Journal of Endocrinological Investigation

, Volume 37, Issue 7, pp 675–687 | Cite as

Medical treatment in gender dysphoric adolescents endorsed by SIAMS–SIE–SIEDP–ONIG

  • A. D. Fisher
  • J. Ristori
  • E. Bandini
  • S. Giordano
  • M. Mosconi
  • E. A. Jannini
  • N. A. Greggio
  • A. Godano
  • C. Manieri
  • C. Meriggiola
  • V. Ricca
  • Italian GnRH analogs study ONIG group
  • D. Dettore
  • M. Maggi
Position Statement



Despite international guidelines being available, not all gender clinics are able to face gender dysphoric (GD) youth population needs specifically. This is particularly true in Italy. Centers offering specialized support are relatively few and a commonly accepted Italian approach to GD youth has still not been defined. The aim of the present Position Statement is to develop and adhere to Italian guidelines for treatment of GD adolescents, in line with the “Dutch Approach”, the Endocrine Society (ES), and the World Professional Association for Transgender Health (WPATH) guidelines.


An in-depth brainstorming on the application of International guidelines in the Italian context was performed by several dedicated professionals.


A staged approach, combining psychological support as well as medical intervention is suggested. In the first phase, individuals requesting medical help will undergo a psycho-diagnostic procedure to assess GD; for eligible adolescents, pubertal suppression should be made available (extended diagnostic phase). Finally, from the age of 16 years, cross-sex hormonal therapy can be added, and from the age of 18 years, surgical sex reassignment can eventually be performed.


The current inadequacy of Italian services offering specialized support for GD youth may lead to negative consequences. Omitting or delaying treatment is not a neutral option. In fact, some GD adolescents may develop psychiatric problems, suicidality, and social marginalization. With access to specialized GD services, emotional problems, as well as self-harming behavior, may decrease and general functioning may significantly improve. In particular, puberty suppression seems to be beneficial for GD adolescents by relieving their acute suffering and distress and thus improving their quality of life.


Gender Dysphoria Adolescents Puberty suppression 



Società Italiana di Andrologia e Medicina della Sessualità (Italian Society of Andrology and Sexual Medicine)


Società Italiana di Endocrinologia (Italian Society of Endocrinology)


Società Italiana di Endocrinologia e Diabetologia Pediatrica (Italian Society for Paediatric Endocrinology and Diabetes)


Osservatorio Nazionale sull’Identità di Genere (National Observatory of Gender Identity)


Conflict of interest

The authors declare no conflict of interest.


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Copyright information

© Italian Society of Endocrinology (SIE) 2014

Authors and Affiliations

  • A. D. Fisher
    • 1
  • J. Ristori
    • 1
  • E. Bandini
    • 1
  • S. Giordano
    • 2
  • M. Mosconi
    • 3
  • E. A. Jannini
    • 4
  • N. A. Greggio
    • 5
  • A. Godano
    • 6
  • C. Manieri
    • 7
  • C. Meriggiola
    • 8
  • V. Ricca
    • 9
  • Italian GnRH analogs study ONIG group
  • D. Dettore
    • 10
  • M. Maggi
    • 1
  1. 1.Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical SciencesUniversity of FlorenceFlorenceItaly
  2. 2.CSEP/iSEI, The University of Manchester, The School of LawWilliamson Building Oxford RoadManchesterUK
  3. 3.Gender Identity Development ServiceHospital S. Camillo-ForlaniniRomeItaly
  4. 4.Endocrinology and Medical, Sexology, Experimental MedicineUniversity of L’AquilaL’AquilaItaly
  5. 5.Pediatric Endocrinology and Adolescence Unit, Department of Woman and Child HealthHospital-University of PaduaPaduaItaly
  6. 6.ASL 1 Piemont RegionTurinItaly
  7. 7.University of Turin, SCDU Endocrinology and Metabolic DiseasesTurinItaly
  8. 8.Interdepartmental Center for Sexual Health Protection, Gynecology and Physiopathology of Human ReproductionUniversity of Bologna and S. Orsola-Malpighi HospitalBolognaItaly
  9. 9.Psychiatric Unit, Department of Neuropsychiatric SciencesUniversity of FlorenceFlorenceItaly
  10. 10.University of Florence, Department of Health SciencesFlorenceItaly

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