My surgery was paid for by the german public health insurance. They also pay for therapy and HRT, they are reluctant however to pay for breast implants though usually it can be done if one can demonstrate a need (usually that means however pay various amounts of money in addition, especially if choosing a surgeon that is not the cheapest) and are very yucky when it comes to facial hair removal. Technically they do pay for it, but in practice no doctor will do it as it is underpaid, so most people pay for laser treatment themselves or pay for an electrologist. So all of this costs not a lot really and it is quite easy as one does not even have to pay and then get a refund or such, it is all paid directly. BUT there is a rather strict system of procedures. This consists of mandatory therapy and examination for some specific genetic problems and intersex indicators as well as psychological conditions that could mimick TS plus a brain scan to exclude tumours. Then there is a requirement for a year of real life change before HRT is assigned (which is cruel and I know of no one who kept that order except one - everyone else got their "drugs" somewhere else). Then follows an assessment by two therapists who have to sign off on the need for surgery describing it as the only solution to solve the gender dysphoria. Sadly, not all of the surgeons will do this on health insurance money as they usually do not pay well (thanks to the stupid neolibera agenda since the 1980ies) and charge extra money. Plus it is not easily possible to go out of the country with it, all treatment has to be within the country of Germany.
