Albania's Hormone Therapy Guideline Doesn't Come With the Funding Everyone Assumed

Earlier this year, Albania’s Ministry of Health quietly approved something advocates had pushed for over years of closed-door meetings: a Clinical Practice Guideline that finally lays out how transgender adults can access gender-affirming hormone therapy through the public healthcare system, via the Endocrinology Service at Mother Teresa University Hospital Centre in Tirana.

It should have been a quiet, technical win. Instead, it set off a wave of online hate — built almost entirely on a claim that isn’t true.

As BIRN (Balkan Insight) reported this week, posts spreading across Albanian social media insisted the guideline meant taxpayers would now be funding hormone treatment for trans people, including minors. Neither part of that is accurate. Xheni Karaj, head of the LGBT Alliance, the Albanian NGO that has tracked the guideline’s rollout, was direct about it: “The guideline regulates the provision of healthcare and the clinical protocol, but it does not provide for the reimbursement or public provision of hormones.”

In other words, the guideline tells doctors how to evaluate and monitor patients. It says nothing about who pays for the medication. According to official documents and statements from the Ministry of Health, no reimbursement exists for adults, and the guideline does not extend hormone therapy to minors at all. People who qualify for treatment still have to buy their own hormones out of pocket.

That distinction matters, because the backlash was never really about budget lines. It was about visibility — the fact that trans healthcare now has an official, government-sanctioned pathway in Albania, however limited, and that made some people uncomfortable enough to invent a funding scandal that doesn’t exist.

A protocol that exists mostly on paper

The guideline was developed as part of Albania’s National Action Plan for LGBTQ+ people (2021–2027), with technical support from the Council of Europe and input from healthcare institutions and civil society groups, according to the Ministry of Health. On paper, that makes it a genuine policy achievement — Albania is one of relatively few countries in the Western Balkans with any formal clinical pathway for trans healthcare at all.

In practice, Karaj says, it barely functions. The LGBT Alliance has tracked the first cases referred under the new protocol, and the results aren’t encouraging: patients received contradictory information from different institutions, and the promised streamlined referral process hasn’t materialized. During drafting, advocates had pushed for direct referral to the Tirana hospital’s Endocrinology Service, specifically to avoid the discrimination trans patients have long reported at local health centers. Instead, the first people to try the system were told to start with their family doctor — the very gatekeeping step the guideline was supposed to route around.

There’s also a basic communication failure at the center of this. Karaj told BIRN that the trans community in Albania was never directly informed the guideline had been approved. People found out, if at all, through word of mouth, advocacy channels, or the same social media storm that spread misinformation about it. The Mother Teresa University Hospital Centre, Deputy Health Minister Eugena Tomini, and the head of the Endocrinology Service did not respond to BIRN’s requests for comment.

Part of a longer pattern

This is the second round of hormone-therapy controversy in Albania this summer. Earlier reporting on the guideline’s initial approval documented similar backlash rooted in religious and social conservatism, with critics falsely suggesting the policy would make gender-affirming care freely available to children. Those claims were false then, too — the guideline has never applied to minors.

What’s actually true is more mundane, and arguably more revealing: Albania built a legal pathway for trans healthcare and then failed to fund it, publicize it, or staff it consistently enough for patients to reliably use it. For a country in the middle of EU accession talks that include benchmarks on LGBTQ+ rights, that gap between the law on paper and the experience on the ground is the real story — not the manufactured outrage over a subsidy that was never on the table.

For now, trans Albanians who want to start hormone therapy through the public system have a guideline that recognizes their care as legitimate, and a bill they have to pay themselves.