Continuing long-term hormone therapy in Spain

Key rules

• Health card: Public follow-up needs registration in the public system with a health card; visitors usually pay.
• First stop: Your family doctor is the usual first step for thyroid, menopause and, in many regions, gender-affirming care.
• Gender units: Each region sets its own route to its gender identity unit, by referral or direct entry.
• Existing hormones: Whether you can continue current hormones without a new assessment depends on the region and unit.

Practice and waiting times vary by region, so confirm the gender-affirming care route with your local health centre before acting.

Start with your family doctor and a health card

Your treatment continues through the public system once you have a health card (tarjeta sanitaria). Register first, then book a first appointment with your family doctor (médico de familia). Visitors who are not registered usually pay privately.

Bring your current prescriptions and recent medical reports. Translated copies help, but are not essential for a first visit. Also bring your latest blood test results if you have them.

Thyroid conditions

Your family doctor manages most underactive thyroid (hypothyroidism). They order tests, adjust your levothyroxine dose and renew the prescription electronically. Chronic prescriptions are usually renewed for periods of up to a year, so you should not run out between visits.

You will be sent to an endocrinologist if you have nodules, an overactive thyroid, thyroid cancer, pregnancy complications or poor control of your levels. If one of these applies to you, ask for the referral at the first appointment and bring your reports.

Menopause

Your family doctor or the gynaecology or women's health service handles menopause symptoms. Either can prescribe or review hormone therapy. Complex cases, or cases where hormones may not be safe for you, are referred on to a specialist.

Say which hormones and doses you take now, and for how long. This lets the doctor continue them rather than start from scratch.

Gender-affirming hormone therapy

Most regions now have a public gender identity unit or pathway. Access differs by region. Some allow direct entry or self-referral. Others need a referral from your family doctor, to the unit or to endocrinology or psychiatry. Ask your health centre which route your region uses.

Registered foreign residents are generally treated like Spanish residents. A national law from 2023 recognises the right to this care.

Whether you can keep your current hormones without a new assessment depends on the region and the unit. Many units continue existing therapy, but some want their own evaluation first. Ask this when you book. Bring prescriptions and reports, translated if you can, to speed things up.

What to expect on timing

Waiting times for specialists and units vary by region. Your family doctor can bridge the gap by renewing a prescription while you wait, where the treatment allows it. Ask about this at your first visit. The checklist and questions below cover the practical steps.

Checklist

• Confirm you are registered in the public system with a health card (tarjeta sanitaria).

• Bring your current prescriptions and medical reports, translated if possible.

• Ask your family doctor to order thyroid tests and renew your levothyroxine on the electronic prescription.

• Ask for a referral to endocrinology if you have nodules, hyperthyroidism, thyroid cancer or poor control.

• Ask your health centre how your region reaches its gender identity unit, by referral or direct entry.

• Ask the unit whether it will continue your existing hormones or needs its own evaluation first.

Frequently asked questions

Who renews my levothyroxine prescription in Spain?

Your family doctor normally renews your levothyroxine through the electronic prescription. Renewals typically run for up to a year. You are referred to endocrinology only for nodules, hyperthyroidism, thyroid cancer, pregnancy complications or poor control.

Can I get menopause hormone therapy from my family doctor?

Yes, your family doctor can prescribe menopause hormone therapy, though a gynaecologist can also do it. Complex cases or contraindications are referred to gynaecology or a women's health service.

Do I have to see my GP first to reach a gender-affirming care unit?

Yes, in many regions you start with your GP, who refers you to the regional trans unit or to endocrinology. Some regions allow direct entry or self-referral, so ask your health centre what applies where you live.

Can I keep taking my current hormones without a new assessment?

It depends on the region and the unit: many units continue existing therapy, but some require their own evaluation first. Bring your prescriptions and medical reports, ideally translated.

Do visitors pay for gender-affirming care in Spain?

Yes, visitors usually pay privately, because public care needs registration with a health card (tarjeta sanitaria).