Citt della Salute e della Scienza C I

Città della Salute e della Scienza C. I. D. I. Ge. M. Centro Interdipartimentale Disturbi Identità di Genere Molinette Fondazione Carlo Molo ONLUS MULTIDISCIPLINARY APPROACH IN TRANS PEOPLE CARE: THE EXPERIENCE OF A GENDER TEAM IN A ITALIAN PUBLIC INSTITUTION. P. Bogetti, A. Cavalot, C. M. Crespi, G. Datta, A. Gualerzi, C. Manieri, V. Mineccia, M. Molo, L. Petruzzelli, P. Petruzzelli, L. Rolle, M. Timpano

THE TRANSFORMATION PROGRAM

OSSERVATORIO NAZIONALE SULL’IDENTITÀ DI GENERE (1998) STANDARDS OF THE TRANSFRMATION PROGRAM OF GENDER IDENTITY (www. onig. it) Italian guidelines, elaborated by ONIG based on the WPATH Standards of Care adapted to our culture and social model. These Standard are not state laws, but associate professionals are to follow and respect them.

the Italian reality the law 164/1982 …and its integration ,

INFORMATION DESK Città della Salute e della Scienza San Giovanni Battista Molinette Hospital Fridays 1. 30 pm - 4. 30 pm Tel. 011/633. 36. 92

CARING TEAM ENDOCRINOLOGY PSYCHOLOGY PLASTIC SURGERY PSYCHIATRY URO-ANDROLOGY GYNECOLOGY E. N. T. (Ear Nose and Throat) GENERAL LAPAROSCOPIC SURGERY

THE TRANSFORMATION PROGRAM PSYCHODIAGNOSIS 6 months R. L. E. REAL LIFE EXPERIENCE 12 months 18 MONTHS

WELCOME MEETING q Inform on pathway q Collect health notes q Hand out brochures q Ensure signed informed consent q Book the first appointment

PROCEDURE (1) • Clinical interviews • Tests PSYCHO • Medical examinations DIAGNOSIS (endocrinological and psychiatric) • Hormonal Therapy R. L. E. • Psychological support • Programmed medical examinations

PROCEDURE (2) Final Team Report Legal procedure to obtain the authorization for Sexual Reassignment Surgery S. R. S. Surgery

PSYCHOLOGIST Before Hormonal treatment clinical interviews During RLE psychological support (if required also with the family) After SRS Psychological support (if required) and group sessions based on Sexocorporelle Approach (Prof. Desjardins) 02/11/09

from 2005 to 2014 398 subjects: 283 Mt. F 115 Ft. M NOW IN CHARGE Before HT: 21 Mt. F 19 Ft. M

Subjects attending C. I. D. I. Ge. M – a Public Health Service for GID people in Turin, Italy, in order to enter the programme for Sex Reassignment Surgery, from January 2005 to February 2012

Drop out

PSYCHIATRIST Before Hormonal treatment clinical evaluation During RLE/After. SRS If necessary

ENDOCRINOLOGIST Cross-Sex Treatment Ft. M Mt. F Testosteron 17β-Estradiolo Androgen antagonist Persons in charge in R. L. E. : 50 Mt. F/23 Ft. M Follow-Up (post-S. R. S. ): 58 females/21 males

OTORHINOLARYNGOLOGIST VOCAL CORDS SURGERY 82 patients (90% coming from other regions) Cricotyiroid approximation with condroplastic surgery when required and possible Waiting list for surgery: 18 months 85% of successes 3 complications in a short-long term: all resolved Hospitalization: 24 hours in a double room

PLASTIC SURGEON: MAMMOPLASTY and GENITALS’ REVISION 10 patients Mt. F for mammoplasty 3 patients Mt. F for genitals’ revsion (clitoris and labia) Waiting list for mastoplasty : 18– 30 months 1 complication, resolved Hospitalization: 1 -2 days in a double room (for female) Waiting list for genitals’ revision: 12 -18 mounths

A D B Almost 1 year After HT to evaluate breast development Cut off for the surgery in NHS: > 6 cm distance between the muscle and the nipple E C With X-Ray mammography

GENERAL SURGEON and GYNECOLOGIST: GENERAL LAPAROSCOPIC, PLASTIC AND GYNECOLOGICAL SURGERY Ft. M: 18 cases Total laparoscopic bilateral hysteroannessiectomy associated with bilateral mastectomy Waiting list: 4 -6 months Hospitalization: 3 -5 days in a single or double room (with males) No complications in the short/long term (only 1 case of postoperative pyrexia)

Mt. F: 10 cases access to the gynecological clinic The most common problems are: - worry about inadequate vaginal length and caliber - poor lubrication - fear of having penetrative sex intercourse We found in all cases a good aesthetic and functional result with an appropriate vaginal size for penetrative sexual intercourse.

UROLOGIST 52 patients Mt. F 10 patients Ft. M Waiting list: 24 months Patients in waiting list: 24 Mt. F ; 12 Ft. M Hospitalization: 7 days in a single room Revisions for: 3 vaginal stenosys (ileovaginoplasty), 7 uretral meatus stenosys and 5 asimmetric labia majora and hipertrophic clitoris

OPEN ISSUES ü italian guidelines are strong based to the social and cultural environment ü gender team works in a public hospital: waiting list and kind of services provided ü services provided are hormonal therapy, SRS, and, in some rare case, mammoplasty ; services not provided are laser and mammoplasty

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