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P. Bogetti, A. Cavalot, C. M. Crespi, G. Datta, A. Gualerzi, C. Manieri,

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

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P. Bogetti, A. Cavalot, C. M. Crespi, G. Datta, A. Gualerzi, C. Manieri,

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

  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 ,

  5. 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

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

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

  8. WELCOME MEETING • Inform on pathway • Collecthealth notes • Hand out brochures • Ensuresignedinformedconsent • Book the first appointment

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

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

  11. 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)

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

  13. 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

  14. Drop out

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

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

  17. 82 patients (90% coming from other regions)Cricotyiroid approximation with condroplastic surgery when required and possibleWaiting list for surgery: 18 months85% of successes 3 complications in a short-long term: all resolvedHospitalization: 24 hours in a double room OTORHINOLARYNGOLOGIST VOCAL CORDS SURGERY

  18. PLASTIC SURGEON: MAMMOPLASTY and GENITALS’ REVISION 10 patients MtF for mammoplasty3 patients MtF for genitals’ revsion (clitoris and labia)Waiting list for mastoplasty : 18–30 months1 complication, resolvedHospitalization: 1-2 days in a double room (for female)Waiting list for genitals’ revision: 12-18 mounths

  19. A D B C E 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

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

  21. MtF:10 cases access to the gynecological clinicThe 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.

  22. UROLOGIST 52 patients MtF10 patients FtMWaiting list: 24 months Patients in waiting list: 24 MtF ; 12 FtMHospitalization: 7 days in a single room Revisions for: 3 vaginal stenosys (ileovaginoplasty), 7 uretral meatus stenosys and 5 asimmetric labia majora and hipertrophic clitoris

  23. OPEN ISSUES • italianguidelines are strong based to the social and cultural environment • gender team works in a public hospital: waiting list and kind of servicesprovided • servicesprovided are hormonaltherapy, SRS, and, in some rare case, mammoplasty ; servicesnotprovided are laser and mammoplasty

  24. THANK YOU !

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