Gender dysphoria has been estimated in the source material to occur in approximately 0.3% of the general population. Healthcare for transgender people requires appropriately trained professionals. In Hungary, both primary and specialist transgender healthcare remain areas that require further development. Suitable professional training can be difficult to access internationally as well. In recent years, the World Professional Association for Transgender Health (WPATH) has developed a high-level, multidisciplinary education system for professionals, including psychiatrists, psychologists, general practitioners, endocrinologists and specialists involved in gender-affirming procedures, such as general surgeons, plastic surgeons, urologists, gynaecologists and ear, nose and throat surgeons. Dr Noémi Bordás has participated in this specialist international training.
WPATH developed and continues to update one of the best-known sets of transgender healthcare standards, the WPATH Standards of Care. The absence of detailed national guidance is a challenge in Hungary and in other countries, but it is not the only reason patients may have difficulty finding supportive professionals. Some clinicians cite religious or political concerns, legal uncertainty, lack of experience or fear of litigation in a field that may not be fully regulated. The source material emphasises that refusing appropriate care may have serious consequences for the people concerned and highlights research reporting a high prevalence of suicide attempts among transgender people, as well as the potential protective effect of access to hormone therapy and other specific transgender healthcare.
The following sections are intended to provide general information. A more detailed professional and scientific review remains under development. Like every branch of medicine, this field is changing rapidly, and the material is intended to be expanded and revised periodically. Suggestions for revision are welcome. It is not possible to address every aspect of gender-affirming care here, so an in-person consultation with a specialist experienced in transgender healthcare is recommended when questions arise. The material focuses mainly on gender-affirming surgery but also refers to adult gender-affirming hormone therapy because its feminising or masculinising effects are relevant to surgical planning and may form an integral part of preparation and aftercare. Legal and ethical issues, mental healthcare, and transgender healthcare for children and adolescents are not discussed in detail.
Gender-affirming surgery
For transgender people, various elements of transition may reduce severe dysphoria, including legal recognition, gender-affirming hormone therapy and gender-affirming surgery. From a medical perspective, the aim is to improve quality of life through positive functional, social and psychosexual changes. Masculinising procedures may include mastectomy and chest reconstruction, removal of the uterus and ovaries, metoidioplasty, phalloplasty and selected aesthetic plastic-surgical procedures. Feminising procedures may include bilateral orchiectomy, removal of the penis with vaginal construction, breast augmentation, facial and other aesthetic surgery, and hair transplantation. Reproductive wishes and fertility-preservation options should be discussed at appropriate points in care, including during surgical planning. Eligibility for operations is commonly assessed with reference to the surgical criteria in the WPATH Standards of Care.
In simplified terms, older international criteria often expected supportive mental-health documentation and a period of hormone treatment or lived experience before certain genital procedures. Some operations, such as facial procedures or chest reconstruction involving mastectomy, may not require prior hormone therapy. In addition to international criteria, local practice in some countries may traditionally request further specialist opinions, for example from urology, gynaecology or endocrinology, or evidence of legal gender recognition and updated identity documents. Current requirements must always be checked individually because standards and legislation can change.
For a detailed explanation of surgical criteria and individual options, an in-person consultation with a transgender healthcare specialist is recommended in addition to reading the relevant sections of current professional guidance. International guidance does not prescribe a compulsory order for gender-affirming operations. No one should be required to undergo a particular operation during transition, and one procedure should not automatically be made a mandatory condition for later surgery. From an ethical perspective, legal gender recognition should not depend on compulsory surgery.
Gender-affirming surgery requires consideration of complex and individual needs, and no single surgical technique alone can guarantee success. The development of multidisciplinary centres is important internationally and in Hungary to improve the quality of transgender healthcare. Broad reconstructive experience, an appropriate case volume, the involvement of a sufficient number of competent specialists, the use of consistent international standards and cooperation with other transgender healthcare institutions are all important factors in building such centres.