Single Step is the only organisation in Bulgaria that provides a comprehensive health programme specifically designed for trans, intersex, and non-binary individuals. The program covers key aspects of health care — mental health, medical transition, and referrals to appropriate healthcare professionals.
We aim to build sustainable and accessible healthcare services for LGBTI+ people in the country, while also supporting the systematic and professional development of the medical community’s capacity.
What We Do
- We provide psychological support tailored to the individual needs of trans, intersex, and non-binary people.
- We offer consultations regarding medical transition, including the benefits and risks of hormone replacement therapy (HRT).
- We maintain and expand a network of medical professionals experienced in working with trans, intersex, and non-binary patients.
- We refer clients to knowledgeable and affirming doctors and specialists.
- We develop educational resources for healthcare professionals to build awareness, sensitivity, and understanding on these topics.
- We establish partnerships with organizations and institutions in Bulgaria and abroad.
All program activities are aligned with the WPATH Standards of Care, Version 8, ensuring that our approach follows the most up-to-date and ethical international practices.
Main Goals of the Program
Protect the health rights
of trans, intersex, and non-binary patients by ensuring access to informed, high-quality, and respectful medical care
Prevent self-administered HRT
by providing support and access to qualified professionals
Reduce stigma
among healthcare providers and the general public
Inform and empower
trans, intersex, and non-binary individuals about their patient rights, the HRT process, and overall health care
Frequently Asked Questions
Can I start HRT if I am under 18 years old?
Minors can only access psychological support services provided by the Single Step Foundation. In Bulgaria, medical transition for minors is not conducted in any form.
Will you prescribe hormones?
No. The specialists working at Single Step do not prescribe or distribute hormonal medications. What we can do is discuss the potential benefits and risks of HRT and refer you to appropriate professionals.
Hormone therapy can only be prescribed by an endocrinologist. Self-administering HRT can cause serious side effects that negatively impact your health, including the endocrine and cardiovascular systems. Therefore, HRT must always be conducted under medical supervision, following all professional recommendations and regular checkups.
How long does a medical transition take?
The duration varies for each individual, depending on personal goals, health condition, and other factors. According to medical literature, the main physical changes typically begin within six months of starting HRT, with the most significant changes observed around the second or third year. Trans people generally continue with HRT throughout their lives, with dosage adjusted by their endocrinologist based on individual needs.
Single Step does not set deadlines for contacting specialists or conducting tests. Each participant decides when and whether to take the next step in their medical transition. Scheduling appointments depends both on your preferences and the specialists’ availability.
Will the psychiatrist’s medical certificate appear in my health records? Could it be a problem when applying for a job?
After a thorough evaluation, the psychiatrist issues a medical certificate confirming or ruling out a diagnosis of transsexualism (ICD-10 – F64.0). This document states that, due to gender dysphoria, it is medically appropriate to receive HRT and ongoing follow-up care. Based on this expert opinion, your endocrinologist may prescribe the necessary medications.
Currently, there is no requirement to issue an outpatient record. However, if you wish to obtain one, you can request it from your examining doctor. Accumulated outpatient records help show health authorities that trans people in Bulgaria exist and require proper professional care.
The medical certificate and outpatient record are two separate documents. The certificate does not appear in your general practitioner’s records or in any electronic system and cannot become publicly available. Therefore, it does not affect the medical documentation required when starting a new job.
Can you explain the process of changing names and documents?
At this time, our team cannot provide legal advice regarding name or document changes. For such matters, you can contact Youth LGBTI Organisation Deystvie.
Do you offer financial assistance for trans and non-binary people undergoing medical transition?
Currently, there is no financial support programme for trans and non-binary people in Bulgaria. If you are facing employment challenges, explore our VentureOUT Career Counseling Programme.
I’m on HRT but moving abroad. How can I access my hormones there?
Unfortunately, Single Step’s services are only available in Bulgaria. You should look for local organizations in your new country that support trans, intersex, and non-binary individuals, and find out how to access HRT there. Another option is to periodically return to Bulgaria for checkups with your endocrinologist.
My family is worried about me starting HRT. Can you talk to them?
Yes. Family consultations are part of the services we offer. They can be conducted with a psychologist or a health consultant. Write to us if you feel such a session would be helpful.