Court mandates Bas-Rhin CPAM to cover mastectomy for gender transition.

Historic Victory for Trans Rights in France

A trans man has won a significant legal battle against the **Primary Health Insurance Fund (CPAM)** of Bas-Rhin. The ruling, delivered on May 14 at the **Strasbourg Court**, marks an unprecedented moment in France’s legal landscape regarding **trans rights**. According to his lawyer, the decision is described as “**unpublished**” within the French legal framework.

The **Social Pole** of the Strasbourg Judicial Court mandated that the CPAM is responsible for covering the costs related to the surgical procedure of **bilateral mastectomy**. Furthermore, the court has ordered the CPAM to pay the applicant **3,000 euros** in damages.

The ruling identifies that the requirements previously set by the CPAM—including the need for a medical certificate and a prior memorandum of understanding—were **contrary** to Articles 8 and 14 of the **European Convention on Human Rights**. This stipulation is particularly crucial as it highlights the potential **inequality in healthcare access** related to gender identity.

The CPAM has been ruled guilty of committing a **”mistake,”** as this error inflicted direct and substantial damage on the applicant. He faced unwarranted delays in what already was a long and complex healthcare journey, which affected his transition in a manner completely contradictory to his civil status.

A Discriminatory Decision Acknowledged

“This is the first time a French judge has acknowledged the discriminatory nature of the CPAM’s refusal and violations of privacy. It’s unprecedented,” lauded **Me Laura Gandonou**, the applicant’s lawyer, in a statement to the **France-Presse agency (AFP)**.

“I feel very relieved and grateful. This decision is something I have been waiting a long time for,” expressed the 31-year-old applicant, who chooses to remain **anonymous**. He hopes this ruling will pave the way for other trans individuals facing **discrimination**.

The applicant began his transition in **2017**, starting with a social transition by announcing it to friends and family. He then transitioned officially with changes to his first name and civil status. Most recently, he commenced a medical transition, which included hormonal treatments in the **summer of 2022**.

Due to his experience of **gender dysphoria**, the applicant sought a long-term medical plan to receive complete care, specifically focusing on surgical options. However, he faced a partial denial from a doctor-advisor. Frustrated by this, he reached out to the amicable appeal committee in **November 2022**; however, this committee also denied his request in **January 2023**. Following this, he took his case to court.

Wider Implications for Trans Healthcare

During the court hearing on **March 12**, representatives from the CPAM argued that their decision relied on a **“medical opinion.”** However, Me Gandonou refuted this stance, dubbing their refusal as **“abusive and poorly founded.”**

Me Gandonou emphasized that the healthcare journey should mirror the experiences of **cisgender individuals**, lamenting that the CPAM has enforced **excessive conditions** for obtaining reimbursements for gender transition-related medical care.

Additionally, Me Gandonou is representing eight other trans individuals who have lodged appeals against various CPAMs in regions such as **Lyon, Cahors, Bobigny, Toulouse,** and **Grenoble**. In **Bobigny**, two applicants contested the decision of the Seine-Saint-Denis CPAM, with a ruling planned for **June 23**.

In March, **James Leperlier**, the president of the inter-LGBT group, observed that “not all CPAMs handle trans identity uniformly.” He highlighted that many trans individuals are compelled to seek judicial intervention to secure their rights, expressing hope that these legal appeals will foster clarity in healthcare policies.