Infotrans

The gender affirming pathway at a glance

Some transgender people (not all) may intervene on their body to make it more like the way they feel through a medical gender affirming path that comprehends different stages, such as hormonal and/or surgical treatments.

A gender affirming path is not mandatory and not the same for all people. Attempts are made to adapt the pathway according to actual individual needs (for example, not all people feel the need to undergo surgical treatments). Before starting a medical gender affirming path, the person must be informed about all the procedures and available therapies, about the risks that these may entail and about the irreversibility of some of them. The aim is for the person to be able to express a written informed consent. The informed consent, regulated by Law no. 219/2017, represents the agreement of the interested party together with the involved professionals to undergo a medical treatment. It constitutes the prerequisite for the legitimacy of the doctor's activity. In fact, according to the Italian law, no one can be subjected to medical treatment against their will (Article 32 of the Constitution). Therefore, consent must be free, aware and informed and can be revoked at any time.
If a person wishes a gender affirming path, it is recommended to contact specialized centers. Infotrans.it offers a list of the current public or public-private partnership centers available in Italy in the section "Map of services".

Psychological interviews allow to acquire self-awareness with respect to the definition of one's gender identity (if confusion is present) and to define individualized pathways that are characterized by correct knowledge and realistic expectations. Psychological support during a gender affirmation journey is not mandatory, but the person may require it at certain sensitive times such as coming out, social transition, changes following hormonal therapies, job placement, etc. In the event that the person wishes a change of name on the documents and/or a gender affirming surgery, a psychological report can be edited in order to attest the need for such interventions for the purpose of the person's well-being. Furthermore, this can be presented to the Court of residence (to which the authorization request must be made to), as established by the Law 14 April 1982, n. 164, entitled “Norme in materia di rettificazione di attribuzione di sesso”.

According to the person’s wishes, hormone treatment may be prescribed. Based on the 8th edition of the Standards of Care of the World Professional Association of Transgender Health (WPATH) and other international guidelines, the following criteria must be met in order to start hormonal treatment: 1) persistent and well documented Gender Dysphoria; 2) ability to make a fully informed decision, provide informed consent to treatment; 3) if the person presents with physical and/or mental health problems, proper medical care; 4) understanding of the effects of hormone therapy on fertility and discussion of fertility preservation options. Hormone treatment must be tailored according to the person’s needs and wishes. A person assigned male at birth may request a feminizing and/or demasculinizing treatment, while a person assigned female at birth may request a masculinizing treatment. During the feminizing hormone treatment, estrogens are usually prescribed (for example for breast growth and female body shape), while antiandrogen are used in order to de-masculinize the body (for example to reduce body hair or erections). During the masculinizing hormone treatment, testosterone is commonly used (see hormone treatment for more information). Hormone treatment should be individualized according to the individual's needs and goals, taking into account his or her general health condition

Gender affirming surgeries can be undertaken with the authorization by the Court of residence issued with a sentence (with the exception of the augmentation mammoplasty in AMAB people). In the event that the person intends to undergo gender affirming surgery abroad, the sentence of the Court may not be necessary since it is not specifically requested by the State in which the person has decided to undergo this surgical treatment.

Gender affirming surgeries consist in the modification of primary and/or secondary sexual characteristics with the aim of affirming one’s gender identity.

Before a surgical gender affirming intervention, the person must be aware of its limits and that this step is in no way mandatory. In fact, while such surgeries are effective in removing genitals (uterus and ovaries; testicles and penis), to date a complete assignment of the desidered genitals is not possible. The surgical team has the task to describe all aspects related to surgery and its limits. This allows the person to develop realistic expectations and obtains, as a result, a good degree of satisfaction with the results achieved.

A person can request to the Court of residence the authorization for both gender affirming surgery and the change of name and gender on documents, or only the latter. For this purpose, it will be necessary to prove, including through medical/psychological documentation, one's gender dysphoria/gender incongruence. Following the important pronouncements of the Supreme Court and the Constitutional Court, if the person does not require, for his or her own psychological and physical well-being, to undergo gender affirmation surgery, he or she will be able to apply to the court for a name and gender change only. In fact, according to the person’s needs to reach personal wellbeing, one may request a change of name and gender without asking the authorization for gender affirming surgery. In cases where the person intends to undergo also gender affirmation surgery, he or she may apply for both authorizations at the same time.