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Due to the lack of legal recognition or proper health care, many transgender Albanians receive hormone therapy without medical supervision or seek expensive help abroad.
Fiona, who is transgender, started hormone therapy a few years ago but stopped after three months due to overwhelming anxiety. She was doing this on her own, without any advice or guidance from any doctor.
When we asked her where she got the medicine, Fiona, who declined to give her last name, replied: “At the pharmacy. That's what all girls do."
The experience prompted her to seek professional psychological support, but she has never seen a specialist to discuss hormone therapy, before, during, or since. She says she will never try it again.
In Albania, there is neither hormone therapy nor sex reassignment surgery, which means transgender Albanians like Fiona are forced to self-medicate or travel to North Macedonia, Serbia, or Turkey. The costs, financial and psychological, can be huge.
Xheni Karaj, who runs the LGBT Alliance, said the organization has lobbied the Ministry of Health to introduce a medical protocol that allows transgender people to receive hormone therapy.
"Although the ministry has expressed a willingness to develop this protocol, the whole process is moving very slowly," Karaj told BIRN.
"As a result, we have a large number of people within the community who are forced to travel to other countries to receive these services, which is very expensive... The rest who do not have the opportunity to travel end up getting drugs on the black market without the monitoring of doctors, which puts their health at high risk."
Gender identity is included in non-discrimination legislation in Albania, but the country does not have legislation that regulates the legal recognition of gender.
The European Commission against Racism and Intolerance, ECRI, has repeatedly urged Albania to regulate gender reassignment procedures and administrative recognition of a change of name and gender, "in accordance with the guidance of the Council of Europe and the judicial practice of the European Court of Human Rights. "
In 2020, ECRI highlighted the importance of "promoting equality for LGBTI persons in the health and education sectors, completing the legislative gap analysis and raising awareness, as well as building capacity at the municipal level outside Tirana". He also noted that the relevant unit in the Ministry of Health "reportedly has a very limited number of staff members dealing with this topic".
But while Albania's National Action Plan for LGBT people, covering the period 2021-2027, calls for such recognition and for the LGBT community to have full access to the health system, Karaj said little progress had been made since an effort failed to change the law in 2012.
"Throughout these years we have faced resistance and a lack of political will."
The lack of action has forced David Cuka, 30, to make a 15-hour round trip to North Macedonia every three to six months for hormone therapy, having already traveled to Turkey for surgery.
"My mental health has been affected and there are many aspects to consider - health, financial, and also legal," he told BIRN. But, he said, his transformation "is not a matter of choice", but of belonging.