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PSYCHOLOGICAL, MEDICAL AND SURGICAL MANAGEMENT IN
GENDER IDENTITY DISORDERS A PICTURE OF EUROPEAN
CENTERS Mariateresa MOLO, Chiara CRESPI,
Valentina MINECCIA Fondazione Carlo Molo
Onlus, Turin Italy Gender Team
C.I.D.I.Ge.M., Turin Italy
AIM IN THE OCCASION OF THE FIRST EUROPEAN MEETING
ON TRANSSEXUALISM HELD IN TURIN ON MAY 2012, A
QUESTIONNAIRE WAS SENT TO SOME EUROPEAN CENTERS
DEALING WITH TRANS PEOPLE. THE AIM OF THIS
QUESTIONNAIRE WAS TO GET A PICTURE OF THE
EUROPEAN SITUATION ABOUT CARE AND TREATMENTS
OFFERED TO TRANSSEXUAL, TRANSGENDER AND GENDER
NON CONFORMING PEOPLE (WPATH 7TH VERSION OF
STANDARDS OF CARE, SEPTEMBER 2011).
COUNTRY YEARS of ACTIVITY N of PATIENTS FOLLOWED STRUCTURE PROFESSIONALS
SWEDEN 13 450 General Hospital 14
HOLLAND 38 375 General Hospital 14
SPAIN 12 730 General Hospital 7
SWITZERLAND 4 50 Private Practice 20
UNITED KINGDOM 15 160 General Hospital 11
ITALY (MEAN of 5 CENTRES O.N.I.G. ) 10 227 General Hospital 9
QUESTIONNAIRE THE QUESTIONNAIRE USED IS COMPOSED
OF 36 ITEMS TO INVESTIGATE CRITERIA OF TAKING IN
CHARGE, DIAGNOSIS, REAL LIFE EXPERIENCE, MEDICAL
AND SURGICAL TREATMENTS, NUMBER AND QUALIFICATION
OF PROFESSIONALS.

T1
T2
T3
T4
T5 DIAGNOSIS
HORMONAL TREATMENT RELA LIFE
EXPERIENCE Sex Reassignment Surgery FOLLOW
UP

TRANSFORMATION PROGRAMME
T1 DIAGNOSIS
T2 HORMONAL TREATMENT PSYCHOLOGICAL EVALUATION
FOR HORMONAL TREATMENT IS MANDATORY FOR ALL THE
EUROPEAN CENTERS

• SELF DIAGNOSIS
• No center accepts self diagnosis except

• World Profesisonal Association for Transgender
  Health ( WPATH) Standards of Care followed by

• T3 REAL LIFE EXPERIENCE
• IN EVERY CENTER THE LENGTH IS ALMOST 12 MONTHS
• PSYCHOTERAPY BEFORE S.R.S. IS RACCOMANDED BY
  EVERY CENTER EXCEPT
• KIND OF PSYCHOTERAPY INDIVIDUAL OR GROUP
• PSYCHOLOGICAL OR PSYCHIATRIC EVALUATION, BEFORE
  S.R.S., IS MANDATORY FOR ALL CENTERS

NO
YES, but only some criteria
YES

• ITALY follows National Standards of
  Care by O.N.I.G.(Gender
  Identity National Observatory)

TESTS
CLINICAL INTERVIEW
DSMIV-TR ICD 10

• DIAGNOSTIC
• TOOLS

SERVICES DIRECTED TO CHILDREN AND ADOLESCENTS
WITH ATYPICAL GENDER IDENTITY ORGANIZATION
(A.G.I.O.)
MtF

• T4 SURGERY
• HORMONAL TREATMENT IS FREE OF CHARGE IN EUROPEAN
  CENTERS WITH SOME DIFFERENCES IN ITALIAN GENDER
  TEAMS
• S.R.S. IS UNDER N.H.S. FOR EACH COUNTRY

• MOST OF CENTERS OFFER
• FREE OF CHARGE MAMMOPLASTY UNDER SPECIFIC
  CONDITIONS
• (IN ITALY IT IS FREE OF CHARGE IN SOME CENTRES)
• LASER IS FREE OF CHARGE ONLY IN
• NO CENTERS OFFER FREE OF CHARGE VOCAL CORD
  SURGERY EXCEPT
• AND, IN SOME CASES,

FtM
PENILE PROSTHESIS IS FREE OF CHARGE EXCEPT
FOR
T5 FOLLOW UP
After S.R.S. follow up is done by
not by
CONCLUSIONS

• ALL CENTERS SHARE THE GENERAL INTERNATIONAL
  STANDARDS OF CARE, EVEN IF THERE ARE SPECIFIC
  DIFFERENCES IN EACH COUNTRY RELATED TO CULTURAL
  ASPECTS
• IT IS IMPORTANT UNDERLINE THAT ALL THESE
  EUROPEAN GENDER TEAMS DO NOT ACCEPT THE SELF
  DIAGNOSIS PRINCIPLE BUT THEY HIGHLIGHT THE NEED
  OF PSYCHOLOGICAL OR PSYCHIATRIC EVALUATION BEFORE
  BOTH THE HORMONAL TREATMENT AND THE SURGERY
• MOST OF EUROPEAN GENDER TEAMS ARE PUBLIC
• IN ITALY THE PSYCHOTERAPY DURING R.L.E. IS
  STILL A MATTER OF DEBATE AMONG DIFFERENT CENTERS