Lili consulted two physicians, both of whom diagnosed her as homosexual, a third physician diagnosed her as intersexed and claimed she had rudimentary female sex organs. In fact, when the sex reassignment surgery commenced, the surgeons found shrunken female ovaries. Hormonal assays taken just before her first surgery indicated more female than male hormones present. It is likely that she had XXY sex chromosome karyotype (Klinefelter's Syndrome) a condition not medically recognized until 1942. The fact that Lili was Intersex is not mentioned in the film.
The paintings in the film were done by the film's production designer Eve Stewart and by British artist Susannah Brough. The film's paintings weren't exact replicas of Gerda Wegener's work, they had to be to adapted because they didn't look like Eddie Redmayne. The original portrait of ballerina Ulla Poulsen, was also altered to resemble Amber Heard's face.
Einar Wegener/Lili Elbe wasn't the first transgender person nor the first to undergo sex reassignment surgery, she was only among the first. Dora Richter/Dörchen Richter (also known as Dora R., 1891-1933) - who was born as Rudolph Richter, became the first trans woman of whom records remain to undergo vaginoplasty. According to Dr. Felix Abraham, a psychiatrist working at the Institute for Sexual Science, where Dora was employed as a domestic servant, her first step to feminization was made by means of castration in 1922. After this there was a long pause, until the beginning of the year 1931, when the penis amputation was done and in June, the here described surgery - a highly experimental vaginoplasty performed by Dr. Erwin Gohrbandt, who later becomes a decorated surgeon-general in the Luftwaffe. Carla van Crist and Toni Ebel had also got the surgery before Lili arrived in Berlin. The Institute for Sexual Research (founded by Magnus Hirschfeld in Berlin, in 1919), was doing the operations, but the Nazis destroyed the files in 1933 so there is no way of knowing who truly was the first person to undergo sexual reassignment surgery. Lili's last operations were made by Dr. Kurt Warnekros at the Dresden Women's Clinic. Her first surgeries (castration and penectomy) had been performed by Dr. Ludwig Levy-Lenz under Hirschfeld's supervision in Berlin in 1930. These preliminaries have sometimes caused confusion over the date of Lili's 'sex change', but Dora/Dörchen Richter was the first transgender woman who underwent sex reassignment surgery, that began in 1922.
Alicia Vikander's Oscar nomination for Best Actress in a Supporting Role, instead of Best Actress in a Leading Role, was seen by many as a critical category fraud, as she has 59 minutes and 37 seconds of screen time, or 49.9% of the movie's length, this amount of screen time qualifies her for a Best Actress Oscar. Distributor Focus Features, a subsidiary of Universal Studios, decided to campaign for Vikander as supporting actress because they thought it would increase her chances of winning, as she would have been competing against Brie Larson for her role in Room (2015) decreasing her chances of winning the award. Vikander has refused to comment on the debate.
Many details of Einar Wegener's life were hard for both the author of the book and the crew of the film to track down. Denmark didn't have records. Dresden's women's hospital had medical records, but nothing remained after WWII. They found brief newspaper items, memoirs of the Wegeners' friends, and accounts of some similar surgeries in those days.