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

A transgender person who intends to undergo gender-affirming surgery in Italy, if they have already obtained a court ruling rectifying their name and gender in civil records, may undergo the procedure freely, without the need for prior authorization from the court (Constitutional Court, ruling no. 143/2024).
Only in the absence of legal gender rectification, where the court has deemed the transition process insufficient for such rectification, will authorization issued by a ruling from the court of residence be required for surgical procedures (with the exception of breast augmentation surgery for AMAB individuals).

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.