Center for Kønsidentitet

UPDATED 7-JUL-2026

Table of Contents

• History and General Structure
• CKI Services
• The Evaluation Process
  • Step 1 - Getting a Referral
  • Step 2 - CKI Receives the Referral
  • Step 3 - The Initial Consultation
  • Step 4 - The Diagnostic Evaluation
  • Step 5 - The Multidisciplinary Meeting (MDT)
  • Step 6 - Treatment
• Gatekeeping and Conversion Practices
  • About Waiting Times
• Practical Advice for Getting Through CKI

History and General Structure

There are three clinics in Denmark that share the name Center for Kønsidentitet (CKI). The clinics were established in 2017¹, 2019² and 2020³ in Aalborg, Copenhagen and Odense respectively. The clinics are trans-segregated and patients go through months to years long evaluation process, after which the clinicians might prescribe hormones or offer surgery(ies). They only accept patients who are 18 or above, see KKBU for the trans-segregated and age-segregated clinic for patients under 18.

Before the clinics opened, public funded trans care was segregated to Sexologisk Klinik (SK), but private gynecologists and doctors in general were allowed to give private care to trans people⁴.

Until around 2025, trans people under 18 were referred to Sexologisk Klinik, a clinic that also treats pedophilia. The new clinic, called "Kompetencecenter for Kønsidentitet hos Børn og Unge" has since opened and we have written an article specifically about it: KKBU.

Because of the atrocious conditions in the public trans-segregated clinics, Amnesty Denmark launched a campaign called sygt-system.

At time of writing, trans care is regulated as "højt specialiseret behandling" (highly specialized care), which means that it is legally troublesome for private doctors to provide any care that could be viewed as being "trans care".

CKI Services

Here is a compiled list of all the CKI services. Whether they are actually given or not, and what caveats there are pertaining to each service.

• Hormones
  • Estradiol
    • patches, pills, gel (no injections)
    • there are often shortages of these medications see this recent article
  • Testosterone
    • Gel or injections
    • They start you on gel ⁵
    • They are generally not great at giving the correct dose ⁶
• Anti-androgen
  • Only cyproterone acetate (androcur)
  • They used to prescribe it at very high dosages
  • Historically used to chemically castrate patients.
  • It's not neccesary at high enough dosages of estradiol.
  • Gay patients in conversion therapy used to be prescribed anti-androgens
• Surgeries
  • Masculinizing masectomy top surgery
    • it is unclear how many are done per year, but the author personally knows no trans people who have gotten state funded mastectomy.
    • Currently we know that most trans people are either going to Germany or Sweden for masculinising masectomies ⁶.
    • CKI Copenhagen wants you to take testosterone for 6-9 months before giving you access to mastectomy ⁵. However it seems that CKI Aalborg offers it to patients before taking testosterone ⁷
  • feminizing top surgery
    • CKI Copenhagen claims to offer breast augmentation to trans women who haven't had "enough" breast growth after 24 months on estradiol ⁸. The clinic decicides how much breast growth is "enough" ⁹.
  • Bottom surgery
    • in a report by LGBT+ Denmark from 2021, it is reported how many trans people get bottom surgery through the state per year. There is a lot of missing data, but the table is inserted below: (INSERT TABLE/IMAGE)
    • The clinics only offer bottom surgery after a minimum of 12 months of HRT. It is treated as care separate form HRT, meaning that you have to go through the entire approval process again to access it. Getting approved for HRT does not mean getting approved for surgery ¹⁰
    • The clinics gatekeep access to surgery even more than HRT. CKI's reason for this being that it is a much more "radical" form of treatment. ¹⁰
    • At least one patient experienced the surgeon breaking the patient down so thoroughly that the patient's subsequent breakdown was used as a reason by CKI to deny surgery⁹.
    • The stated goal of the evaluation process is "ensuring we do not treat anyone who is not sure" ¹⁰

In many clinics in the USA, as well as in private clinics in the EU such as Imago, hormones are offered on an informed consent basis¹¹, which means that after you are informed of the effects of HRT, you can consent to the treatment and receive it unconditionally. In some countries, like Thailand, estradiol and progesterone is an over-the-counter drug, which means anyone, whether they're trans or not, can walk into a pharmacy and buy estradiol and progesterone with no gatekeeping at all.

The Evaluation Process

In order to access hormones or surgeries in Denmark, a trans patient must be permitted by a series of cis gatekeepers to progress through an opaque system with effectively no recourse other than paying private EU clinics abroad, or DIY. This pattern is not unique to Denmark, a similar system exists in Britain¹².

The CKIs are required to follow the Danish Health Authority's guidance on care VEJ nr. 9921 which are Danish guidelines about gender-affirming health care in Denmark. It is evident and obvious that they do not follow the guidelines. For example, the guideline states "[Equal treatment for gender affirming healthcare] means easy and equal access to healthcare, treatment of high-quality, coherence between services, freedom of choice, easy access to information, a transparent healthcare system and short waiting times for treatment."¹³ (Own translation). Access to the CKIs is not easy, it is not equal, the treatment is not of high-quality, there is no coherence between the services, there has been at least one report of no freedom of choice, there is no easy access to information, the system is not transparent, and the idea that there are short waiting times for treatment, would be laughable if it weren't so dire.

• Easy access
  • We will go through the many hurdles that trans people have to go through to get treatment. It will be clear that it cannot be described as "easy".
• Equal access
  • The clinics are trans-segregated. If there was a desire to make the access equal, it would be as easy for a trans woman to get estrogen, as it is for a cis woman to get estrogen.
• High-quality treatment
  • the clinics often give the wrong dose or varying dosages ⁶.
  • the clinics don't offer estradiol injections, and the clinics force you to start testosterone on gel instead of injections
  • surgery complications are higher than other clinics that provide the same types of surgeries
  • surgery types performed by CKI are mostly outdated
• Coherence between services
  • There are significant differences between the treatment you get in the different clinics ⁷.
• Freedom of choice
  • Normally this means that a patient could be referred to private providers if the wait times are over 2 months ¹⁴. However SRS, are specifically exempt from this.
• Easy access to information and a transparent healthcare system
  • In writing this article, the authors have found it incredibly hard to find information of how and what care is provided.
  • The CKIs will sometimes withhold information from patients, like the rates of complications in surgery.
• Short waiting times
  • The authors know trans people who have waited over two years just to get their first appointment at CKI Aalborg, a clinic notorious for long waiting lists due to it's better reputation. (June, 2026)

Step 1 - Getting a Referral

First you must visit your doctor¹⁵ and get them to give you a referral to one of the CKIs. Doctors will sometimes not know how to refer patients to a CKI clinic, claim to not know how, outright deny a referral, or lie about having referred the patient¹⁶.

This is the first step where you can get rejected - in this case by your doctor unlawfully refusing to refer you.

It costs 40kr to switch general practitioner and you can do it online right now! If your doctor isn't helping you or if you're unhappy with the care, you can have a new doctor tomorrow.

If CKI knows a patient is in an active psychiatric treatment or is in contact with psychiatry, they will reject referrals unless they are from the psychiatrist. They claim to do this "so that the psychiatric conditions are well-described".¹⁷ The requirement acts as an additional barrier to care and makes accessing trans care unequal.

CKI requires referrals to include the following arbitrary and largely irrelevant factors¹⁸ (Own translation):

• duration of gender dysphoria
• desired treatments
• psychiatric comorbidities
• BMI or height and weight (presumably to calculate your BMI)
• In young people under 25: the presence of a support network
• Alcohol/drug abuse during the last 6 months
• Documentation of a diagnosis from abroad, if the patient is already on hormones
  • Since there is no global consensus on how to diagnose transness¹⁹, it is unclear what exactly they would want.
• a list of current medications

If you're already on hormones in a different clinic, they still require that you go through their evaluation process. CKI Odense explicitly mentions that they do not recognise GenderGP or similar clinics abroad and do not always recognise diagnoses from the other CKIs. They do not mention any clinics that they do recognise.²⁰

There is no medical reason to require a specific "duration of gender dysphoria" before accessing care. ²¹ There is no medical reason to deny care to patients above a certain BMI.²². Again and again these doctors posit that certain things are "necessary" for access to gender-affirming healthcare, but they are not.

GPs²³ are supposed to not refer patients who meet any of the following criteria:

• patients with a short, unclear, or unstable gender identity
• psychiatric instability such as frequent or recent stays in the psychiatric ward
• current suicidal thoughts
• suicide attempt within the last 6 months
• drug or alcohol abuse
• BMI > 35 or < 18.5 ²²
• cognitive problems, that affects the ability to cooperate in diagnosis and treatment (such as autism and psychosis)²⁴

Your GP is not allowed to start you on hormones, because CKI has a monopoly on trans care. Only after an agreement between your GP and CKI can your GP provide trans care. This includes updating your presciptions, handling blood tests, and giving testosterone injections ⁶.

Picking a Clinic

You have the right to choose what clinic you go to, however there are only 3 to pick from in the country, and they each have pros and cons. A lot of trans people choose CKI Aalborg because they have a reputation for being more accepting of neurodiversity and less restrictive about requirements for surgery. However, CKI Aalbog has a reputation of having longer waiting lists. CKI Copenhagen has a reputation for shorter waiting lists and being more restrictive, especially about neurodiversity and requirements for surgery

Step 2 - CKI Receives the Referral

If you succeed in getting your doctor to refer you to CKI, the second step in the process is getting CKI to accept your referral. Unfortunately, CKI will reject your referral if you are too skinny, too fat, or too insane²⁵.

The clinic will reject your referral based on the same criteria noted in Step 1. This means that the clinic could still reject you if you even if you met their criteria according to your GP, for example, if CKI and your GP disagree on the stability of your phyche.

If you are in any kind of psychiatric treatment, CKI requires you to "be stable for a minimum of 6 months" before you get referred, and the same criteria of "stability" applies to newly diagnosed psychiatric diagnoses²⁵. For example, patients that have started at OPUS ²⁶ can be referred earliest after 1 year of treatment ^{25 27}.

However, CKI gets to arbitrarily decide what "stable" means. The authors have heard of cases where, for example, 6 months of medication and feeling good from the patient, does not count as "stable" for some reason.

This is the second step where you can get rejected.

Step 3 - The Initial Consultation

If CKI accepts your referral, CKI will invite you to an initial consultation to decide if CKI want to offer you gender-affirming treatment. The initial consultation takes approximately 1 hour and they will discuss the following with you:

• Gender identity and dysphoria
• Your plans and thoughts on changing your name and Danish civil registration number (CPR)
• Sexuality
• Treatment wishes
• Childhood and family relations
• Schooling, education and employment
• Allergies
• Genetic disposition to somatic and psychiatric diseases
• Prior contact with psychiatrists or psychologists
• Drug use
• Current social conditions (housing, financial situation, etc.)
• Your general well-being
• Medication you regularly take

Many of the items on this list are obviously irrelevant for assessing whether you would be fit to receive care. For example, sexuality, childhood and family relations, and employment should have no bearing on your treatment plan. Only a few items are (or might be) relevant, such as treatment wishes, allergies, and drug use. Asking a bunch of irrelevant questions is a way for CKI to legitimize spending so much time with patients. These items also show CKI's expectation of how a trans person should look and act, something that has transferred over from when all trans healthcare was handled by SK. A reason why CKI asks questions about your living situation, employment and education is that they want to make sure that you can "handle" the treatment yourself ⁶.

After the meeting CKI will send you a digital post letting you know the outcome of their decision.

This is the third step where you can get rejected.

Step 4 - The Diagnostic Evaluation

According to CKI Copenhagen¹⁰, the diagnostic evaluation will take approximately six to eight months.

CKI will assign you a health professional (a doctor, nurse, or psychologist)¹⁰ who will see you throughout the meetings. Each meeting lasts 45 minutes and focuses on different topics including childhood, current dysphoria, hopes/dreams with gender-affirming care, and sexuality (but with a focus on sexual practices)¹⁰, but clinicians can say and do anything during the meetings. For example, multiple patients have stated that they felt pressured to answer questions about how they masturbated and how often⁹. At least one patient was pressured to reveal her breasts to a clinician as part of an evaluation⁹.

The CKIs generally forces patients to attend 6 sessions, even though CKI Copenhagen implies fewer sessions are possible and write "up to 6 consultations"¹⁰ on their website. The CKIs typically schedule at least 1 month between each session. In some cases, there are multiple months between sessions because CKI cancels or moves meetings without explanation. Sometimes clinicians adjust the number of these sessions up or down based on their subjective assessment of you, but clinicians usually stick to the arbitrary number of 6⁶. Some patients didn't have anything to talk about in the last few sessions but were forced by the clinic to attend them anyway⁹, in effect delaying medical care for months.

The authors want to highlight that waiting is completely unnecessary. It is especially unnecessary for 4.5 hours of evaluation to be spread over 6 - 8 months¹⁰. The effect of this waiting time is to prevent trans people from transitioning.

Step 5 - The Multidisciplinary Meeting

[After the diagnostic evaluation], your practitioner at CKI will discuss your case at a multidisciplinary team (MDT) conference with the other practitioners and the physicians who prescribe hormone therapy. This team will decide whether you can be offered hormone therapy.

• CKI Copenhagen¹⁰

Patients are not allowed to participate in this meeting. Incase of rejection, the letter containing the MDT decision might contain reasons for rejection, but it is not a detailed summary of the meeting. Patients can make a complaint and request further information ⁶.

You can access what the CKI clinician writes about you! Here's how to access your patient records.

1. Go to sundhed.dk, and log in
2. Go to "Min Side"
3. Click on "Journaler", and scroll down
4. Your patient records can be viewed in the column "notat" You can see the same information in the app "MinSP" (Android iOS) under "Aftaler og journalnotater" The letter containing the MDT decicion is sent to you via digital post, but sometimes it can also be found with your patient records

The complete control that clinicians have over patient journals and the fact that patients cannot attend the MDT conference works to eliminate any autonomy patients have over their care. If a patient complains about the treatment, CKI uses the patient records as a record of what happened during the treatment. The patient records are often used to discredit patients who try to complain about the treatment recieved ⁹.

This is the fourth step where you can be rejected.

Step 6 - Treatment

If you make it through purgatory, you might get offered hormones! :O

It might take up to 14 days for CKI to give you the prescription, from the time of the MDT decision ²⁸. If a patient needs testosterone, the clinic will start you on gel for 6 months first ⁵, before giving you the option of injections, and they don't offer estradiol injections for patients needing estradiol ²⁹. There is no medical reason for this.

The estradiol patches are notorious for going out of stock ³⁰.

CKI is known to make mistakes in dosing, often underdosing patients with hormones, and overdosing them with anti-androgen ⁶. The authors know of at least one case of overdosing with testosterone, resulting in physical harm to a patient ⁹.

CKI will offer you free blood tests, and review them at checkups to see how you're doing, "There will be follow-ups scheduled after three months, six months and one year. After this, there will be a yearly follow-up." ¹⁰.

Gatekeeping and Conversion Practices

It's easy to believe that CKI exists as a publicly funded institution in order to help trans people. However, the primary effect the CKIs have had is delaying and denying medical care to trans people. It is not the CKI clinician's primary task to help you transition, the primary task is to find reasons to deny patients care.

The task of the healthcare professionals is primarily to clarify whether there is gender incongruence to such an extent that treatment is indicated according to the Danish Health Authority's current guidance in the area³¹, and whether there are decisive contraindications that speak against therapeutic interventions (own translation)

• Malene Hilden, staff physician and director of CKI Copenhagen, sundhed.dk³²

The clinicians primary task is not to provide care, it is to decide who should be permitted to medically transition, and specifically whether or not there are contraindications to giving that treatment.

Director of CKI Copenhagen Malene Hilden directly said that she functions as a gatekeeper³³. She acknowledges that informed consent exists as a model in the US and explicitly says that she does not agree with implementing this in Denmark, because she wants to involve her professional knowledge. The article goes on to say that Malene Hilden and her colleagues "view it as their role to get the patient to (re)consider alternatives" (own translation) when it comes to gender-affirming surgery. Malene Hilden states that "That's our job when the patient doesn't see other options on their own. Then we talk to the patient about what life might look like if they didn't get surgery" (own translation) ³⁴.

We want to make it very clear that the actions of CKI are conversion practices. CKI wants to persuade you away from, delay you from, or deny you medical transition - especially when that care carries changes that might make it harder for you to detransition into a cis-passing person, such as surgery. CKI is not an institution that exists to help trans people.

Clinicians at CKI posit themselves as the authority and experts on trans healthcare but they're fallible. Clinicians are still susceptible to transphobia, racism, fatphobia, saneism, ableism and other bigotries. The Danish healthcare system is made up of humans, humans who were educated in institutions who have these biases, and these biases get transferred to clinicians who in turn reinforce them in healthcare systems.

If trans people accept the CKIs conversion practices and monopoly on publicly funded trans care, they will subject themselves to it despite there being effective and less harmful alternatives³⁶ to the CKIs (DIY, Imago, etc.). The CKIs (a system made up of cis people) does not and should not have authority over trans people, their transition, their gender expression, their bodies or their understanding of medical transition. Trans people do not have to submit to the CKIs' authority.

Accepting the CKIs as legitimate can result in patients recounting an honest and raw version of themselves to the clinicians, which gives clinicians an opportunity to use those statements to deny care. If instead a patient conceals hobbies that could be construed as stereotypically autistic or claims to be more binary and gender conforming than they are, clinicians have fewer reasons to deny the patient care. The idea that you should change your gender expression and modify yourself in an attempt to access care is unequivocally horrifying, but is a direct consequence of the CKIs' structure and conversion practices. It is 100% valid to do whatever you can to get through these barriers, to get the care you need, just as it is 100% valid to circumvent these barriers and get access to the care you need yourself. It is an act of autonomy and resistance against the state to take control of your bodily autonomy and healthcare in the face of such a system. Lying to clinicians in order to access care or circumventing mainstream medical systems entirely is reasonable, and both have historical precedent.

About Waiting Times

Time is a cheap weapon Purgatory

Let us be clear: the CKIs enact violence upon you. Denying you life-saving care is a form of violence. Making you wait years to receive this care is a form of violence. It's a form of slow violence, that instead of it being fast-acting, explosive, and immediately harmful, creeps in on you while you wait patiently in line, conforming to the cistem. The result is traumatized trans patients. Time is one of the cheapest weapons the cistem can enact on you. They do not have to spend money to keep you in line, they do not have to do anything. They simply make you wait and pretend that it is care. It is not. Ask yourself, what is the difference between being rejected and having to wait? You don't recieve care in either case.

Ask yourself, how much of your life have you already given to the state? How much of your life have you spent waiting for something that doesn't in itself require waiting?

You come to believe that you deserve to be treated like that.

It becomes normalized after a while, and the bar sinks lower and lower until it is in hell. When one person inevitably fits their criteria well enough to get care, you can be tricked into thinking CKI is not that bad. But in the end, you have simply lowered the bar for standards of care so much that mediocre, ineffective, actively harmful care is seen as "fine" when it objectively is not.

We don't need professionals to tell us whether or not we are trans "enough" to get treatment. The CKIs start with the assumption that you are cisgender, and trans people have to work their way up to convince them that they are in fact trans. If you express any doubt in your transness, the clinics will often use that against you, meaning that even if you do require time to think about what you want in your transition, this is not something the clinics will help you with - quite the opposite.

The trans medical system would run much smoother if trans people were just believed and listened to.

CKI puts forth the premise that it is legitimate or valid that the clinics make accurate judgements on your gender/sex and own wishes for gender expression, as well as that they are even capable of making this judgement for you. They are not.

Practical Advice for Getting Through CKI

If you need to or of your own autonomy choose to go through the clinics, we want to give some advice on how to do it as fast and with as little harm as possible. Therefore we have created this list of recommendations. Some of the advice will also depend on what clinic you go to, which provider you're assigned, and what care you need.

Please remember that you can also get help elsewhere, see our article on DIY, or check out private providers such as Imago and GenderGP

1. Bring a support person

This can be a family member, a friend, or even a stranger. If you can't think of anyone to bring, reach out to some local lgbt organizations and see if they can help you. You're also welcome to email us (transparens.gay@protonmail.com) and we might be able to help.

2. Always record the meetings with the clinics.

According to danish law, you only need to get consent from one party participating in the conversation in order to take an audio recording of it ³⁷. This could potentially help you if they misrepresent how you were treated, since the records are written by the healthcare workers.

3. Don't express any doubt that you want treatment

4. If you suspect that you have other mental health issues or neurodivergencies, the clinics will want you to be treated for those before starting. You will have to decide which kind of treatment you want first.

The following points are more debated within the community, and typically depends on which provider you're assigned

5. Say that you're straight or be vague about your sexuality.

6. Say that you're binary (aka. either fully a man or fully a woman), even if you're not.

7. Emphasize your dysphoria - but not to the point of sounding like you need other mental health care.

8. Say that you have always felt "wrong" in your assigned gender.

9. Dress masculine if you need masculinizing treatment, and feminine if you need feminizing treatment.

10. Emphasise that you have a strong support network

For a quick overwiev, LGBT+ Danmark has this flowchart: This is only for treatment of people 18 or older.