Trans healthcare for adults in Andalusia: how it works and what to expect

Written by Rocío Rodríguez Boza

General Health Psychologist · COPAO AN13748

Clinical review: Héctor Lozano Jiménez, General Health Psychologist · COPAO AN11777

Published 19 September 2026

“I want information, but I don't know whether I want treatment.” “Do I have to see mental health before I can be referred?” “What if I only want some changes?” “What do I say to my GP?” These are reasonable questions, and much of the anxiety comes from imagining trans healthcare as a chain of decisions that cannot be stopped once it begins.

In practice, needs are more individual. One person may want information only. Another may wish to discuss hormone treatment. Another may want to ask about voice, fertility or one particular procedure. Another may decide they do not want gender-related medical care at all. Being trans or non-binary does not automatically determine any of those choices.

Not every trans person wants medical care

Transition can involve social, legal and medical elements, but there is no requirement to pursue all of them. You may want to change how you live socially without wanting medical treatment. You may want hormones and not surgery. You may be interested in one intervention and not another. You may not want to change documents. You may explore and decide that, for now, you want no further steps.

This matters because people sometimes arrive carrying a learnt rule: “if I'm really trans, I should want everything”. Healthcare should respond to individual needs rather than using one pathway as a test of authenticity.

For a clearer explanation of these separate areas, see our guide to social, legal and medical transition.

Where do I start as an adult in Andalusia?

For somebody entering the Andalusian public pathway as an adult, the patient route currently linked by the SAS and Junta begins in primary care, with the GP/family doctor. The purpose of that first stage is to clarify what you are asking for and respond to your needs, rather than assume you want a complete medical transition.

Where a request involves specialist gender-related medical care, the pathway includes coordination with the provincial UAPT (Unidad de Atención a Personas Transexuales) and the relevant medical specialties. The Fifth Biennial Report published by the Junta in 2026, covering activity in 2023–2024, confirms a decentralised model with specialist units across all Andalusian provinces.

There is an obvious exception: people already receiving gender-related care in adolescence may move into adult care through continuity arrangements rather than beginning at exactly the same point as somebody making a first request as an adult.

Some official Andalusian documents retain the term transexualidad. This article uses the broader contemporary term “trans people” while keeping official document titles accurate.

If you live in Palmones or the Campo de Gibraltar

The current SAS entry for Consultorio Palmones places it within Área de Gestión Sanitaria Campo de Gibraltar Oeste, Los Barrios basic health zone, with Hospital Punta Europa as its general hospital reference area. That tells you where your local primary-care service sits.

However, the public sources we checked do not clearly identify the exact UAPT to which every adult referral from Palmones or the Campo de Gibraltar is currently assigned. It would be misleading to invent this or assume that the specialist trans unit must be located at the general reference hospital.

The safest route is to begin with your assigned primary-care centre and ask them to confirm the current referral pathway. For SAS administrative information you can also contact Salud Responde, available 24 hours on 955 54 50 60.

What might happen at a first appointment?

There is no identical script for every person, and this section should not be treated as a compulsory checklist. The content depends on where you are seen and what you are asking for.

In the official route, primary care begins by clarifying your request and needs. If you are considering a medical intervention, relevant general health, current medicines and medical history may need review, and tests may be requested where they are clinically relevant. When the UAPT is involved, the published pathway includes completing the health history, arranging tests or other specialist input where needed and explaining the proposed plan.

Expectations, previous treatment or fertility may also be discussed when they are relevant to the decision being considered. Clinically relevant questions are different from unnecessary curiosity about private aspects of your body or history.

Do I have to prove that I am trans?

Current Andalusian law does not support turning identity into a prior test for access to rights. Law 8/2017 states that a person cannot be required to undergo tests or examinations intended to determine gender identity or expression in order to decide access to benefits or other rights.

That is consistent with a basic affirmative clinical principle: you should not have to perform a stereotyped version of masculinity or femininity to be heard. You do not need to have “known since childhood”, hate your whole body, dress in a particular way, have a particular sexual orientation or want surgery for your healthcare questions to be legitimate.

A healthcare professional may still need medically relevant information before a particular intervention. Asking about health conditions, medication, previous treatment or expectations is different from asking you to prove that your identity is real.

Do I have to see psychology or psychiatry first?

Not as a general gatekeeping requirement for specialist trans healthcare. Article 28.4 of Andalusian Law 8/2017 states that psychological care for LGBTI people is the ordinary psychological care available to other health-service users and that specialist healthcare cannot be made conditional on a prior psychological or psychiatric examination.

This does not mean mental healthcare disappears. If somebody has anxiety, depression, trauma, ADHD, autism or another difficulty, they can receive appropriate care in its own right. A person may also choose psychological support to explore decisions. The distinction is between support and having to pass an identity test.

Existing mental-health difficulties do not automatically invalidate a trans identity either. Good care can address both without using one to erase the other.

Ocnos tool 1: my aim for this appointment

Asking for information is not the same as consenting to treatment

Information is what makes meaningful decisions possible. A consultation can help you understand available options, known benefits and risks, alternatives, likely follow-up and which considerations depend on your own health.

Andalusian legislation and the latest official implementation report place informed consent within healthcare procedures. Consent is not simply saying yes to something; it depends on receiving information you can understand well enough to decide.

You can also choose not to decide yet. Sometimes the most informed next step is asking for another explanation, reading the information provided, asking a new question or separating one large decision into several smaller ones.

Ocnos tool 2: what I want / what I do not want / what I do not know

You do not have to make every decision at once

Hormones, surgery, fertility, documents, coming out, work, relationships and social presentation are separate decisions. Their connections do not mean they all need to be settled at the same time or in one prescribed order.

Separating them can reduce a common fear: “if I ask about one thing, I am agreeing to everything else”. You are not. One area can be explored while others stay completely open.

Affirmative clinical writing also recognises that gender pathways are diverse and that not every trans person wants permanent medical change. Useful therapy helps decisions move closer to the person's own needs rather than external expectations.

Ocnos tool 3: questions for a healthcare appointment

Hormones: general information, not a treatment schedule

Some adults consider hormone treatment and others do not. Effects and their timing vary between people; some changes may alter after treatment stops, others can persist to different degrees, and every option has risks, contraindications and monitoring needs that require individual assessment.

For that reason, this article does not provide doses, combinations, routes of administration or testing calendars. Even where an older official document contains a particular schedule, that does not make it the correct plan for every person in 2026.

For a general explanation of hormones, surgery and fertility, see hormones, surgery and fertility for trans people. Individual decisions belong with the healthcare team that knows your health.

Surgery: an option for some people, not a compulsory “final step”

Different procedures exist and many trans people do not want any of them. Andalusian law and the public pathway include adult-specific surgical care within the healthcare framework, but access, indications, technique, risks and recovery depend on the procedure and individual assessment.

Surgery should not be presented as a graduation that “completes” transition. It may be very important to one person, irrelevant to another and something a third person wants to consider years later.

Fertility: information does not oblige you to preserve anything

Some medical interventions can have reproductive implications. If you are considering one of them and future fertility might matter —even if you are unsure today— it is reasonable to ask beforehand about known effects, uncertainty and any preservation options relevant to you.

If you know you do not want children, that decision deserves respect too. Learning about fertility does not create an obligation to preserve reproductive material or change your life plans. The purpose is informed choice, not imposing an expectation of future parenthood.

Your other health conditions still matter

A trans person can also have hypertension, diabetes, migraine, epilepsy, autoimmune disease, chronic pain, anxiety, depression or any other health condition. Healthcare should not reduce every consultation to being trans.

When a new treatment is being considered, current medication and relevant health conditions do matter because they may influence safety, follow-up or clinical choices. That is individualised medicine rather than questioning identity.

If you are autistic or have ADHD, you may find clear explanations, written information or extra organisation before an appointment useful. Neurodivergence neither proves nor disproves a trans identity.

Current medication and self-medication: do not make changes from internet information

If you take prescribed medication, tell the healthcare team. Do not abruptly stop, change the dose or alter a treatment because of an article, forum or another person's experience.

If you are already using hormones without medical monitoring, shame is not useful either. The safer step is to seek healthcare and be honest about what you are taking so that your health and follow-up needs can be reviewed. This guide does not provide instructions for obtaining, combining or adjusting hormones independently.

Follow-up and blood tests: why there is no universal calendar here

The official pathway includes clinical and laboratory follow-up where treatment is involved, but frequency depends on the intervention, results, medical history, medication and clinical judgement. It would be unsafe to convert one timetable from an older document into a rule for everybody.

At your appointment, ask which monitoring you need, why it is being done and how it will be coordinated between primary and specialist care. Understanding follow-up is part of informed decision-making too.

Realistic expectations: what do you hope will change, and what may not depend on it?

Medical changes can be profoundly important for some people and may improve comfort with the body or general wellbeing. That potential should not be minimised. At the same time, one intervention should not have to solve every difficulty in a person's life.

Medical treatment does not automatically remove trauma, a harmful relationship, workplace discrimination, anxiety, learnt shame, financial problems or low self-esteem. Some areas may improve indirectly; others need their own support.

Before, during and after an appointment

Ocnos tool 5: health summary for an appointment

What if my goals change?

Decision-making is not always linear. Somebody can ask for information, wait, begin an intervention, revise their aims, pause a decision or return to it later. That does not automatically mean the earlier decision was a mistake.

If you are dealing with uncertainty, a pause or a change in how you understand previous decisions, see detransition and re-identification support, which approaches those experiences without treating them as failure or using them to invalidate other trans pathways.

If you are already taking a prescribed treatment, any change or discontinuation should be discussed with the responsible clinician. Personal reflection about your goals does not replace medical review.

Names, documents and healthcare systems

There can be differences between the name you use, your registered details and what appears in particular administrative systems. A general guide should not promise that every database is updated in the same way.

If your main question concerns legal name or registered-sex changes, see changing your name and registered sex in Spain. For a specific SAS data issue, use the health service's citizen-support channels.

“I didn't feel listened to”: distinguish a poor consultation from discrimination

An appointment can feel poor for several reasons: time pressure, unclear explanations, an inappropriate remark, different expectations, an administrative problem or genuine discrimination. Not every clinical disagreement is transphobia, but disrespect should not be normalised either.

Try to identify what actually happened: was an old name used deliberately, were intimate questions asked without relevance to your healthcare, was an unrelated medical problem automatically attributed to transition, did you lack enough information to understand a decision, or was the difficulty organisational?

A qualitative Andalusian study by Casas-Ramírez and colleagues interviewed 18 trans adults who had used the Andalusian Public Health System. Most described positive aspects of care, while participants also reported experiences they perceived as discriminatory or pathologising and asked for better information and professional training. This was a small qualitative sample, so it does not describe every service or estimate how common particular experiences are.

If you believe there has been genuine discrimination and need to understand general routes for help, see transphobia, discrimination and getting help in Spain.

Can I have psychological support without wanting medical treatment?

Yes. In private psychological practice, people may seek therapy for gender exploration, anxiety, body image, fear of medical appointments, discrimination, relationships, family issues, self-esteem or decision-making without wanting hormones or surgery.

That support should not be about certifying whether you are “trans enough”. It can help distinguish your own wishes from social pressure, tolerate uncertainty, prepare questions, refine expectations and process difficult experiences.

Ocnos provides psychological care, not endocrinology, surgery or hormone prescribing. We can help you organise decisions and emotions; medical indications belong with the clinicians responsible for your healthcare.

Where can I check current official information?

The SAS page on trans healthcare within primary care continues to direct adults to the specific PAI. The Junta also maintains the official adult Integrated Care Pathway page and its patient route.

Because the underlying clinical pathway document is not recent, operational details —the exact unit, local referral, appointment arrangements, documentation or organisational changes— should be confirmed with your health centre, relevant UAPT or Salud Responde. We have not included waiting-time estimates because we did not find one current official waiting period that applies uniformly across Andalusia.

Frequently asked questions about adult trans healthcare in Andalusia

Sources

1. Andalusian Health Service and Junta de Andalucía. Primary-care portfolio: Atención a personas transexuales (updated 07/11/2025) and the current Integrated Care Pathway for Adult Trans People page. SAS (Spanish) · Junta PAI (Spanish).
2. Junta de Andalucía. Law 8/2017 of 28 December on LGBTI equality and non-discrimination in Andalusia, particularly arts. 6 and 28. Official consolidated text (Spanish).
3. Junta de Andalucía. Fifth Biennial Report on implementation of Law 2/2014, 2023–2024, published in 2026; sections on healthcare, integrated pathways and UAPT units. Official PDF (Spanish).
4. Casas-Ramírez, M., Martínez-Linares, J. M., Cortés-Martín, J. J. & López-Entrambasaguas, O. (2024). Trans people perceptions of care received from healthcare professionals: A phenomenological study. Heliyon, 10(1), e23328. PubMed.
5. Scarrone Bonhomme, L., Davies, S. & Beattie, M. (2023). Gender Affirming Therapy: A Guide to What Transgender and Non-Binary Clients Can Teach Us. Open University Press.