Gender confirming treatment has proven to relief gender dysphoria as a symptom and to improve psychological functioning in transgender persons. Nevertheless, small percentage shows regret after their surgical treatment. Risk factors for regret are the presence of psychiatric problems, dissatisfaction with the results of surgery and poor socializing. In Belgium, euthanasia can be applied for in a situation of constant and unbearable mental or physical suffering. In recent years, three patients applied for euthanasia in the Gender clinic of the University Hospital Ghent, Belgium. We report on one case of a trans-woman applying for euthanasia and discuss on implications for assessment and treatment.