This article reports findings from research about trans* citizenship in 14 post-socialist countries. It evidences substantial deficits concerning trans policy making, and a lack of policy debate in this area. Most examined countries have a lack of protocols for official gender change in birth certificates, IDs, passports and other documents. Usually there are no guidelines, measures and procedures defining the standards of healthcare for trans persons. Practice concerning healthcare varies widely, and trans people and advocates exercise agency in negotiating access to care. The article suggests that trans citizenship studies need to foreground legal and social aspects of citizenship, as these are highlighted in the post-socialist context. Policy implications are discussed in relation to key citizenship debates including those concerning challenges to normative models of citizenship.