Some transgender people (not all) may intervene on their body through a medical gender affirming path that comprehends different stages, such as hormonal and / or surgical treatments.
Some transgender people (not all) intervene on their body through a medical gender affirming path that includes different stages, such as hormonal and / or surgical treatments. A gender affirming path is not mandatory and not the same for all people. In fact, it must be tailored according to one’s personal needs (for example, not all people feel the need to undergo a gender affirming surgery). 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 structures available in Italy in the section "Map of services".
Psychological interviews allow to acquire self-awareness and to define tailored made paths. In particular, every choice is thoroughly investigated in order to develop realistic expectations and acquire correct information regarding benefits and limits of every gender affirming step. During the gender affirmiming path, psychological support is not mandatory; however, it is recommended in order to help (if needed) with challenges that may arise, such as coming out, social transition, changes due to hormonal therapies, job placement. 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. 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. The 7th edition of the WPATH Standards if Care, currently under revision, outlines specific criteria that need to be met in order to start hormone treatment: (1) persistent and well documented Gender Dysphoria; (2) ability to make a fully informed decision, provide informed consent to treatment and (3), if the person presents with physical and / or mental health problems, proper medical care. Hormone treatment must be tailored according to the person’s needs and wishes, taking into account general health conditions. 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 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).
Gender affirming surgeries can be undertaken with the authorization by the Court of residence issued with a sentence. 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.
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. 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. For this purpose, documentation certifying the condition of gender dysphoria is usually required.