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Czechia’s ministry writing is a legal-sex-change process.
The Metodický pokyn for health-service providers on issuing certificates for official sex change (in force 1 July 2025; also Věstník MZD 9/2025) standardises diagnosis of transsexualism (ICD-10 F64.0) and the two certificates used by the registry office. Expert consensus in the pokyn: care may start before 18; the confirmation for official sex change should not be issued before 18. Further care after diagnosis may include hormonal treatment, including long-term hormones, and surgery — described as voluntary.
That is a pathway. Medical is Affirming.