Click here to download

Reflections on the actual Italian Gender Transition Path
Journal Title: RIVISTA DI SESSUOLOGIA CLINICA 
Author/s: Luca Semenzato, Clara Baldin, Maria Laura Mitra, Giuseppe Pappalardo, Laura Giovanna Giannoni, Massimo Di Grazia 
Year:  2020 Issue: Language: Italian 
Pages:  18 Pg. 83-100 FullText PDF:  259 KB
DOI:  10.3280/RSC2020-002005
(DOI is like a bar code for intellectual property: to have more infomation:  clicca qui   and here 


In this paper, the authors will examine the Italian gender confirmation treatment procedures. World Professional Association on Transgender Health (WPHAT) and the Italian National Observatory on Gender Identity (ONIG) guidelines will be discussed considering the latest scientific research and literature reviews on the matter. The authors will show how the current treatment of every other psychiatric condition before the treatment of gender dysphoria could be modified to improve patients’ wellbeing, by treating the gender dysphoria before or at the same time as the secondary diseases. The authors will also highlight how people with gender dysphoria are more susceptible than the general population to develop a psychiatric condition, with a considerable expense on public health and people quality of life. In the end, the authors state that improving on public health infrastructure for transgender and gender non-conforming (TGNC) people will also mean improving the quality of life of Italian TGNC people, also due to the depathologization of non-conforming identities.
Keywords: Transgender, Gender dysphoria, GCT, Secondary mental illness, ONIG, WPATH.

  1. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). 527-537. Washington, DC: American Psychiatric Pub.
  2. American Psychological Association (2014, December 1). Answers to your questions about transgender people, gender identity, and gender expression. -- Testo disponibile al sito: http://www.apa.org : http://www.apa.org/topics/lgbt/transgender, consultato in data 7 Ottobre 2020.
  3. American Psychological Association (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 70(9): 832-864.
  4. Arcelus J., Bouman W.P., Van Den Noortgate W., Claes L., Witcomb G., Fernandez-Aranda F. (2015). Systematic review and meta-analysis of prevalence studies in transsexualism. European Psychiatry, 30(6): 807-815.
  5. Becker I., Auer M., Barkmann C., Fuss J., Möller B., Nieder T.O., Richter‑Appelt H. (2018). A cross-sectional multicenter study of multidimensional body image in adolescents and adults with gender dysphoria before and after transition-related medical interventions. Archives of Sexual Behavior, 47(8): 2335-2347.
  6. Blanchard R., Clemmensen L.H., Steiner B.W. (1983). Gender reorientation and psychosocial adjustment in male-to-female transsexuals. Archives of Sexual Behavior, 12(6): 503-509.
  7. Bockting, W. (2015). Internalized transphobia. The international encyclopedia of human sexuality, 583-625.
  8. Bockting W.O., Miner M.H., Swiburne Romine R.E., Hamilton A., Coleman E. (2013). Stigma, mental health, and resilience in an online sample of the US transgender population. American Journal of Public Health, 103(5): 943-951.
  9. Bonierbale M., Baumstarck K., Maquigneau A., Gorin-Lazard A., Boyer L., Loundou A., Auquier P., Lançon C. (2016). MMPI-2 profile of French transsexuals: the role of sociodemographic and clinical factors. A cross-sectional design. Scientific Reports, 6(1): 1-9.
  10. Bouman, W. P., Claes, L., Marshall, E., Pinner, G. T., Longworth, J., Maddox, V., Witcomb, G., Jimenez-Murcia, S., Fernandez-Aranda, F., Arcelus, J. (2016). Sociodemographic variables, clinical features, and the role of preassessment cross-sex hormones in older trans people. The Journal of Sexual Medicine, 13(4): 711-719.
  11. Bradford J., Reisner S.L., Honnold J.A., Xavier J. (2013). Experiences of transgender-related discrimination and implications for health: results from the Virginia Transgender Health Initiative Study. American Journal of Public health, 103(10): 1820-1829.
  12. Browne K. (2004). Genderism and the bathroom problem: (Re)materialising sexed sites, (re)creating sexed bodies. Gender, Place, Culture, 11(3): 331-346., DOI: 10.1080/096636904200025866
  13. Castro-Peraza M.E., García-Acosta J.M., Delgado N., Perdomo-Hernández A.M., Sosa-Alvarez M.I., Llabrés-Solé R., Lorenzo-Rocha N.D. (2019). Gender Identity: The Human Right of Depathologization. International Journal of Environmental Research and Public Health, 16: 978.
  14. Clements-Nolle K., Marx R., Katz M. (2006). Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization. Journal of Homosexuality, 51(3): 53-69.
  15. Colizzi M., Costa R., Todarello O. (2014). Transsexual patients’ psychiatric comorbidity and positive effect of cross-sex hormonal treatment on mental health: results from a longitudinal study. Psychoneuroendocrinology, 39: 65-73.
  16. Colton Meier S.L., Fitzgerald K.M., Pardo S.T., Babcock J. (2011). The effects of hormonal gender affirmation treatment on mental health in female-to-male transsexuals. Journal of Gay, Lesbian Mental Health, 15(3): 281-299., DOI: 10.1080/19359705.2011.58119
  17. Davis S.A., Colton Meier S.L. (2014). Effects of testosterone treatment and chest reconstruction surgery on mental health and sexuality in female-to-male transgender people. International Journal of Sexual Health, 26(2): 113-128., DOI: 10.1080/19317611.2013.83315
  18. De Cuypere G., Elaut E., Heylens G., Van Maele G., Selvaggi G., T’Sjoen G., Rubens R.B., Monstrey S.M., Hoebeke S. (2006). Long-term follow-up: psychosocial outcome of Belgian transsexuals after sex reassignment surgery. Sexologies, 15(2): 126-133.
  19. de Vries A.L.C., Doreleijers T.A.H., Steensma T.D, Cohen‐Kettenis P.T. (2011). Psychiatric comorbidity in gender dysphoric adolescents. Journal of Child Psychology and Psychiatry, 52(11): 1195-1202.
  20. Dhejne C., Van Vlerken R., Heylens G., Arcelus J. (2016). Mental health and gender dysphoria: A review of the literature. International Review of Psychiatry, 28(1): 1369-1627., DOI: 10.3109/09540261.2015.111575
  21. Doan P. L. (2010). The tyranny of gendered spaces- reflections from beyond the gender dichotomy. Gender, Place, Culture, 17(5): 635-654.
  22. Eisenberg M.E., Gower A.L., McMorris B.J., Rider G.N., Shea G., Coleman E. (2017). Risk and protective factors in the lives of transgender/gender nonconforming adolescents. Journal of Adolescent Health, 61(4): 521-526.
  23. Fisher A., Castellini G., Bandini E., Casale H., Fanni E., Benni L., Ferruccio N., Meriggiola M.C., Manieri C., Gualerzi A., Jannini E., Oppo A., Ricca V., Maggi M., Rellini A. (2014). Cross‐sex hormonal treatment and body uneasiness in individuals with gender dysphoria. The Journal of Sexual Medicine, 11(3): 709-719.
  24. Fisher A.D., Castellini G., Ristori J., Casale H., Cassioli E., Sensi C., Fanni E., Amato A.M.L., Bettini E., Mosconi M., Dèttore D., Ricca V., Maggi M. (2016). Cross-sex hormone treatment and psychobiological changes in transsexual persons: two-year follow-up data. The Journal of Clinical Endocrinology, Metabolism, 101(11): 4260-4269.
  25. Frey J.D., Poudrier G., Thomson J.E., Hazen A. (2017). A Historical Review of Gender-Affirming Medicine: Focus on Genital Reconstruction Surgery. The Journal of Sexual Medicine, 14(8): 991-1002.
  26. Fuss J., Auer M.K., Briken P. (2015). Gender dysphoria in children and adolescents: A review of recent research. Current Opinion in Psychiatry, 28(6): 430-434.
  27. Gleming, M., MacGowan, B., Robinson, L., Spitz, J., Salt, P. (1982). The body image of the postoperative female-to-male transsexual. Journal of Consulting and Clinical Psychology, 50(3): 461-462.
  28. Gómez-Gil E., Vidal-Hagemeijer A., Salamero M. (2008). MMPI-2 characteristics of transsexuals requesting sex reassignment: comparison of patients in prehormonal and presurgical phases. Journal of Personality Assessment, 90(4): 368-374., DOI: 10.1080/0022389080210802
  29. Gómez-Gil E., Zubiarre-Elorza L., de Antonio I.E., Guillamon A., Salamero M. (2014). Determinants of quality of life in Spanish transsexuals attending a gender unit before genital sex reassignment surgery. Quality of Life Research, 23(2): 669-676.
  30. Gómez-Gil E., Zubiaurre-Elorza L., Esteva I., Guillamon A., Godás T., Almaraz M., Halperin I., Salamero M. (2012). Hormone-treated transsexuals report less social distress, anxiety and depression. Psychoneuroendocrinology, 37(5): 662-670.
  31. Gordon A.R, Meyer I.H. (2007). Gender nonconformity as a target of prejudice, discrimination, and violence against LGB individuals. Journal of LGBT Health Research, 3(3): 55-71., DOI: 10.1080/1557409080209356
  32. Gorin‐Lazard A., Baumstarck K., Boyer L., Auquier P., Lançon C., Bonierbale M. (2012). Is hormonal therapy associated with better quality of life in transsexuals? A cross‐sectional study. The Journal of Sexual Medicine, 9(2): 531-541.
  33. Gorin-Lazard A., Baumstarck K., Boyer L., Maquigneau A., Penochet J.-C., Pringuey D., Albarel F., Morange I., Bonierbale M., Lançon C., Auquier P. (2013). Hormonal Therapy Is Associated with Better Self-esteem, Mood, and Quality of Life in Transsexuals. The Journal of Nervous and Mental Disease, 201(11): 996-1000.
  34. Hanna B., Desai R., Parekh T., Guirguis E., Kumar G., Sachdeva R. (2019). Psychiatric disorders in the U.S. transgender population. Annals of Epidemiology, 39: 1-7.
  35. Hepp U., Kraemer B., Schnyder U., Miller N., Delsignore A. (2005). Psychiatric comorbidity in gender identity disorder. Journal of Psychosomatic Research, 58(3): 259-261.
  36. Herman J. L. (2013). Gendered restrooms and minority stress: The public regulation of gender and its impact on transgender people’s lives. Journal of Public Management, Social Policy, 19(1): 65-80.
  37. Heylens G.V., Verroken C., De Cock S., T’Sjoen G., De Cuypere G. (2014). Effects of different steps in gender reassignment therapy on psychopathology: a prospective study of persons with a gender identity disorder. The Journal of Sexual Medicine, 11(1): 119-126.
  38. Heylens G., Elaut E., Kreukels B., Paap M., Cerwenka S., Richter-Appelt H., Cohen-Kettenis P., Haraldsen I., De Cuypere G. (2014). Psychiatric characteristics in transsexual individuals: multicentre study in four European Countries. The British Journal of Psychiatry, 204(2): 151-156.
  39. Khobzi Rotondi N. (2012). Depression in trans people: A review of the risk factors. International Journal of Transgenderism, 13(3): 104-116., DOI: 10.1080/15532739.2011.66324
  40. Dean J., T’Sjoen G. (2013). Gender Dysphoria. In Kirana P., Tripodi F., Reisman Y., Porst H. (2013). The EFS and ESSM syllabus of clinical sexology. Amsterdam: Medix Publishers, p. 1064 ‒ 1085Leavitt F., Berger J.C., Hoeppner J., & Northrop G. (1980). Presurgical adjustment in male transsexuals with and without hormonal treatment. Journal of Nervous and Mental Disease, 168(11): 693-697., DOI: 10.1097/00005053-198011000-0000
  41. Legge 164 (1982). Tratto da Gazzetta Ufficiale: https://www.gazzettaufficiale.it/ eli/id/1982/04/19/082U0164/sg
  42. Lombardi E. (2009). Varieties of transgender/transsexual lives and their relationship with transphobia. Journal of homosexuality, 56(8): 977-992., DOI: 10.1080/0091836090327539
  43. Mazaheri Meybodi A., Hajebi A., Ghanbari Jolfaei A. (2014). Psychiatric Axis I Comorbidities among Patients with Gender Dysphoria. Psychiatry Journal, 2014: 1-5., DOI: 10.1155/2014/97181
  44. Murad H.M., Elamin M.B., Garcia Z.M., Mullan R.J., Murad A., Erwin P.J., Montori V.M. (2010). Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes. Clinical Endocrinology, 72: 214-231.
  45. Namaste K. (1996). Genderbashing: Sexuality, gender, and the regulation of public space. Environment and Planning D: Society and Space, 14(2): 221-240.
  46. Newfield E, Hart S., Dibble S., Kohler L. (2006). Female-to-male transgender quality of life. Quality of Life Research, 15(9): 1447-1457.
  47. ONIG. (2020). Standard sui percorsi di affermazione di genere nell’ambito della presa in carico delle persone transgender e gender nonconforming (TGNC).
  48. Owen-Smith A., Gerth J., Sineath R., Barzilay J., Becerra-Culqui T., Getahun D., Goodman M. (2018). Association between gender confirmation treatments and perceived gender congruence, body image satisfaction, and mental health in a cohort of transgender individuals. The Journal of Sexual Medicine, 15(4): 591-600.
  49. Owen-Smith A., Sineath C., Sanchez T., Dea R., Giammattei S., Gillespie T., Goodman M. (2017). Perception of community tolerance and prevalence of depression among transgender persons. Journal of Gay & Lesbian Mental Health, 21(1): 64-76., DOI: 10.1080/19359705.2016.122855
  50. Papadopulos N.A., Lellé J.D., Zavlin D., Herschbach P., Henrich G., Kovacs L., Schaff J. (2017). Quality of Life and Patient Satisfaction Following Male-to-Female Sex Reassignment Surgery. The Journal of Sexual Medicine, 14(5): 721-730.
  51. Pitts M., Couch M., Mulcare H., Croy S., Mitchell A. (2009). Transgender People in Australia and New Zealand: Health, Well-being and Access to Health Services. Feminism & Psychology, 19(4): 475-495., DOI: 10.1177/095935350934277
  52. Russell S., Pollitt A., Li G., Grossman A. (2018). Chosen name use is linked to reduced depressive symptoms, suicidal ideation, and suicidal behavior among transgender youth. Journal of Adolescent Health, 63(4): 503-505.
  53. Schilt K., Westbrook L. (2009). Doing Gender, Doing Heteronormativity: “Gender Normals”, Transgender People, and the Social Maintenance of Heterosexuality. Gender & Society, 23(4): 440-464., DOI: 10.1177/0891243209340034
  54. Seelman K.L. (2016). Transgender adults’ access to college bathrooms and housing and the relationship to suicidality. Journal of Homosexuality, 63(10): 1378-1399., DOI: 10.1080/00918369.2016.1157998
  55. Seelman K.L. (2014). Transgender individuals’ access to college housing and bathrooms: Findings from the National Transgender Discrimination Survey. Journal of Gay & Lesbian Social Services, 26(2): 186-206., DOI: 10.1080/10538720.2014.891091
  56. Slabbekoorn D., Van Goozen S., Gooren L., Cohen-Kettenis P. (2001). Effects of cross-sex hormone treatment on emotionality in transsexuals. International Journal of Transgenderism, 5(3): 2-18., DOI: 10.1037/0735-7044.116.6.982
  57. Su D., Irwin J., Fisher C., Ramos A., Kelley M., Mendoza D., Coleman J. (2016). Mental health disparities within the LGBT population: A comparison between transgender and nontransgender individuals. Transgender Health, 1(1): 12-20.
  58. Tucker R.P., Testa R.J., Simpson T.L., Shipherd J., Blosnich J., Lehavot K. (2018). Hormone therapy, gender affirmation surgery, and their association with recent suicidal ideation and depression symptoms in transgender veterans. Psychological Medicine, 48(14): 2329-2336.
  59. Van de Grift T., Cohen-Kettenis P., Elaut E., De Cuypere G., Richter-Appelt H., Haraldsen I., Kreukels B. (2016). A network analysis of body satisfaction of people with gender dysphoria. Body Image, 17: 184-190.
  60. Van de Grift T., Elaut E., Cerwenka S., Cohen-Kettenis P., De Cuypere G., Richter-Appelt H., Kreukels B. (2017). Effects of medical interventions on gender dysphoria and body image: A follow-up study. Psychosomatic Medicine, 79(7): 815-823.
  61. Vargas-Huicochea I., Robles R., Real T., Fresán A., Cruz-Islas J., Vega-Ramírez H., Medina-Mora M. (2018). A Qualitative Study of the Acceptability of the Proposed ICD‑11 Gender Incongruence of Childhood Diagnosis Among Transgender Adults Who Were Labeled Due to Their Gender Identity Since Childhood. Archives of Sexual Behavior, 47(8): 2363-2374.
  62. Westbrook L., Schilt K. (2014). Doing gender, determining gender: Transgender people, gender panics, and the maintenance of the sex/gender/sexuality system. Gender & Society, 28(1): 32-57., DOI: 10.1177/0891243213503203
  63. Witcomb G., Bouman W., Claes L., Brewin N., Crawford J., Arcelus J. (2018). Levels of depression in transgender people and its predictors: Results of a large matched control study with transgender people accessing clinical services. Journal of Affective Disorders, 235: 308-315.
  64. WPATH (2011). Standards of Care per la Salute di Persone Transessuali, Transgender e di Genere Non-Conforme. Testo disponibile al sito: www.wpath.org. Consultato in data 7 Ottobre 2020.

Luca Semenzato, Clara Baldin, Maria Laura Mitra, Giuseppe Pappalardo, Laura Giovanna Giannoni, Massimo Di Grazia, Reflections on the actual Italian Gender Transition Path in "RIVISTA DI SESSUOLOGIA CLINICA" 2/2020, pp. 83-100, DOI:10.3280/RSC2020-002005

   

FrancoAngeli is a member of Publishers International Linking Association a not for profit orgasnization wich runs the CrossRef service, enabing links to and from online scholarly content