1. 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 MULTIDISCIPLINARY APPROACH IN TRANS PEOPLE CARE: THE EXPERIENCE OF A GENDER TEAM IN A ITALIAN PUBLIC INSTITUTION. Città della Salute e della Scienza C.I.D.I.Ge.M. Centro Interdipartimentale Disturbi Identità di Genere Molinette Fondazione Carlo Molo ONLUS

2. THE TRANSFORMATION PROGRAM

3. 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.

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

7. 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

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

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

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

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

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

13. 02/11/09 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)

14. from 2005 to 2014 398 subjects: 283 MtF 115 FtM NOW IN CHARGE Before HT: 21 MtF 19 FtM

15. 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

16. Drop out

17. PSYCHIATRIST Before Hormonal treatment clinical evaluation During RLE/AfterSRS If necessary

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

19. 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 OTORHINOLARYNGOLOGIST VOCAL CORDS SURGERY

20. 10 patients MtF for mammoplasty 3 patients MtF 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 PLASTIC SURGEON: MAMMOPLASTY and GENITALS’ REVISION

21. A B E D C 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 With X-Ray mammography

22. FtM: 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) GENERAL SURGEON and GYNECOLOGIST: GENERAL LAPAROSCOPIC, PLASTIC AND GYNECOLOGICAL SURGERY

23. MtF: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.

24. UROLOGIST 52 patients MtF 10 patients FtM Waiting list: 24 months Patients in waiting list: 24 MtF ; 12 FtM 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

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

26. THANK YOU !