Regional Differences in the Healthcare of Children and Adolescents with Gender Incongruence in Germany

<title>Abstract</title> <p> Objective In recent years, the number of children and adolescents experiencing gender incongruence (GI) and gender dysphoria (GD) has increased within the German healthcare system. The present study assesses healthcare structures, opportunities for referral and clinical confidence regarding treatment of children and adolescents with GI/GD of healthcare professionals, with an emphasis on regional differences between rural/urban areas, eastern/western and northern/southern Germany. Method An online survey was answered by <italic>N</italic>  = 868 healthcare professionals. Ratings are analyzed using descriptive statistics and group comparisons. Results Healthcare professionals rated the healthcare structure for children and adolescents with GI/GD as partially developed. Regarding referral opportunities, 22% stated that they do not know to whom they could refer patients. Clinical confidence was rated as partly secure. However, if gender-affirming medical interventions are not considered, the average clinical confidence increases. Conclusion The geographical comparisons indicate no differences in healthcare between eastern/western and northern/southern regions. Nevertheless, healthcare structures in urban areas were rated as more positive as in rural areas. To ensure access to healthcare for children and adolescents with GI/GD and their families, it is essential to expand services, especially in rural areas. Healthcare professionals’ clinical confidence should improve to adequately meet the growing demand for care, which could be accomplished by appropriate education and training. </p>