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Health

Lgbtq+, from research to healthcare discrimination

According to Arcigay's survey, 30% of transgender people reported negative experiences with their GP.

by Ilaria Potenza

28 June 2025

5' min read

Key points

European data
Gender identity affirmation course
Training shortage
The regulatory framework
Out of Europe
Exclusion costs

5' min read

Sexual orientation and gender identity are clinically invisible in the international health care setting. This is shown by a study published last year in The Lancet, which highlights how systemic discrimination, social prejudices and organisational gaps contribute to poorer access to care and health outcomes for LGBT+ people.

In fact, medical practice continues to revolve around the paradigm of a patient - male, cisgender, heterosexual - on which protocols, diagnostic tools, languages and treatment paths are constructed. For those who do not correspond to this model, access to health services may mean encountering obstacles, delays, misunderstandings or renunciations. This issue particularly concerns transgender and non-binary people, who in Italy are confronted with an almost total absence of public policies dedicated to their health. The first data on the health status of the adult transgender population in Italy, published by the Istituto Superiore di Sanità in 2022, showed, for instance, that in our country rates of depression among transgender people are higher than those of the general population: between 40% and 60% report clinically significant symptoms, against a national average of between 4% and 7%. Adherence to cancer screening is also very low: only 20% of transgender people assigned female at birth regularly undergo a Pap test, compared to 79% among cisgender women. Moreover, 46% of trans people claim to have experienced discrimination when accessing health services.

A barrier that is not only social, but clinical. The same study points out that, in addition to material barriers, there is a widespread distrust of the system, a reluctance to seek treatment for fear of being judged or rejected.

European data

At the European level, the picture does not change much. According to the European Union Agency for Fundamental Rights (FRA), 16% of LGBT+ people have experienced at least one incident of discrimination in the health sector. In the case of transgender people, the percentage rises to 34%. In Italy, the 'Vite ai margini' survey conducted by Arcigay on a sample of more than 5,000 Lgbtq+ people confirms this trend: 38% of transgender people reported hostile experiences with health professionals, while almost a quarter of the total actively avoided contacting doctors or health facilities for fear of prejudice. In the field of sexual prevention, the availability of PrEp - HIV pre-exposure prophylaxis - is another example of systemic shortcomings. Although it was introduced in the National Health Service in May 2023, it is now accessible in fewer than 30 public centres, mainly concentrated in large cities. Outside metropolitan areas, access is hampered by additional costs and a shortage of trained personnel. Even injectable cabotegravir, an innovative preventive treatment for HIV, is only available in a few experimental facilities, leaving much of the country uncovered.

Gender Identity Affirmation Path

One of the areas where inequalities emerge most strongly is that of gender affirmation pathways. In Italy, there are only nine active public centres, in Bari, Bologna, Turin, Trieste, Naples, Rome, Torre del Lago and Florence. Just in Florence, the centre of the Careggi hospital has seen a net increase in requests, from 60 visits in 2022 to 150 in 2023. The average age of first visit is around 14-15 years.

The Tuscan centre offers a multidisciplinary pathway consisting of psychological, psychiatric, endocrinological and social consultations. The services are covered by the co-pay, but the waiting lists remain long: six months for the first psychological examination, the same for the endocrinological one. Surgeries - vaginoplasties, scrotoplasties, hysterectomies - are scheduled with times ranging from 18 to 24 months.

At Careggi, in the two-year period 2021-2022, sixteen vaginoplasty operations, six hysterectomies and two scrotoplasties were performed. The centre is considered a public excellence, but many other areas do not even offer a specialised access point, forcing people to travel hundreds of kilometres or turn to private facilities.

Testimonies collected through forums and online groups on social networks confirm the fragmented nature of the system. Some users recount waits of over a year to obtain a diagnosis, up to four or five years for surgery. Others report the need to turn to the private sector to speed up the time, with often unaffordable costs.

In the absence of public pathways, there are those who start hormone treatments on their own or turn to clinics abroad in order to start a process that is deemed urgent and necessary.

Training deficiency

The lack of trained personnel is one of the main causes of these difficulties. No degree course in medicine, nursing or psychology in Italy provides compulsory modules on LGBT+ health. Continuing education is left to the personal initiative of professionals, with uneven outcomes. The lack of preparation generates uncomfortable situations for patients: errors in the use of pronouns, refusal to prescribe drugs with the patient's name of choice, reticence in following courses already started. According to Arcigay's survey, 30% of transgender people reported negative experiences with their GP.

The regulatory framework

In the European panorama, Italy appears to be lagging behind. In France, the health system has official protocols for accompanying transition. In Spain, the 'ley trans' (tarns law, ed.) of 2023 introduced self-determined paths, the elimination of the obligation of psychiatric diagnosis for gender change and a specific public health network. The Council of Europe has repeatedly called on Italy to close this gap, urging disaggregated data collection, the introduction of compulsory training and the creation of territorially distributed pathways.

Out of Europe

There are also significant differences outside Europe. In the United States, the Trump administration has in recent weeks revoked numerous health protections for transgender people: funds for research projects of the National institutes of health have been cancelled, prevention programmes blocked and anti-discrimination initiatives in the federal health care system removed. The American medical association has documented a 15% increase in transgender people dropping out of care.

The costs of exclusion

In the current context, talking about LGBT+ health in Italy means addressing a structural paradox that is revealed in the formal existence of a public and universal health service

which, in fact, excludes those who do not fit into the dominant models of medicine. This is not just a cultural gap, but an organisational and political problem. Without systematic data collection, without mandatory training for health personnel, without a national network of equitable and accessible services, inclusion remains an abstract statement.

The costs of this exclusion fall not only on those affected, but on the entire system. Inequalities are exacerbated, social costs are raised, and trust in the public service is distorted. Yet solutions already exist. Other European countries have introduced national guidelines, self-determination paths, compulsory academic training, widespread access to prevention. The most advanced Italian experiences - such as the Careggi centre in Florence - show that a competent and inclusive public system is not only possible, but is already in operation, albeit in an isolated manner. What is needed is the consistent application of rights through structural and coordinated choices. The National Health Service can no longer afford the illusion of universality if it ignores those who do not fit the patient model on which it was built. Making people's identity and orientation visible in health pathways is neither a concession nor an exception: it is an institutional duty and a systemic necessity. Inclusion is not an aesthetic addition, but a criterion of efficiency, prevention, sustainability. Universality is built in the details: in the data collected, the university forms, the up-to-date tax codes, the waiting rooms, the hormone therapies prescribed without hesitation. Universality, in healthcare, is measured by who actually manages to access it. And by who is still left out.