How Trans Healthcare in Greece is Pushed Outside the System

Athens, Greece — A trans woman was found dead in Thessaloniki two days ago and two separate transphobic attacks in Athens have made the news this year. The culture of violence and threats on trans people in Greece are intensifying while they face challenges accessing healthcare.

Trans people in Greece have no map to navigate their healthcare access within the current system. There is no clear entry point, and no guarantee that the next step will lead anywhere stable.

Sadie’s story is one of many, a brief view into the barriers that exist in the medical system but one that cannot be told without acknowledging the broader climate in which trans lives in Greece are lived.

Sadie at the Athens subway checking herself at the mirror before she enters the trains. Photo contributed by Sophia Potsi.

“I had to figure it out myself by then. And most things in my transition, I’ve had to figure out on my own, to be honest.”

For Sadie, a 27-year-old trans woman living in Athens, this was the reality she had to navigate: fragmented information, uneven access, and a system that only partially exists. Advice from friends, a bit of luck and trial and error in finding the right doctor, unexpected disruptions, like medication costing up to €200 per dose, suddenly being taken off insurance coverage and a constant requirement for patience.

The system does not disappear. It is still there, in fragments: insurance codes, prescriptions, psychiatrists, endocrinologists, legal procedures that exist on paper but cost money and require expertise to navigate. It is a process of trial and error, a continuous search for information, resources, and occasionally luck. The right piece of advice at the right time can mean avoiding months of delay or unnecessary hardship. Community knowledge becomes essential: what you read, who you meet, what they tell you and what you are told along the way by the people that you are made to meet through this process.

In Sadie’s case, that guidance was minimal in the beginning.

“Back in the day, I don’t think I received much guidance,” she says. “I don’t think many people really helped me.”

There were exceptions. One person stands out in her memory, a trans woman.

“She gave me some small guidance. Nothing extreme.”

She pauses.

“I don’t hold that against anyone,” she says. “If you don’t know people, it’s not possible.”

Now, she is on the other side of that equation. When younger trans people reach out to her, she responds eagerly to offer the information and share her experience.

“That’s why I actually like it now when younger trans people come and talk to me and ask how you do this or that, and I share information openly, about doctors and all that stuff, and, you know, legal things and surgery things.

Because it’s something I feel I didn’t have, and I think it fucking sucked that I didn’t have it. And I’d like to be able to provide it to other people, because it’s a kind of strange situation, and that information isn’t properly structured anywhere, as it should be, I think.”

In Greece, gender-affirming healthcare is not entirely absent. Hormones exist. Doctors exist. Legal pathways exist. What does not exist is a system. Instead, care is distributed across disconnected points, what Sadie jokingly calls “side quests”: a web of private psychiatrists, endocrinologists, informal networks, and inconsistent insurance coverage. There is no centralized pathway, no standardized protocol, and of course no guarantee of access.

The result is that for a person seeking this kind of healthcare, their experience is shaped less by institutional support than by informal networks, personal finances, and individual persistence. Although all these services are theoretically accessible, there is no standardized pathway guiding trans people through the process. Access frequently depends on finding the “right” doctor through community recommendations, enduring long waiting periods in the public sector, and navigating or avoiding discriminatory and pathologizing treatment.

According to research, many trans people describe approaching hospitals and clinics with fear, while mental health services, although functioning in practice and legally required as a prerequisite for proceeding with medical transition, are often experienced as inconsistent, leading some individuals to abandon public healthcare altogether in favor of private providers despite the financial burden.

Surgical procedures remain almost entirely excluded from public coverage and are commonly classified as cosmetic interventions, forcing many trans people to rely on crowdfunding or seek care abroad.

In the absence of coherent institutional support, shared knowledge and community has effectively become an alternative healthcare infrastructure, with information about trusted doctors, medications, legal procedures, and safer treatment options circulating informally among trans people and filling the gaps left by the state. So for many, that navigation begins alone.

Sadie at the Athens subway walking out. Photo contributed by Sophia Potsi.

Sadie knew she was trans long before she had language for it. She grew up in a small community outside Athens.

“I had thoughts when I was three or four,” she says. “Fourth of fifth grade I started doing cross dressing secretly so I knew that it was something I wanted to do.”

She moved to Athens when she was 20 and as she says she delayed in starting her transition due to facing problems with her mental health.

“I was in a dark cloud for three years. I struggled, depression, trauma from living in a smaller community outside of the city. A lot of alcoholism, drugs, I had problems with substances.”

Talking about this period, she says:

“I knew it was something I wanted, everyone knew it was something I wanted. I lived as a woman at night,” she says. “During the day, I didn’t exist,” she says. “ I was sitting at home, looking at the wall and crying.”

Her entry into the medical system came through intervention. The first step was talking to a psychiatrist.

“I was so bad I was staring death in the face. A friend took me to their psychiatrist,” she says. “Basically, I was taken there. The person who took me there told me it was time to do what fate has written for me.”

Before going to the private psychiatrist that her friend knew, she tried to call a public structure. She recalls that the people they talked with on the phone were acting weird and asking irrelevant questions, so she preferred to continue with the private sector. She began private psychiatric monitoring and completed the required six months before accessing hormone therapy while doing this in parallel with other procedures, like laser hair removal.

After that she proceeded to find an endocrinologist.

“I had a really bad experience with an endocrinologist before I found the one everyone recommends,” she recalls. “We had already spoken on the phone and I had explained exactly why I wanted to see him. But when I arrived, he told me, ‘We don’t take cases like yours,’ and started making strange comments. I left furious. I was a complete mess.”

Sadie portrait. Photo contributed by Sophia Potsi.

The constant failures and barriers in her process though are not an individual issue. According to the same research cited before, participants often report stress when visiting healthcare providers, anticipating uncomfortable situations, discriminatory behavior, or having their gender identity questioned.

Many are forced to choose between self-respect and access to care, sometimes avoiding treatment altogether with all the repercussions this decision may have.

Her eventual doctor, “the good one,” which she found from a friend, is competent and honest. But even that relationship operates within constraints.

“He’ll tell you what works, no bullshit,” she says. “But he won’t get it for you.”

In Sadie’s case, pills weren’t working. Her early treatment involved multiple medications per day, frequent dosage adjustments, and not the desirable hormone levels.

“I was taking 6 estradiol pills and 2 progesterone pills per day,” she says. “Plus more. I wasn’t stable, not physically, not mentally,” she adds. “They caused very intense emotional and psychological mood swings.”

After limited results, she had to find an alternative way of treatment. So she moved to injections following her doctor’s recommendation. However, injections are not available in Greece.

“With the injection, you’re basically set. You’re much better off, and the changes are also much more immediate,” she says. “The feminization is much more immediate compared to everything else, skin, fat distribution, all of it. It’s really, really effective, and I wish I had started with that from the beginning.”

As injections are unavailable, she relied on informal routes, ordering from Germany or asking someone to bring them from abroad. While not illegal, access involves bureaucratic and logistical barriers, informal supply chains, and trust-based networks. It also requires learning to self-inject.

Sadie’s experience reflects a wider lack of consistent medical guidance. The difficulties she encountered were not only logistical but also stemmed from gaps in training and uneven preparedness among healthcare professionals, leaving her to navigate aspects of her treatment without clear instruction or stable support. This added to the psychological pressure of the process, layered on top of the everyday struggles of life itself.

And that is the reality for many trans people in Greece. And adding to all of the above is the financial burden which extends far beyond hormones. Starting with legal transition, including name and gender marker changes which is a process that requires a lawyer and has significant other costs.

Sadie was able to access a lawyer through personal connections.

“I got lucky,” she says. “I paid much less than normal.”

Without that connection, the cost would have been significantly higher, and entirely out of pocket.

“No one covers it,” she says.

Surgery presents an even greater challenge. Gender-affirming surgeries are not covered by the public healthcare system, as they are classified as cosmetic procedures. Apart from that, finding a doctor that can do a surgery like this in Greece with good results is a puzzle.

Reportedly in some cases, outcomes are not fully functional, which may lead to the need for revision surgeries and essentially repeating the process from the beginning. The cost in all these cases is approximately 15,000 euros if you decide to do the surgery in Greece and the cost rises if you decide to do it in a country abroad like Thailand with travel expenses.

“What I’ve heard from other girls,” she says carefully, “is to avoid doing it in Greece like the devil avoids holy water.”

Though this is not her personal judgment, it is something that is well known in the community circles.

Faced with these obstacles, many trans people turn to crowdfunding to cover the high costs and the lack of another option. But this fact reveals social and healthcare inequalities.

Studies on crowdfunding for gender-affirming care highlights deep inequalities in who is able to raise money and how successful those efforts are. Overall success rates were low: few campaigns reached their financial goals, and on average, trans fundraisers raised less than half of what they aimed for. And even this limited success is unevenly distributed, shaped by existing social biases that influence who in the end receives support.

Another part of it is the fact that visibility, rather than personal connections, is key to outcomes; campaigns that were shared more widely on social media raised substantially more money, often through many small donations rather than a few large ones. At the same time, outcomes were uneven across groups: older recipients tended to raise more, and trans women often raised lower proportions of their goals compared to trans men, reflecting broader structural inequalities. Taken together, the findings suggest that access to gender-affirming care through crowdfunding is not only limited but also shaped by existing hierarchies of race, age, gender presentation, and digital visibility.

Individuals have to expose their life, their goals and why they need this. And while this may be second nature to some, for others, it means that they have to choose between their privacy and being public to be able to get access to gender affirming surgery. Privacy in this case becomes a privilege that not a lot of individuals can afford. And the alternative is waiting, often with psychological consequences.

“I’ve basically been posting publicly for years, and I have a bit more of my own personal… persona, in a way, online. But I think the same applies to people who might not do what I do, there’s still support and all that, although it still involves turning pain into a commodity. There’s no other way around it. I believe that once people start sharing it, and more and more people repost it and spread it around, the money will be raised sooner or later.”

Even though Sadie was comfortable with being in the public eye in the process of building her campaign she knew that she had to explain everything and make her story known. As she says she took time to curate everything, and she also learned to operate a new graphic design software to be able to make the cover of her crowdfunding herself. The whole process took two days and when she made it public she was anxious waiting for the results – see her campaign here.

“If it hadn’t gone well, it would have destroyed me,” she says. “I would have felt like I had no chance, like nothing would come of it, that I couldn’t make it work.”

The process of crowdfunding for transition turns healthcare into a visibility-based competition. Care becomes conditional. The individual has to rely on the kindness of strangers and their social networks and popularity. While some may choose to share it openly, this exposure can shift the experience closer to a performance, where personal vulnerability is subject to public view, engagement, and validation. In this context, pain risks being commodified, measured through attention and support, and reframed as a kind of contest.

“Even now that it has gone well, I’m still thinking about how to move it forward, how to develop it,” she adds. “I haven’t reached my goal yet, but I can’t be ungrateful. There has already been a lot of support, and I’m very grateful for that,” she continues. “But if it hadn’t had any response, it would have been a harsh reality check, not so much about what people think of me, but about where I stand, in a way.”

Crowdfunding introduces a new form of selection. Care, in this sense, becomes conditional and increasingly tied to a kind of popularity contest. This is the consequence of replacing a service that should be universally and freely provided with a digital marketplace of visibility, where survival often depends on one’s ability to attract attention and mobilize an audience.

Within this framework, access to surgery becomes not just a medical milestone but a deeply personal threshold in how Sadie imagines her future.

“I feel that after that, at least for me, I’ll have completed everything I need, and I can simply start living.”

And what follows for her is not framed as a sudden transformation, but as the gradual opening of possibilities that have long felt blocked by discomfort and self-consciousness. Things like going back to the sea, spending time at the beach without hesitation, and reconnecting with physical activities like going to the gym, choosing what to wear and not having to structure daily life around concealment or restriction. Overall, it is the removal of a persistent weight, an easing of tension that has shaped many small decisions.

And if there is one word that holds all of this together, as she says, it is: γαλήνη ( gha-lin-ee ) — calm, peace.

That sense of calm, however, remains something to be reached rather than lived, emerging at the end of a long process shaped by uncertainty.

Trans healthcare remains uneven and often difficult to access, shaped by structural gaps between a number of obstacles. Even in more urban contexts like Athens, pathways to gender-affirming care can depend heavily on financial means, personal networks, and information shared within communities rather than consistent public provision.

In that context, Sadie reflects on what is ultimately at stake beyond the procedures themselves:

“We just want to exist. We are not here to bother anyone. The fact that we change the world is a side effect of simply being ourselves. You know. I think people are afraid of change. But we didn’t come here to revise anything. Essentially, we came here just to create space for ourselves. Because there is no space for us. Not in the state, not in the country, not anywhere. We came here within our own circles to do our own things and to make our dreams come true, basically. And I think people don’t like that. Because when you are part of the mass, seeing people who are different can be frightening.”

The problems that trans people face in Greece are escalating. Earlier this year, a group of roughly fifteen men in the Patisia neighborhood followed a trans refugee woman from Pakistan, identified as M., and her friends before surrounding them outside a betting shop where they subjected them to prolonged verbal abuse, hurled bottles and other objects at their heads, threw chairs from the shop, and threatened to find M. and kill her.

Less than four months later, in May 2026, a trans woman in the Kallithea neighborhood was subjected to a racist attack by four young men who first verbally abused her, threw eggs and objects at her, and then deliberately ran her over with their vehicle as she was walking home. She was injured.

Two days ago, on June 30, the body of a 20-year-old trans woman was found on a skylight shaft in the city of Thessaloniki, the possibility of a homicide has not been ruled out. In a main square in the same city two years ago, a mob attacked two transgender individuals by hurling bottles and verbally abusing them.

Cover image contributed by Sophia Potsi.

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