1. Model of an Integrated Intervention in a Public Health Service for GID People Angelini G., Cavalot A., Datta G., Fontana D, Gualerzi A, Manieri C., Manzon M., Mariscotti G., Molo M., Rolle G. C IDIGeM Ospedale Molinette Torino Italy IX EFS Congress Rome 2008

2. CIDIGeM, a Public Health Service for GID Diagnosis: eligibility and readiness evaluation Hormone therapy under medical and psychological control (Real Life Experience) Speech therapy SRS Mammoplasty Medical and psychological follow-up at 6, 12, 24 months after surgery.

3. 2005-2007 126 GID people applied to the Service, asking for SRS 100 of them continued the program 75 fulfilled the diagnostic criteria for GID 31 of them were already authorized for SRS 20 underwent SRS (19 MtF, 1 FtM) 19 with good outcome or minor negative consequences 1 with vagina reconstruction 6 had speech therapy 12 had breast development examined 28 completed follow-up

4. PSYCHOLOGICAL THERAPY Weekly individual / group sessions Supporting egosintonic identity Verifying Real life experience for 2 years At the end: final report about rediness to SRS

5. Mammary glands differ in women and men. GID want the breast of the sex they feel to belong to Lipofilling Augmenting mammoplasty At the moment our patients don’t pay for the surgery, but we can’t assure out of charge implants. Adenomectomy, mastectomy and reduction mammoplasty in order to reduce breast volume, remove cutaneus excess and re-define shape and nipples.

6. HUMAN VOICE female frequency range is 145-275 Hz male frequency range is 80-165 Hz Spectroacustic analysis, videostroboscopy and neck TC scan. Speech therapy to correct verbal production habit. Surgical techniques: crico-thyroid approssimation. Reduction of Adam’s apple. Speech therapy fundamental after surgery. Spectroacustic exam after 10 days, one and six months, and one year. Average frequency of our patients 128-149 Hz.

7. Conclusions Multifactorial aspects of GID request a whole well structured intervention, helping each subject to be integrated in the sex they feel to belong to. cultural stigma and low socio-economic status to offer them the medical, psychological and surgical care they need free of charge and in an unique structure, with the same professionals who know and understand them, without any prejudice.