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.