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

  • Position Statement
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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

Results

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.

Conclusions

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.

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Notes

  1. For a full account of sex and gender development see Giordano, S. (2012). Children with Gender Identity Disorder, a clinical, ethical and legal analysis. London and New York: Routledge

    .

Abbreviations

SIAMS:

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

SIE:

Società Italiana di Endocrinologia (Italian Society of Endocrinology)

SIEDP:

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

ONIG:

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

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Conflict of interest

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Sexual Medicine and Andrology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy

    A. D. Fisher, J. Ristori, E. Bandini & M. Maggi

  2. CSEP/iSEI, The University of Manchester, The School of Law, Williamson Building Oxford Road, Manchester, M139PL, UK

    S. Giordano

  3. Gender Identity Development Service, Hospital S. Camillo-Forlanini, Rome, Italy

    M. Mosconi

  4. Endocrinology and Medical, Sexology, Experimental Medicine, University of L’Aquila, L’Aquila, Italy

    E. A. Jannini

  5. Pediatric Endocrinology and Adolescence Unit, Department of Woman and Child Health, Hospital-University of Padua, Padua, Italy

    N. A. Greggio

  6. ASL 1 Piemont Region, Turin, Italy

    A. Godano

  7. University of Turin, SCDU Endocrinology and Metabolic Diseases, Turin, Italy

    C. Manieri

  8. Interdepartmental Center for Sexual Health Protection, Gynecology and Physiopathology of Human Reproduction, University of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy

    C. Meriggiola

  9. Psychiatric Unit, Department of Neuropsychiatric Sciences, University of Florence, Florence, Italy

    V. Ricca

  10. University of Florence, Department of Health Sciences, Florence, Italy

    D. Dettore

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  1. A. D. Fisher
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  2. J. Ristori
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  8. A. Godano
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  9. C. Manieri
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  10. C. Meriggiola
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  13. M. Maggi
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Italian GnRH analogs study ONIG group

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Correspondence to M. Maggi.

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The Italian GnRH analogs ONIG study group: Florence (Alessandra D. Fisher, Mario Maggi, Davide Dèttore, Paolo Antonelli, Jiska Ristori, Egidia Fanni), Turin (Chiara Manieri, Adriana Godano).

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Fisher, A.D., Ristori, J., Bandini, E. et al. Medical treatment in gender dysphoric adolescents endorsed by SIAMS–SIE–SIEDP–ONIG. J Endocrinol Invest 37, 675–687 (2014). https://doi.org/10.1007/s40618-014-0077-6

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