Married trans people in Lithuania are being denied access to gender-affirming healthcare because of their marital status, and trans people with a migration background are among those hit hardest. On 25 September 2026, the National LGBT Rights Organization LGL sent a formal appeal to the Ministry of Health, calling for clear non-discrimination rules in the procedure that governs this care.
A copy of the appeal (No. LGL20260925-1) was sent to the Office of the Equal Opportunities Ombudsperson.
A requirement that exists nowhere in the rules
Access to diagnostics, psychiatric, psychological and endocrinology consultations, hormone therapy and follow-up is governed by the Procedure for the Diagnosis and Treatment of Gender Identity Disorder , approved by Minister of Health Order No. V-1307 of 4 August 2022. The Procedure sets only medical criteria: a diagnosis and a persistent wish lasting at least two years. Nowhere does it require a patient to be unmarried.
Yet the Procedure also does not state that services must be provided regardless of marital status. According to the information available to LGL, this gap is being resolved in practice against the patient.
LGL has received testimonies from two married trans women. The first sought to begin hormone therapy, but says treatment remained out of reach because she is married, and that her mental health has suffered badly as a result. The second, who lives in Lithuania, says she could not officially begin medical transition for the same reason.
LGL is not representing these individuals or asking for their cases to be investigated. They are shared as examples of a systemic problem.
Trans migrants: no way forward at all
The barrier weighs especially heavily on trans people with a migration status. According to the testimonies LGL has received, many of them cannot even proceed with a divorce in Lithuania as they claim they are not being given clear guidance by the authorities.
The ‘divorce first’ rule pits health against family, though Lithuania’s Constitution protects both.
Why the practice is unlawful
Article 2.27 of the Civil Code gives an unmarried adult the right to change sex where medically possible. But in L. v. Lithuania (2007), the European Court of Human Rights read this provision as concerning surgical gender reassignment. The Procedure was adopted on a separate legal basis, the Law on Health Care Institutions. LGL argues the Civil Code’s condition therefore cannot be stretched to diagnostics, psychotherapy or hormone therapy. Restrictions on rights can only be set by law, not by administrative practice.
The Constitution protects human dignity, private life and the family, and obliges the state to ensure medical care. Forcing someone to end their marriage to get treatment would set two constitutional values, health and family, against each other. LGL argues this is not a proportionate means of pursuing any legitimate aim.
European law points the same way. In MB (C-451/16, 2018), the Court of Justice of the EU held that requiring a trans person to end their marriage to access a right others enjoy without that condition is direct sex discrimination. In Shipova (C-43/24, March 2026), it ruled that member states must have a working legal gender recognition procedure, at least for their citizens who have exercised free movement. In Lithuania, LGL warns, trans people risk a double trap: changing documents is linked in practice to medical treatment, while treatment is conditioned on divorce.
National law also prohibits discrimination in services. The Law on Patients’ Rights forbids restricting patients’ rights on grounds including sex and social status, and the equal opportunities laws ban sex discrimination in services, which under EU law covers gender identity.
What LGL is asking for
LGL proposes that the Ministry of Health:
- Add a new point 3¹ to the Procedure stating that services are provided to all adult patients who meet the medical criteria, regardless of marital status, sex, gender identity, citizenship, legal residence status or other circumstances unrelated to their health, and that services cannot be conditioned on divorce.
- Specify that the medical panel and specialists decide on services solely on the basis of the Procedure’s medical criteria.
- Until the amendments take effect, immediately send health care institutions, the Lithuanian Psychiatric Association and other professional bodies a methodological clarification that services do not depend on marital status.
- Monitor how the Procedure is applied and collect data on cases where services were refused or stopped for non-medical reasons.
LGL has also asked the Equal Opportunities Ombudsperson to assess whether a divorce requirement amounts to discrimination on grounds of sex and gender identity, and whether the Civil Code’s “unmarried” condition covers access to healthcare at all. The Ombudsperson is further asked to consider an own-initiative investigation and to recommend that the Ministry amend the Procedure, and that the Seimas and the Government amend Article 2.27 of the Civil Code.
LGL stands ready to take part in drafting the amendments. Trans people, including those with a migration status, who have been refused care because of their marital status can contact LGL at office@gay.lt.
