The Haute Autorité de Santé (HAS) is publishing today clinical practice guidelines for the care of trans adults, developed at the request of the Ministry of Health. This represents a major step forward in recognising the right to self-determination and to care that is respectful, accessible and based on up-to-date evidence.
Self-determination recognised
Breaking with a historically pathologising approach, these guidelines stand out from the outset through their clear commitment to depsychiatrising transition pathways, in line with the reclassification of gender incongruence within the field of sexual health by the WHO in 2018 (ICD-11). The HAS emphasises that trans identity is not a mental disorder; as a result, psychiatric assessment is no longer positioned as a prerequisite or condition for access to transition-related care. This measure aims to put an end to humiliating or discouraging practices experienced by many trans people.
Another essential innovation is the formal recognition of the principle of self-determination as the foundation of medical support. Any person may self-identify as trans without having to undergo a validation process of their gender identity. This paradigm shift places trans people as active agents in their own care pathways, rather than as objects of a normative protocol. Healthcare professionals become partners rather than gatekeepers. This constitutes an ethical and clinical repositioning of major importance.
The document also puts an end to a binary and uniform vision of transition pathways by officially recognising their diversity. The guidelines include trans men and trans women, non-binary, gender-fluid, and questioning people, and affirm that each pathway is unique – whether medicalised or not, with or without surgery or hormone treatment. This flexibility makes it possible to provide care that is genuinely tailored to each person’s needs and expectations.
The language used is itself a strong signal of change. The HAS recommends adopting the term “trans person” as a non-pathologising umbrella term, and no longer using expressions now considered stigmatising or imprecise, such as “transsexualism,” “biological man/woman,” or “gender identity disorder.” These lexical guidelines, supported by the work of WPATH and community feedback, help to foster a more respectful medical culture.
General practice at the centre of care pathways
One of the most significant shifts in these recommendations is the positioning of general practice at the centre of the care pathway. Beyond receiving and listening to a person’s request, general practitioners should also be able to initiate prescriptions for gender-affirming hormones, without any requirement for referral to a psychiatrist, a hospital-based team, or validation by a multidisciplinary case meeting. This represents a major transformation in access to care, enabling trans people to begin their transition in a local, community-based setting, with appropriately trained professionals.
Historically, the French system was characterised by hospital-centred, specialised, lengthy and fragmented pathways, sometimes experienced as arbitrary. By contrast, the HAS proposes a fluid pathway, coordinated by primary care, rooted in first-line healthcare, and articulated with specialists (GPs, endocrinologists, surgeons, gynaecologists, etc.) who are involved according to individual needs rather than systematically.
Another major development lies in the clear and up-to-date framework for hormone prescriptions, for both transfeminine and transmasculine people. Therapeutic regimens are described in detail, incorporating expected effects, risks, and follow-up modalities. Fertility is systematically addressed upstream, with the possibility of gamete preservation prior to any medical treatment with potentially lasting effects.
A non-discriminatory approach
With regard to surgery, the HAS sets out guidelines for gender-affirming procedures, whether genital, chest, vocal or facial. Eligibility criteria are aligned with those required for equivalent surgical procedures in cisgender people (such as breast reduction or augmentation), meaning that they are centred on full information and informed consent, rather than on psychiatric assessments or medical validation processes.
However, prior to any hormonal or surgical care, a “reasonable and proportionate reflection period” is recommended, which is likely to give rise to differing interpretations. By way of comparison, statutory reflection periods in aesthetic medicine are set at 15 days. It therefore seems difficult, from both a medical and legal standpoint, to justify practitioners imposing a longer delay, particularly where the health benefit is clear.
A strengthened social framework
The psychological component, far from reintroducing a pathologising filter, is presented as support throughout the care pathway, serving the person’s well-being and offered when they feel the need for it. Screening for potential psychiatric disorders is recommended, but “referral to a mental health professional must not result in an additional delay in care.” Psychotherapeutic support may be offered, never imposed.
The guidelines explicitly recognise the overexposure of trans people to violence, discrimination, precarity and marginalisation, and call for heightened vigilance regarding these social factors. The HAS emphasises the active role of healthcare professionals in identifying violence, referring patients to appropriate resources, and working with community and social organisations to ensure a holistic approach to health, extending beyond the strictly medical sphere.
The document also devotes space to the fluidity of care pathways, incorporating the realities of detransition, identity readjustment or changes in trajectory. Far from stigmatising them, these experiences – although rare – are integrated as possible variations in a personal journey, and do not call into question the legitimacy of the initial steps taken. This new perspective de-dramatises detransition and enhances people’s safety through an appropriate, responsive approach to changes in care pathways.
Another innovative aspect is the recognition of the crucial role of trans-led organisations in access to care, information, psychological support, mediation with institutions, and the fight against discrimination. The HAS recommends structuring collaboration between healthcare professionals and community organisations in a logic of complementarity, territorial anchoring, and user participation in the continuous improvement of the healthcare system.
Policy directions for public authorities
As a preamble to its recommendations, the working group draws the attention of public authorities and the Health Insurance system to the need to adapt “the regulation of prescribing, dispensing, and coverage of medications,” in order to ensure 100 % coverage of transition-related care, whether or not the treatments have marketing authorization.
The working group calls for a profound reform of health care professional training. It recommends “strengthening initial and continuing training for professionals caring for transgender people by integrating the concerned individuals into the development of training content.” This is a central lever for putting an end to inequalities in access to care and to medical discrimination that remains all too frequent. While waiting for such training programs to be implemented, clinicians are encouraged to proactively build their competencies in order to ensure effective care.
Recommendations to come for trans minors
It is nevertheless notable that the HAS recommendations ultimately concern only trans adults, for the time being leaving aside care specifically dedicated to minors, even though the 2022 scoping note had initially planned for recommendations covering those aged 16 and over.
At a press conference held on Friday 18 July 2025, the HAS returned to this age-based division of recommendations, placing on its 2026 agenda the launch of work concerning people under 18. The TJT teams will of course make themselves available to contribute to the working group for these future recommendations, which are essential to improving the health, autonomy and well-being of trans and gender-questioning youth.
TYT invites healthcare professionals to continue caring for trans minors as they currently do. The existing legal framework allows physicians a degree of prescribing freedom, regulated in particular by established scientific evidence. The most recent international medical consensus to date – the AWMF (2025) – largely follows the WPATH (2022) recommendations and recognises the benefits of gender-affirming care for trans adolescents who express a need for it. The (at least temporary) absence of HAS recommendations on care for minors therefore does not call into question the relevance of these treatments.
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By articulating a vision grounded in respect for human rights, international scientific standards, and the lived realities of trans people, the HAS is undertaking a major overhaul of the French medical framework. These recommendations call for a deep, systemic change that all stakeholders in the healthcare system must implement. They provide clear reference points to guarantee equal, dignified and informed access to transition-related care.