Rosa Almirall, Catalan Healthcare Institute.
Public health service that provides medical, psychological and social care, advice and support to trans* people and their families.
What solution does the innovation propose?

A depathologizing biopsychosocial model, based on the concept of identity as a human right, and the idea that transsexuality and transgenderism are just different expressions of gender diversity.

The care model of health offers a variety of services based on informed consent: users are considered active agents suited to receive information and consequently exert full decision capacity according to their own personal needs. The medical and therapeutical professionals’ practice active listening, offeringoffer all available objective information, adapting theadapt treatments to the usersusers’ individual needs, and supportingsupport them at any time during the process.

Each person has their own individual journey of transition, and unlike other offices there is no standardized protocol. Users self-determinate their path to health care, based on their own definition of identity, which might be more or less normative.


Rosa Almirall is an Ashoka Fellow (2019). First prize in the 10th Conference of Health Administrators of the Catalan Institute of Health in communication (2017). Recognition of the Trànsit model as the new model of health care for trans people in Catalonia. Minister of Health of the Generalitat de Catalunya (2016).

Impact evidence

  • Trànsit has accompanied more than 3,000 transgender people aged 2 to 65.
  • Between 2013 and 2015 Trànsit:
    • Provided care for 77 family members and friends of trans people.
    • Wrote 118 reports for changing name and gender on birth certificates.
    • Trained 108 professionals of the Sexual and Reproduction Healthcare unit (ASSIR) in 28-hour courses.
  • Since 2017, is the current official reference unit for the specific care of trans people in Catalonia.
How does it work?

The service supports trans people during their entire identity and body construction process; supports people close to the users (family members, friends, partners and teachers); raises awareness among healthcare, education and media professionals about the trans reality; trains healthcare professionals so that they can adequately meet the requests of trans people, be it through direct assistance or referring them to specialized services; writes up the medical and psychology reports that are legally necessary to access the gender and name changes in registries.

In order to achieve these goals, Trànsit is divided into two interrelated services with multidisciplinary teams (midwives, social workers, gynecologists, family doctors, psychologists, etc.): Trànsit-AM attends medical matters, and Trànsit-AP provides therapeutic support.

Trànsit-AM’s service includes counseling on prevention of sexually transmitted diseases (STDs), reproductive potential and contraception, promotion of healthy lifestyles, and their core service, advice on hormonal and surgical treatments. Advice has a non-binary perspective of gender and recognizes the vast diversity of trans subjectivity and bodies. An important premise is that the decision to start body modification does not have to be backed-up by a psychiatric diagnostic evaluation, and users decide the type, amount and timing of their transition treatments. Healthcare professionals only provide information, advice and support, which is why the referral to the psychotherapeutic service Trànsit-AP or any other support group is always the user’s choice.

Trànsit-AP uses psychotherapy as a tool to support, develop and reinforce the personal growth and autonomy during the transition and identity construction process. Group and individual therapy work actively to accept gender differences, reduce stigmatization, strengthen interpersonal relations, and combat social exclusion and isolation.

Geographical scope

Where was initially developed
Catalonia (Spain).
Where has been implemented so far
Navarre and Mallorca (Spain), Santiago (Chile), Valletta (Malta).
Last updated: 
September 2020