Living and transitioning in Serbia

Application can be:

• submitted exclusively electronically, for following groups:

  • Employment contract or other contract by which rights in accordance with the Labour Law are exercised;

  • Referred person;

  • Movement within the company;

  • Independent professional;

  • Training and development;

  • Self-employment.

• submitted electronically or in person to the competent authority, for following groups:

  • Accredited foreign journalists;

  • Realization of the project with state authorities of the RS;

  • Volunteering;

  • Production of audio-visual work.

  • Digital nomad;

  • Start-up;

  • Talent;

  • Highly qualified foreign citizen;

You can apply for permanent residence after three years of continuous residence in the Republic of Serbia on the grounds of approved temporary residence or approved temporary residence and work (single permit). You are eligible to apply if you have lawfully temporarily resided in Serbia for at least three consecutive years before applying, while staying in the Republic of Serbia during that period, with the possibility of multiple absences from Serbia for up to ten months or a one-time absence for up to six months.

You apply for permanent residence while your approved temporary residence or issued single permit is still valid. In case you apply during the approved temporary residence or issued single permit meeting the requirement of continuous three-year residence, you can apply at the earliest 60 days before and at the latest by the expiration date of the approved temporary residence / single permit.

More on: https://welcometoserbia.gov.rs/permanent-residence

Permanent residence will provide you with foreigner ID card by default, but you can also further apply for citizenship. However, you will have to give up any other citizenship.

As a Serbian citizen you are able to change your name at your free will (institutions denying name change based on it “not being the right gender” is prohibited). You will also have more available ways to receive public healthcare.

In case you are seeking asylum in Serbia we advise you to contact Belgrade Cnetre for Human Rights for support on this process:

Phone & messages: +381648246508 ; E-mail: bgcentar@bgcentar.org.rs; Website: https://www.bgcentar.org.rs/en/

Serbia has a system of public healthcare with numerous hospitals. Primary care is provided in local centres (“Dom zdravlja”), while secondary and specialized in hospitals (“Bolnica”). To get an appointment you will need healthcare insurance card (“zdravstvena knjižica”), which is regularly provided to citizens and upon request to foreigners.

Public health insurance is guaranteed for all Serbian citizens under the age of 18, for students until they turn 26, and for people older than 65. Additionally, citizens formally registered as unemployed may be eligible for their insurance to be paid by the National employment service.

Everyone else covers it in two ways:

• through work contract with the legal entity registered with Serbian Business registers agency, if the monthly wage is above published minimal amounts to be eligible for full healthcare coverage (https://rfzo.rs/index.php/osiguranalica/zdr-knjizice ).

• by applying at the local Republic fund for healthcare insurance (“RFZO”) to pay the premium (monthly insurance cost) themselves. The premium is determined by the office upon request.

Anyone holding a valid healthcare insurance card (“zdravstvena knjižica”) and having public healthcare insurance covered (see above) can access all healthcare services incl. medications equally and free of charge or at reduced cost (such is the case with gender-affirming surgeries – see below). This includes appointments at gender-affirming specialists in public hospitals, some medications and partially covers certain GA surgeries.

Any hospital in Serbia is obliged to provide emergency care.

• How to get it:

If you have temporary residence permit, meaning you have an address which you registered as a place where you live, you can apply for our public healthcare as a foreigner at the “RFZO” (Republic fund for healthcare insurance) office in the municipality (srb. “opština”) where you are registered. You would also need to give up your home country (or any other) health insurance.

Formally, you would need a confirmation from your home country that you don’t have health insurance there – but this requirement is somewhat vague and you might be able to write a statement that you are not using any other public health insurance by yourself. You should receive details most relevant to your particular case at your local RFZO office. In case you need assistance on this matter, feel free to contact us.

Disclaimer: The following information refers to the process of medical transitioning of people in Serbia, using Serbia’s public healthcare system.

Medical transitioning in Serbia is divided into three phases, of which the first two are mandatory for receiving a legal identity change.

• Psychiatric phase – How long does it last and what does it look like?

The psychiatric phase of transitioning lasts a minimum of one year and during this period the psychiatrist gives the necessary information, support and advice that are relevant to the process of transitioning, as well as exploring and expressing ones gender identity in order for the person to successfully adapt and function on a wider social plan.

The psychiatric process itself consists of regular meetings/sessions in which various themes are discussed, such as childhood, gender recognition (“gender awakening”), relationships with family and friends, schooling, plans for the future etc.

If the person wishes to continue their transition, after the one year period has passed, the psychiatrist gives them a referral letter for the next, endocrinological phase.

How to get to a psychiatrist?

In order to begin your medical transition, firstly, you need a referral from your general practitioner, who will, through the “Integrated health information system of the Republic of Serbia” make an appointment in the first available time-slot.

Because the first free time slots for appointments are usually displayed at the beginning of each month, it is best to visit your general practitioner then.

After making the appointment, people who live on the territory of Belgrade are directed to one of the two institutions in Belgrade in which there are psychiatrists who work with transgender people: “The Cabinet for transgender conditions” which is part of the University Clinical Center of Serbia and “The Psychiatric hospital”, part of The Clinical-hospital center “Dragiša Mišović- Dedinje”.

For people who live outside of Belgrade, the general practitioner will give them a referral to their local psychiatrist, who will then refer the person to one of the aforementioned institutions.

With this referral letter, the person needs to go back to their general practitioner who will then make an appointment for one of the aforementioned institutions.

With these two referral letters, the person goes to their local health insurance fund, in order to gain approval for treatments outside of their local health insurance branch.

Endocrinological phase – what does it look like and how long does it last?

For many transgender people, hormone replacement therapy doesn’t just mean gaining significant physical and bodily changes – hormone therapy has many mental health benefits as well.

The endocrinological phase of transitioning lasts a lifetime; if the person wishes to get gender-affirming surgery, they have to use hormone replacement therapy for a minimum of one year.

The role of the endocrinologist is to prescribe the adequate hormone therapy in line with various parameters that need to be analyzed before the person starts hormone therapy. Hormone therapy has to be adjusted for each person specifically and has to be regularly controlled by the endocrinologist.

After a year of using hormone therapy, if the person wishes, the endocrinologist will give out a referral letter for the last phase of medical transitioning- the surgical phase.

For trans women and trans feminine people, hormone therapy in Serbia consists of every day usage of the female hormone- estrogen, in the form of pills, along with using testosterone blockers; the use of testosterone blockers is stopped after the surgical removal of the testicles.

For trans men and trans masculine people in Serbia, hormone therapy consists of intramuscular injections of a solution that contains the male hormone and is store inside of a vial- testosterone.

How to get to an endocrinologist?

Beginning the endocrinological phase is very similar to the start of the first, psychiatric phase of transitioning.

For people who live on the territory of Belgrade, the general practitioner gives out a referral letter for the “Clinic for endocrinology, diabetes and metabolic diseases” (part of the University Clinical Center of Serbia) on the basis of the referral letter given by the psychiatrist after the one year minimum period.

For people who live outside of Belgrade, the general practitioner gives out a referral letter for a local endocrinologist who will then give out another referral letter, this time for an endocrinologist in Belgrade who specializes in working with transgender people.

With this referral letter and the referral letter given by the psychiatrist, the general practitioner gives out a referral for the “Clinic for endocrinology, diabetes and metabolic diseases”.

It is also necessary to get a letter of approval from the local health insurance fund, in order to gain approval for treatments outside of ones local health insurance branch.

Surgical phase

The last phase of medical transitioning is the surgical phase which consists of gender affirming surgery.

There is no “universal” gender affirming surgery; gender affirming surgery represents an array of various surgical procedures, of and from which trans people can freely choose, depending on their wishes, needs, opportunities.  

Each trans person can choose whether or not they want to have gender affirming surgery, which is no longer a condition for a legal recognition of gender identity.

What’s are the procedures?

The surgical procedures for trans women and trans feminine people whose costs are covered 65% by Serbia’s public healthcare system, while the remaining 35% is covered by the patient themselves are orchiectomy(orchidectomy), vulvoplasty and vaginoplasty.

An orchiectomy(orchidectomy) is the surgical removing of the testicles.

A vulvoplasty is the procedure of constructing the vagina and vulva without the depth of the scrotal and penile tissue.

A vaginoplasty is the procedure of constructing the vagina, in which the clitoris is constructed out of the penis head, while the surrounding penile tissue and scrotum skin are used to form the inner vaginal walls. This is the standard (penile inversion) method provided as it bears the lowest risk of adverse effects. In case of contraindications for that procedure, or in case a second (revision) surgery is needed, Belgrade’s surgical team is also equipped to provide Sigmoid colon vaginoplasty.

The surgical procedures for trans men and trans masculine people whose costs are covered 65% by Serbia’s public healthcare system, while the remaining 35% is covered by the patient themselves are bilateral mastectomy with chest reconstruction and metoidioplasty.

A bilateral mastectomy with chest reconstruction is a procedure that consists of the removal of chest tissue and the reconstruction of the chest in order to gain a more “masculine” look.

A metoidioplasty (micro-penis) is a procedure in which the clitoris(already enlarged by the use of testosterone) is used to form a penis, which “hangs” fully in the front and is connected to the urinary canal.

If the trans person wishes to get a metoidioplasty, they first have to get a hysterectomy with a vaginectomy, in which the vaginal opening is fully closed and the reproductive organs are fully removed.

Gender affirming surgeries are procedures that are done in the University Children’s Clinic – Tiršova and in the GAK People’s Front hospital (Gynecology and obstetrics hospital) in Belgrade.

How to get to a surgeon and surgery which is covered 65% by Serbia’s public healthcare system?

If the person wishes to affirm their gender with gender affirming surgery, which costs are partially covered (65%) and paid for from the budget of the Republic of Serbia, they need to submit a request for a “sex change due to medical reasons” to the Republic fund for health insurance in Belgrade.

The request needs to contain the required documents and paperwork that are set by standards, criteria and procedures that have been laid down by the Republic expert commission for transgender conditions:

1. Two referral letters given by psychiatrists (that are members of the Republic expert commission for transgender conditions), no older than one year

2. A written confirmation by an endocrinologist about the conduction, results and check-ups that have been done in the time of using hormone therapy, no older that one year

3. If the endocrinologist’s confirmation does not contain the following analysis, the person who is applying for surgery needs to submit the following analysis: a regular blood test, glycemic test, cholesterol analysis, HDL and LDL cholesterol tests, triglyceride analysis, SGOT, SGPT, gamma GT, bilirubin pigment and fibrinogen testing, CRP, K, Na, Ca and P levels analysis, a karyotype analysis and several hormonal analysis(follicle-stimulating hormone, luteinizing hormone, prolactin, estradiol, progesterone, testosterone, androstenedione, 17-OH progesterone dehydroepiandrosterone sulphate, FT4 and TSH)

4. HbsAg, HCV and HIV serologies

5. For trans men and trans masculine people: a complete check-up done by a gynecologist ( a mammography if needed), no older than six months

6. For trans women and trans feminine people; a complete urologist check-up, no older than six months

7. For people who have already had genital surgeries- a complete case history, with all of the necessary documents and analysis, no older than six months

8. A photocopy of both sides of the persons health insurance card

9. A written request that contains all necessary personal information, address, contact information (phone number and e-mail) and any other important information

As was the case with the two previous phases of a medical transition, this phase also requires a referral letter given by the general practitioner.

In order to get a referral letter, you need to wait for your surgery request to be approved by the Republic fund for health insurance (the approved request will be delivered to your address).

After this, if the person lives on the territory of Belgrade, their general practitioner (with the two letters of referral given by the psychiatrists, one given by the endocrinologist and the approved surgery request) refers the person to the University Children’s Clinic- Tiršova.

People who live outside of Belgrade need to gain approval from their local health insurance fund for treatments outside of their local health insurance branch.

Disclaimer: The information provided here is gathered from publicly available sources and should be used as an index for the ease of considering different clinics and practitioners. We strongly recommend anyone seeking gender-affirming healthcare to consider and plan their course of treatments and procedures according to their own wishes and needs, their physical and mental health, financial capabilities and available social support. The list is not a recommendation for medical practitioners by “Talas TIRV” or by our TIGV community, and is purely based on known formal qualifications and training of these practitioners. We advise each person to consider different practitioners through multiple sources of information (other patients, online communities, professional associations, etc.) and, if possible, through consultations with different practitioners.

We strongly believe that “one size does not fit all” when it comes to choosing different treatments and gender-affirming healthcare providers, and that each consultation with a licensed medical expert should take into account wishes, psychological and physical needs, overall health and social circumstances of the patient on one side, and expertise, experience, medical skills and communication skills/style of the provider on the other side. These factors should be communicated between patients and their doctors, both ways, and in a manner that the patient can clearly understand. The goal should be a strong cooperation between doctors and patients, with patients being actively involved in making decisions about their health in order to achieve best possible sense of physical, mental and social well-being.

PSYCHIATRISTS who regularly work with trans people and are known to issue referrals for hormone therapy:

• Dr Dragana Duišin (public hospital: http://www.kcs.ac.rs/index.php/sr/klinike/2013-02-22-08-26-02/80-latinica/klinike/106-klinika-za-psihijatriju ; private practice: https://stmedica.com/bolnica/strucni-tim/ )

• Dr Joana Nikolić (public hospital: https://dragisamisovic.bg.ac.rs/kbc-bolnice-psihijatrija.html ; private practice: http://www.seksolog.rs/joana-nikolic/ )

• Dr Dušica Marković Žigić (private practice: http://www.seksolog.rs/dusica-markovic-zigic/ )

ENDOCRINOLOGISTS who are known to prescribe HRT and issue referrals for trans surgeries:

• Dr Svetlana Vujović (public hospital: http://www.kcs.ac.rs/index.php/klinike/klinika-za-endokrinologiju-dijabetes-i-bolesti-metabolizma ; private practice: https://polimedic.rs/endokrinologija/ )

SURGEONS:

• Dr Miroslav Đorđević and his team work in public hospital but are not reachable there without approval for gender confirmation surgery subsidized by public insurance. His private practice: https://stmedica.com/centar-za-urogenitalnu-i-rekonstruktivnu-hirurgiju/ ;

• Dr Miljan Folić is known to work with trans people in the area of nose reconstructions http://alergija-sinusi.rs/nas-tim/

• Dr Vladimir Kojović, urologist surgeon, most well known for his work with intersex people. His private practice: https://www.andromedicacademy.com/o-nama/dr-vladimir-kojovic

Disclaimer: The information provided here is gathered from publicly available sources and should be used as an index of hormone medicine approved for sale by Serbian authorities, for the  planning your hormone medication supplies and/or alternatives you can get while in Serbia. We strongly recommend patients to consult with their endocrinologist before deciding to change form or dosage of their medication. We advise against starting HRT without an appointment with an endocrinologist specialized in gender-affirming healthcare.

We understand that appropriate hormones are not always accessible to everyone, and we strongly advise anyone looking into using hormone medications that are not approved for sale in pharmacies to check their safety and dosage with pharmacists and endocrinologist, and to consider experience of other people on HRT with securing regular supply of hormones.

ANDROGENS („male hormones“)

• Testosteron depo; injections; 250mg testosterone(enanthate)/1mL, pack of 5 (official data)

• Androgel (16.2mg/g); transdermal gel; 20.25mg testosterone = 1.25g of gel per pump push, pack of 88g (official data )

ESTROGENS („female hormones“)

• Lenzetto; transdermal spray; 1.53mg estradiol per pump push = 0.09 ml per pump push, pack of 6.5ml (official data )

• Cyclo-Progynova; tablets; (USE ONLY WHITE TABLETS – this medication was not intended for HRT and only white tablets in the film package are useful and safe for HRT; brown tablets should be discarded as they are not safe for HRT) – it contains 11 white tablets of 2mg estradiol (valerate) (official data )

ANTI-ANDROGENS (for suppresing „male hormones“)

• Androcur 50mg; tablets; cyproterone, pack of 50 tablets (official data )

• Bicadex 50mg; tablets; bicalutamide, pack of 28 tablets (official data )

Since name and gender marker is stated in citizen’s public records, changing gender marker or name is not possible for foreign citizens.

In Serbia legal transitioning is not entirely independent from medical transitioning as the Law on public records allows gender marker change only after minimum of 1 year of hormone therapy supervised by the endocrinologist.

After 1 year has passed from the appointment when the endocrinologist prescribed you HRT you can ask your psychiatrist (who conducted your assessment and referred you to the endocrinologist for HRT) to provide you official “Confirmation of sex change” – a paper signed by the psychiatrist and then by the endocrinologist. The endocrinologist will then file your confirmation to their hospital’s administration, and by law they are obliged to send it within 30 days to the public records office where you are registered as a citizen.

After 30 days you should go to your public records office and simply sign the request for gender marker change. After that your public records officer (“matičar”) makes an official ruling on gender marker change, records the new gender marker, and the local Police office (in the same municipality) gives out the new identification number (“JMBG”). After that it is possible to change name and gender marker in all personal documents.

If you had already completed these steps in another country but did not have your gender marker changed you will still need to make an appointment with local gender-affirming psychiatrist and endocrinologist. However, based on your medical reports from a foreign psychiatrist, endocrinologist or surgeon who performed , they may determine that conditions for gender marker change are already met partially or in full. This right has been also confirmed by the Serbian Ombudsman.