France has a system a bit like the NHS in the UK. There are are certain number of centers (Paris, Lyon, Bordeaux, Marseille and Nice) where pluridisciplinary teams are supposed to cover everything from therapy & HRT through to GRS. Apart from the fact that this means that there are no centers apart from Paris covering all of the northern half of France, these teams are totally underresourced and today there is only one decent GRS surgeon in the whole country, based in Lyon, with a waiting list of 18 months to 2 years once you have been approved for GRS on public funding. Once you are admitted to the publicly administered system I believe HRT and maybe a couple of other things like voice training are also publicly funded but nothing like FFS or BA is.
Both because of the very limited interest in getting involved in a programme which puts all of the decision making about how you manage your transition into the hands of others for little benefit other than a publicly funded, two step, GRS, I believe that anywhere between 80 to 90% of French TG's manage their transition outside of the system. This is my own case and the case of all the people I personally know in France. Happily there are quite a number of trans friendly medical professionals to turn to and my own GP has been brilliant in every manner.
However, end of the day, apart from my medical appointments and medical tests (blood work, X-Rays, electrocardiograms...), I have paid for every step of my transition from my own pocket, even HRT.
Getting name and gender changed in France is just as bad. For both, it is a full fledged legal procedure requiring the services of an attorney, putting together a file containing medical history and evidence that you are already living full time as a woman, a real Catch22 requirement since living as a woman with a male ID can be very complicated . Lastly, you have to produce evidence that you have made irreversible physical changes to align with your "chosen" gender. For most jurisdictions, these means GRS. However, even then and no matter how good your file, the judge has total discretionary power to grant the change or not. For example I have heard of cases where the certificate delivered by a foreign surgeon was rejected by the court.
In my own case, I filed for a civil identity change last September, my request was approved by the public prosecutor in November but afterwards the court simply sat on the file until the legal time limit was reached ie. the court has to make a decision within a year. My hearing was finally scheduled for the 12th September (next week) . My legal costs to date ~ 4000$
The consequences of this are quite dramatic, having certainly contributed to the loss of my present job, totally preventing me from looking for alternative salaried employment and also preventing me from setting up my own business until it is sorted out. While I am pretty certain I will get a positive decision next week, it will still take another 5 - 6 months before I finally have all my new papers. Fortunately I have the means to hold out for a while but without that, given the way things work here I would be facing total destitution.
Not a good story and on a scale of 1 to 5 for supposedly developed countries, I couldn't rate France higher than a 1, maybe 1.5 since we have same sex mariage which means I can get my civil identity change without going through a divorce. My "Aggggghhhh" moment!
Donna
P.S. Just to attenuate this very negative story, I'd have to say that while the laws and administrations are a real bitch, by and large, the people I have been interacting with have been mostly great, both my friends and everyone from my doctor to my hairdresser.
