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

THE TRANSFORMATION PROGRAM

OSSERVATORIO NAZIONALE SULL’IDENTITÀ DI GENERE (1998)

STANDARDS OF THETRANSFRMATION 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

URO-ANDROLOGYPLASTIC SURGERY

  

ENDOCRINOLOGY

PSYCHIATRYPSYCHOLOGY

GENERAL LAPAROSCOPIC SURGERY

E.N.T. (Ear Nose and Throat)

GYNECOLOGY

PSYCHODIAGNOSIS

R.L.E. REAL LIFE EXPERIENCE

6 months

12 months

18 MONTHS18 MONTHS

THE TRANSFORMATION PROGRAM

WELCOME MEETING

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

PROCEDURE (1)

PSYCHO-DIAGNOSIS

• Clinical interviews

• Tests

• Medical examinations

(endocrinological and psychiatric)

• Hormonal Therapy

• Psychological support

• Programmed medical

examinations

R.L.E.

PROCEDURE (2)

Final Team Report

Legal procedure to obtain the

authorization for

Sexual Reassignment Surgery

S.R.S.

Surgery

02/11/09

PSYCHOLOGIST

Before Hormonal treatment clinical interviews

During RLEpsychological support (if required also with the family)

After SRSPsychological support (if required) and group sessions based on Sexocorporelle Approach (Prof. Desjardins)

from 2005 to 2014

398 subjects: 283 MtF115 FtM

NOW IN CHARGE

Before HT: 21 MtF19 FtM

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

1179

191

n = 281

Other

Non-GID

GID

Drop out

PSYCHIATRIST

Before Hormonal treatment clinical evaluation

During RLE/AfterSRSIf necessary

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

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

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

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

FtM: 18 casesTotal 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

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.

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

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

THANK YOU !