pills in the past—Undestor, which is unavailable since 2020-12-31. The alternative here is a gel, Testavan (surcharge around 800 CZK) or Androgel (surcharge around 1100 CZK). The dosage will progressively increase until you are going to switch to injections. Most of the time Sustanon is used here, with surcharge of around 250 CZK per ampule. It is injected once every two to three weeks. In case of serious adverse reactions you will take Nebido instead, which is also injected, once every three months with a surcharge of around 2000–3000 CZK.
Administration via injections has a higher bioavailability (how much of the dose gets into the systemic circulation) compared to oral administration. Oral medicines are weakened by first-pass metabolism—they pass through your gastrointestinal tract and liver before taking any effects. Their bioavailability can sometimes be a few percent. Administration via injections has a bioavailability of almost 100%. This can be beneficial because you'll absorb more of the substance and reduce the impact on your liver. Using higher doses is possible and safe. If you're on Androcur (bad for the liver), have liver issues, or don't reach the desired levels of hormones, injections might be a better choice. For more information, we recommend reading Hormone injections and their application.
Other forms of applications that do not have an official variant in the Czech republic are sublingual rectal and subdermal pellets. Sublingual medication is applied under the tongue, where it already partially enters the bloodstream before contact with the rest of the gastrointernal system. Theoretically any pill can be used Estrofem, for example, is not really fit for that purpose because it wouldn't taste very good although this is a possibility to increase the dose that your body receives. Rectal application exists for progesterone - the suppository exists in a vaginal form but it can be used in this way too. If your levels aren't satisfactory, you will have to discuss it with your doctor. The last variant is subdermal pellets, these are put under the skin and the hormones are released over the course of several months, it is an effective and carefree variant but there is very little information about it in the Czech Republic, and, for example, estradiol only releases values that correspond to the menstrual cycle.
During the transition it is necessary to visit the doctor regularly for blood testing to track how the hormone levels change, but also because of potential side effects. In the beginning of the transition the visits are usually once every 3 months, later once a year should be enough. It is something that a general practitioner could do, so it shouldn't be necessary to visit the already overloaded sexologies. Only if a problem occurs should a sexologist step in.
There is also an option to start the transition yourself, as is shown by the Reddit community TransDIY. This solution, however, comes with considerable risks: high price for various meds without any quality or safety guarantees, no support from experienced professionals - no correct blood tests, properly chosen medications, including doses and frequency. Also it could complicate access to the future SRS or legal gender change, or the way through the current system. It is highly discouraged to be your own doctor, but we felt it was only fair to mention this option that unfortunately some trans people have to take.
Hormone supply outages
It is possible that there might be a temporary disruption to the supply of various medications. Even though such a situation is relatively unlikely, it is good to know what to do in such cases. To check the availability of medications you can use the official database of SÚKL. If a medication is unavailable, SÚKL should make an alternative publicly known. For example, if the tablets Androcur are unavailable, you can learn this way that there is an alternative in the form of injections.
A change of your medication, however, needs to be consulted with your doctor. If you find out that pharmacies don't have your needed medication, you can first check hospital pharmacies as they often keep medications stocked in larger quantities than private ones. If they don't have it either and according to SÚKL the medication isn't available until after your prescription expires, then immediately contact your doctor to ask about an alternative. It is important not to experiment with the dosages without consulting your doctor. In any case, stopping or pausing HRT is a hazard to your health and therefore do not postpone contacting your doctor.
Before changing their legal gender, trans people can only have neutral names or names matching their legal gender. Register offices usually honor a discriminatory guide written by Knappová, where you can find a list of first names directly intended for trans people to use. Some of them can be good, however the fact that you are only supposed to choose from a predetermined list is borderline unethical. Also it is typical to recommend trans people to use -ů ending in their last names, which makes it easy for others to know you're trans.
An alternative is to request a language expert opinion. Until 2023 these were prepared by Mgr. Jana Valdrová, PhD CZ, unfortunately it is no longer possible. Her opinion had to be honored by register offices, because she is one of the three people who has the right CZ to provide these opinions.
Regarding the charge, the sexology will provide you with a form thanks to which the name change is free of charge (one before the legal gender change, one after). Otherwise the cost is 1000 Czech crowns for the first name and 1000 for the last name. The expert opinion is about 1200 Czech crowns, based on the chosen name and surname.
After the approval of your name change, the first thing you have to do is to get your ID card changed. For that you'll need your new birth certificate and your former ID card. In order to change other documents you'll need a new ID card first, as well as changing your personal information in banks and other places. Some other services will also require the approval document from the registry office (e.g. PayPal).
A more complex situation is changing your high school diploma, which is covered in Czech law under Vyhláška č. 3/2015 Sb CZ, §4, article 6. In addition to the approval document from the registry office and your ID card, you'll also need to enclose your previous diploma and a request document for the change. This request, however, doesn't any fixed form. We prepared an example template for you: download here. Due to this law being relatively new and some schools unfamiliarity with it, you can expect that tackling this problem likely won't be very smooth. Also no one is required to answer your emails, so it would be better to resolve this in person.
As trans people, we can often have bad experiences with our general practitioners and other specialists. Not everyone is sufficiently informed about trans people, and there is a chance, that they will blame your problems on the side effects of hormones and not even think about anything else. That's why here is a list of doctors, with whom we have good personal or verified experiences.
- MUDr. Michaela Ježková - Brno (MojeAmbulance Královo Pole) - general practitioner
- MUDr. Barbora Bajgarová - Brno (EMKO SONO) - ultrasound
- MUDr. Martina Vomáčková - Brno (IC Klinika) - proctology
- Kristýna Kvasnicová DiS - Brno (Smile Factory) - dental hygienist
- Mgr. Viera Soldánová - Brno - psychologist
- Mgr. Iveta Plocková - Brno - psychologist
- Mgr. Lucie Herzigová - Pilsen - psychologist
- MUDr. Iva Lamačová - Brno - psychiatrist
- MDDr. Jana Přibylová - Brno (Smile Factory) - dentist
Legal gender is the letter (M or F) that we all have in our ID and other documents. It's tracked in a lot of places that you visit. Even if it was removed, it's still trivially simple to decipher from our personal identification number. Unfortunately others might often address you as the legal gender they see in your documents, even though you are of a different gender and don't look like your gender assigned at birth. This can also happen with your name. For example, as a trans feminine person you can have a very feminine sounding name and still be addressed as "sir". Trans masculine people can now luckily choose to use their surname without the -ová suffix, however trans feminine people cannot choose to add said suffix until the legal gender is changed.
In Czech Republic, your legal gender can only be changed after undergoing the mandatory sterilization or full SRS. We're one of the last countries in Europe that require it. If you are married prior to the legal gender change, you have to have a divorce. If same sex marriage was legal in Czech Republic, this wouldn't be necessary. Jsme Fér is an organization that fights for same sex marriage in Czech Republic. You can see the differences between marriage and civil union here CZ.
Unfortunately we do not have a detailed experience with this part yet, but general tips still apply:
- Be very careful talking about your mental health
- You must be a hundred percent sure of your gender
- You should conform to stereotypical masculine/feminine gender expression
Sterilization is a requirement for a legal gender change in the Czech Republic. But before that, you will have to visit the gender committee. There are several professionals: general practitioner, sexologist, psychiatrist, clinical psychologist, endocrinologist, gynecologist and lawyer. The appointments happen in Prague almost every month. You will need letters of recommendation from both your sexologist and your psychologist. These two letters along with a request are then sent to the Ministry of Healthcare, more information can be found here CZ. Afterwards you will receive an invitation with more details.
For the committee you need to take your psychological evaluation, which cannot be older than three months (this means that you will have to undergo the evaluation mentioned above at least twice in total). It is important to dress well and also to match your binary gender. They will invite you inside, where around 9 people will be sitting: the professionals already mentioned and government employees. You will sign a piece of paper that you are sure, they will tell you their rules and question you with stereotypical questions like "How did you find out that you were trans?". You should prepare a similar story as for the psychological evaluation. If you succeed and they deem you trans enough, you will get a ticket for surgical changes, valid for up to two years after which you will need to go before the committee again.
Here are various other guides, tips and tricks for trans people, which don't necessarily belong to the Survival Guide: