LGBTQ+ rights

LGBTQ+

Gender transition: in Italia, access still depends on where you live

There are highly specialised centres across the country offering gender affirmation programmes, but according to the ISS, there is no structured national network

by Ilaria Potenza

29 June 2026

A member of the LGBTQ+ community holds a placard during the LGBTQ+ Pride parade in Athens, Greece, June 13, 2026. REUTERS/Louiza Vradi REUTERS

4' min read

Translated by AI

Versione italiana

Key points

The intake process
The route through Italia
Regional inequalities and data limitations

4' min read

Translated by AI

Versione italiana

For a transgender person who decides today to embark on a journey of gender affirmation in Italia, the first obstacle may be geographical rather than clinical. In fact, within our National Health Service, there is no structured network of services dedicated to this particular clinical issue. Instead, there are centres that have been set up on the initiative of individual multidisciplinary teams, which are unevenly distributed across the country and characterised by different organisational structures.

In recent years, demand for patient care has grown, whilst public provision continues to be concentrated in a limited number of specialist facilities equipped to accommodate them. This is evident from the survey of centres carried out by the Italian National Institute of Health (ISS), which outlines the profile of the main facilities currently in operation. These include Careggi in Florence, Cidigem in Turin, Sapienza and the Policlinico Gemelli in Rome, as well as university and hospital facilities in Padua, Bologna and Bari. These are units which, over time, have built up multidisciplinary teams capable of integrating expertise in endocrinology, psychology, psychiatry, gynaecology, urology and surgery, in accordance with clinical standards now recognised internationally.

The care pathway

Specifically, the initial phase of patient care is generally devoted to an assessment designed to identify patients’ healthcare needs and stabilise their treatment pathway. This is followed by an endocrinological assessment, which enables the initiation of affirming hormone therapy where appropriate, with regular monitoring of metabolic, hormonal and cardiovascular parameters. In some cases, the pathway continues with surgical procedures, which may involve the chest or genital organs. However, the geographical distribution of these services is not uniform. Data from the ISS show that some centres provide comprehensive multidisciplinary care, whilst others offer only individual specialist services or targeted consultations. Furthermore, in many parts of the country – particularly outside the main university centres – access to these care pathways requires significant travel, fuelling patterns of healthcare mobility that rarely feature in official statistics but which represent a structural aspect of the experience for many patients.

The differences become particularly evident when looking at waiting times for services. The data published in the profiles of the centres surveyed by the ISS show considerable variation even at the initial stage of patient intake. At the Policlinico Gemelli in Rome, access to psychological and psychotherapeutic services is reported to take around fifteen days, whilst endocrinology consultations take an average of one month. At the San Raffaele Hospital in Milan, reported waiting times range from fifteen to thirty days for the main multidisciplinary assessments. The ‘6ComeSei’ centre at Sapienza University of Rome indicates a wait of around twenty-eight days to begin psychological treatment. In other settings, however, waiting times are significantly longer. At Careggi, one of the country’s leading centres, the wait for psychological care can take up to five months, whilst those for endocrinology and psychiatry are around two months, and some genetic consultations can even take three months to be provided.

The route through Italia

This variability is not limited to waiting lists. The composition of the teams, the level of integration between the various professional disciplines, and the ways in which patients are supported throughout their care journey also vary. In the best-organised centres, patient care is delivered through a well-established multidisciplinary approach involving psychologists, psychotherapists, endocrinologists, geneticists, gynaecologists, urologists, sexologists and, where necessary, specialists in reproductive medicine. In other settings, the care pathway is more fragmented and requires the involvement of different services that are not always coordinated with one another. This organisational difference can affect not only the time taken, but also the continuity of care and the ability to support the patient through the various stages of their clinical journey.

From a financial point of view, however, services are generally provided through the National Health Service and are subject to the payment of a patient contribution in accordance with current regional regulations, subject to any exemptions. However, the direct cost of consultations represents only part of the overall financial burden borne by patients. For those living far from the main specialist centres, the need to travel entails additional costs relating to transport, accommodation and lost working days. Added to these, in many cases, is the need to use private healthcare services to reduce waiting times or gain quicker access to specialist professionals. These costs are difficult to quantify at a national level but contribute to making actual access to care less uniform.

Regional inequalities and data limitations

The picture painted by the ISS therefore reveals a system that has developed advanced clinical expertise but which continues to exhibit elements of organisational fragmentation. On the one hand, there are recognised centres of excellence, capable of offering comprehensive, multidisciplinary care pathways. On the other hand, there remains a strong dependence on the resources and organisational decisions of individual regions. This is a feature that partly reflects the historical differences in Italian regional healthcare systems, but which takes on particular significance in a highly specialised field such as gender affirmation. It should be borne in mind, however, that the picture presented by the ISS is incomplete. There is, in fact, a lack of comprehensive and consistent national data that would allow for a systematic description of the actual volumes of patient access, clinical outcomes and the overall duration of gender affirmation pathways. The available information derives mainly from the mapping of individual centres and organisational surveys, which in any case appear incomplete and do not yet allow for a fully standardised interpretation of the phenomenon.

Meanwhile, the skills base continues to grow. The National Institute of Health reports that it has trained around ten thousand healthcare professionals in activities relating to transgender people and associated care pathways. This figure demonstrates a significant investment in professional training and the dissemination of clinical knowledge. However, the development of expertise is progressing more rapidly than the establishment of a uniform network of services. The gap between these two processes currently represents one of the main organisational challenges for the National Health Service. We are talking about an imbalance that, more generally, calls into question one of the cornerstones of the public healthcare system, namely the ability to guarantee equal access regardless of place of residence. This is because, at present, the quality and speed of care provision continue to depend to a significant extent on the patient’s place of origin. And in a universal system, this is a difference that remains difficult to ignore.