The Careggi case: timeline and facts

For years, Careggi hospital in Florence was Italy’s leading center of care for adolescents with gender dysphoria and their families. Thanks to a multidisciplinary team of endocrinologists, psychologists, psychotherapists, and psychiatrists, the Florentine center followed hundreds of young patients, earning a reputation for excellence recognized nationwide. Starting in January 2024, a series of events — a parliamentary inquiry, a ministerial inspection, a prosecutor’s investigation, and an increasingly heated political debate — turned Careggi into the symbol of a battle that extends far beyond the hospital walls. This is the timeline of events.

Careggi before the controversy: a center of excellence

The origins of the service

The gender incongruence clinic at Careggi hospital was established in 2005, within the Department of Sexology and Andrology, as a service dedicated to adults with gender incongruence [1]. In 2014, in response to growing demand from families with adolescent children, the center launched a dedicated pathway for developmental-age patients. This became the clinic for atypical gender identities in developmental age, one of the very few Italian facilities specializing in the care of minors with gender dysphoria.

The team and working model

The center was distinguished by an integrated multidisciplinary approach. The team comprised endocrinologists, clinical psychologists, psychotherapists, and psychiatrists working in close collaboration. Among the key figures, psychologist Jiska Ristori and endocrinologist Alessandra Fisher became essential points of reference for families, with scientific oversight by Professor Mario Maggi, director of the Endocrinology Service.

In 2018, the Tuscany region established the CRIG (Regional Coordination Center for Health Issues Related to Gender Identity), assigning its coordination to Careggi through regional resolution no. 907 of August 6, 2018. It was the first regional coordination center dedicated to gender identity in Italy [4].

Triptorelin and the AIFA ruling

Understanding the Careggi case requires knowledge of the regulatory framework. In 2019, with ruling no. 21756/2019, AIFA (the Italian Medicines Agency) included triptorelin — a GnRH agonist that temporarily suspends pubertal development — in the list of medications fully covered by the National Health Service for minors diagnosed with gender dysphoria [12].

The ruling established that prescription could only occur after evaluation by a multidisciplinary team comprising a child neuropsychiatrist, psychologist, endocrinologist, and bioethicist, and only when psychological, psychotherapeutic, and psychiatric support had proven insufficient. A key point, as will be seen, concerned the interpretation of the term “psychiatric support”: the AIFA ruling used ambiguous wording that left room for different interpretations of what must necessarily precede drug prescription [2][3].

Triptorelin had already been used for decades in pediatrics to treat precocious puberty. Its use in gender dysphoria is intended to temporarily suspend puberty, giving the young patient and their family time to make an informed decision while reducing the distress caused by the development of sex characteristics incongruent with perceived gender identity.

Timeline of events

December 18, 2023: the Gasparri inquiry

The Careggi case officially began on December 18, 2023, when Senator Maurizio Gasparri, leader of Forza Italia in the Senate, filed a parliamentary inquiry addressed to the Prime Minister and the Health Minister. In the inquiry, Gasparri alleged that at Careggi hospital, triptorelin was being administered “to 11-year-old children without any psychotherapeutic or psychiatric support” and that the hospital lacked an adequate child neuropsychiatry service [2][7].

The inquiry explicitly referenced the 2019 AIFA ruling, claiming Careggi was not following its procedures. Gasparri asked the government to verify the facts and intervene.

January 23-24, 2024: the ministerial inspection

The Ministry of Health’s response was swift. Under orders from Minister Orazio Schillaci, an inspection team was sent to Careggi on January 23 and 24, 2024. The inspectors were tasked with verifying “the pathways for the treatment of gender dysphoria in minors and the use of triptorelin” [2].

During the two-day inspection, the team reviewed documentation for 85 cases of minors followed by the center in previous years. It interviewed clinical staff and the hospital administration. The hospital provided detailed data: in 2023, 26 prescriptions of triptorelin had been made out of approximately 150 outpatient visits, and the average age of treated patients was about 15.2 years — very different from the 11 years claimed by Gasparri [2].

January 31, 2024: the response from scientific societies

While the inspection was still ongoing, twelve Italian scientific societies signed a joint statement titled “Stop Disinformation” [5]. The signatories included the Italian Society of Endocrinology (SIE), the Italian Society of Pediatric Endocrinology and Diabetology (SIEDP), the Italian Society of Child and Adolescent Neuropsychiatry (SINPIA), the National Observatory on Gender Identity (ONIG), the Italian Society of Andrology and Sexual Medicine (SIAMS), and others.

The statement declared that triptorelin is “a life-saving drug for very young transgender and gender diverse people, prescribed only after careful multiprofessional assessment,” and that its purpose is not “to chemically castrate or alter sexual orientation and identity,” but “to give suffering young people and families time to make mature, considered choices, preventing social stigma, self-harm, and suicide” [5].

March 2024: the Florence prosecutor’s investigation

On March 2, 2024, it emerged that the Florence Prosecutor’s Office had opened an exploratory file on the Careggi case, based on documentation transmitted by the ministerial inspectors. Chief Prosecutor Filippo Spiezia confirmed that magistrates were “evaluating” the report to determine whether any criminal issues were present [13]. The investigation had no suspects or defined criminal hypotheses: it was a preliminary fact-finding exercise.

April 6, 2024: the inspection results

The official inspection results were released on April 6, 2024, when Minister Schillaci formally responded to Gasparri’s parliamentary inquiry. The inspection report found “very significant critical issues in the pathway of care and management” of patients with gender dysphoria, “including with regard to the use of triptorelin pharmacotherapy” [3][4].

The main findings fell into three categories:

1. Non-compliance with AIFA ruling no. 21756/2019: in some cases, triptorelin had been prescribed without the patient having been examined by a child neuropsychiatrist, as required by AIFA procedures [3][4].

2. Failure to transmit data to AIFA: the hospital had not reported clinical monitoring data for treated patients to the Agency, preventing the oversight required by regulations [3].

3. Organizational issues: deficiencies in organizing the role of the child neuropsychiatrist within the care pathway [3][4].

The Ministry issued eleven recommendations to the Tuscany region, including: ensuring that all cases without exception are seen by a child neuropsychiatrist; urgently producing detailed diagnosis and care procedures; strengthening staff with additional psychologists and psychotherapists; transmitting overdue clinical monitoring data to AIFA; improving clinical record documentation [4][14].

The Tuscany region was given 30 days to respond and 90 to adjust its procedures.

The reaction from Careggi and the Tuscany region

The Tuscany region strongly contested the way results were communicated, calling it “disturbing” that the report’s contents had been leaked to the press — and to Gasparri himself — before the region had even received an official copy [4]. According to the region, the report was transmitted on April 3, but press coverage had already circulated the day before.

On the substance, the region reiterated that the service was not being suspended and that the Ministry’s requested corrections would be implemented. Careggi hospital confirmed its intention to continue the gender incongruence care pathway and announced the inclusion of a child neuropsychiatrist in the multidisciplinary team [14].

However, the Ministry’s report specified that “the activity is not being halted, only some corrective measures are being required” [14]. This is an important clarification: formally, the center was not shut down.

The impact on families

The slowdown in services

Although the center was not closed on paper, in practice things changed profoundly. According to numerous accounts collected by journalists during 2024 and early 2025, the service experienced a dramatic slowdown, to the point of being intermittently paralyzed [1][6].

New patients are no longer being accepted. Those already in care report months of waiting for visits that were previously scheduled regularly. Families describe a “limbo” situation: pathways are not formally interrupted, but in practice they are not progressing [1].

The departure of key figures

During 2024-2025, two of the center’s most important professionals left the service. Psychologist Jiska Ristori, a historic point of reference for families, resigned. Endocrinologist Alessandra Fisher, while continuing to work at Careggi in the Andrology Department, is reportedly no longer available for patients in the dedicated public gender dysphoria pathway, according to several families [1].

The clinics dedicated to gender dysphoria patients were also moved to a more secluded area of the hospital [1]. Many parents state that Ristori and Fisher “saved many lives” [1].

“Let us exist”

The families’ plea crystallized in the slogan “Let us exist” (“Lasciateci esistere”). Through accounts shared publicly in the media, parents like Silvia, mother of a transgender girl who had been in care at Careggi for years, described the importance the center had in their children’s lives and the desperation caused by the blocking of care pathways [6].

Families emphasized that triptorelin, far from being an imposed treatment, represented in many cases the only way to reduce depressive states, suicidal risk, and self-harming behaviors in young people with gender dysphoria. The halt in services did not stop gender dysphoria: it stopped the treatment [6].

The protest outside AIFA

On May 23, 2024, parents and adolescents from the association Affetti oltre il genere (“Bonds Beyond Gender”) symbolically chained themselves outside the AIFA headquarters in Rome, in a peaceful protest against the technical panel established by the Ministries of Health and Family [11]. About ten people, including six parents with adolescent children, participated in the protest. Some adolescents wore T-shirts reading “Ask me if I’m happy” [11].

The demonstrators denounced the fact that the technical panel did not include any representative from transgender organizations or families of minors with gender incongruence, and that the government initiative disregarded available scientific evidence [11].

The political context

The interministerial technical panel

In May 2024, Ministers Orazio Schillaci (Health) and Eugenia Roccella (Family, Birth Rate, and Equal Opportunities) established a technical panel at the Ministry of Health’s Cabinet Office, composed of 29 members including experts and institutional representatives [7][8]. The panel included officials from both ministries, physicians, and representatives from various scientific societies (SIEDP, SIAMS, SINPIA, SITCC, SIPS, SIGO, SPI, SIP, SIGIS, SIE).

The mandate was twofold: to survey how gender dysphoria is treated in minors across the country and to reexamine the international scientific literature in light of shifts in approach in other countries, such as the United Kingdom following the publication of the Cass Review [8].

Associations and family groups of transgender people criticized the panel’s composition as unbalanced and not inclusive of the direct voices of patients and families involved [11].

The National Bioethics Committee opinion

On December 16, 2024, the National Bioethics Committee (CNB) published a response to the query posed by the Ministry of Health regarding the use of triptorelin in the diagnosis of gender dysphoria [9][15]. The opinion, approved by a large majority with only one dissenting vote and two abstentions, highlighted:

• The insufficiency of scientific data on the use of puberty blockers and the need to strengthen research through independent clinical studies funded by the Ministry of Health [9].

• The recommendation that puberty blocker prescriptions should occur “only in an experimental context,” in line with the shifts in approach adopted by other European countries [9][15].

The opinion was welcomed by political forces favoring more restrictive regulation, while scientific societies and family associations criticized it as a step backward from the 2019 AIFA ruling.

The Gender Dysphoria Bill

The Careggi case directly contributed to the genesis of Bill 2575, known as the ”Gender Dysphoria Bill,” approved by the Council of Ministers on August 4, 2025 at the proposal of Ministers Schillaci and Roccella [10]. The bill introduces:

• Mandatory diagnosis by a multidisciplinary team with documentation of prior psychological pathways.
• A national AIFA registry for drug prescriptions and dispensing, with data transmitted to the Ministry every six months.
• A mandatory preliminary opinion from the national pediatric ethics committee for drug administration.
• Exclusive dispensing through hospital pharmacies [10].

Associations and scientific societies harshly criticized the bill, arguing that the national registry amounts to a “cataloging” of transgender minors and that the complexity of the required bureaucratic steps risks making care inaccessible in practice [10].

The underlying issue: what the inspection actually found

It is important to distinguish between the media and political narrative of the case and the facts contained in the inspection report. The inspection did not challenge the use of triptorelin itself, nor did it determine that treatment was clinically inappropriate [3][14].

The issues identified were procedural and organizational in nature: the lack of neuropsychiatric consultation in all cases, the failure to transmit monitoring data to AIFA, and deficiencies in clinical documentation. These are formal violations of the AIFA ruling, not judgments on the effectiveness or safety of treatment.

The Ministry’s report did not order the center’s closure, did not suspend the ability to prescribe triptorelin, and did not challenge the gender dysphoria diagnoses of the patients being followed [14]. It requested procedural and organizational corrections, to be implemented within 90 days.

However, the real impact goes far beyond the written recommendations. The climate of political and media pressure, the opening of a prosecutorial file, and the departure of key figures produced a deterrent effect that has made the center essentially inoperative for new patients [1].

Current state of affairs (early 2026)

At the time of publication of this article, the situation at Careggi remains characterized by great uncertainty:

• The gender dysphoria center formally exists, but has not accepted new underage patients for over a year [1].
• Patients already in care report extended wait times and difficulty accessing appointments [1].
• Jiska Ristori has left the center. Alessandra Fisher still works at Careggi but, according to families, no longer follows patients in the public gender dysphoria pathway [1].
• The Gender Dysphoria Bill is under review by the XII Social Affairs Committee of the Chamber of Deputies. Hearings were held between November and December 2025, but the text is still being discussed [10].
• The outcome of the Florence Prosecutor’s investigation has not been publicly disclosed.
• The interministerial technical panel completed its work, the results of which fed into the drafting of the bill [7][8].

Other centers in Italy

Careggi’s slowdown has made the fragility of Italy’s network of gender dysphoria centers even more apparent. The main centers that continue to operate include:

• SAIFIP (Service for the Alignment of Physical and Psychological Identity), at San Camillo-Forlanini hospital in Rome. It is the historic national reference center, active for both adults and minors.
• CIDIGem (Interdepartmental Gender Dysphoria Center), at the Molinette hospital in Turin (AOU Citta della Salute e della Scienza). It offers pathways for adults and dedicated clinics for minors with support groups for adolescents and parents.
• The center at San Paolo hospital in Milan.
• Clinics and services in various other cities, cataloged on the Infotrans.it platform of the National Institute of Health.

However, these centers also operate in a climate of increasing regulatory uncertainty. The Gender Dysphoria Bill, if approved in its current form, would introduce new procedures and restrictions affecting all centers nationwide, not just Careggi.

A timeline to remember

Date	Event
2005	Careggi’s gender incongruence clinic is established (adults)
2014	The dedicated pathway for minors is launched
2018	Establishment of CRIG (regional coordination center, Tuscany)
2019	AIFA ruling no. 21756: triptorelin covered by the National Health Service for gender dysphoria
December 18, 2023	Gasparri’s parliamentary inquiry on Careggi
January 23-24, 2024	Ministerial inspection at Careggi (85 cases examined)
January 31, 2024	Joint statement from 12 scientific societies: “triptorelin is life-saving”
March 2, 2024	Florence Prosecutor’s Office opens an exploratory file
April 6, 2024	Schillaci announces inspection results: “significant critical issues”
April 2024	Eleven recommendations from the Ministry to the Tuscany region
May 15, 2024	Establishment of the interministerial technical panel (29 members)
May 23, 2024	Parents chain themselves outside AIFA headquarters in Rome
December 16, 2024	CNB recommends triptorelin use only in an experimental context
August 4, 2025	The Council of Ministers approves the Gender Dysphoria Bill
Early 2026	Careggi is not accepting new underage patients; bill in parliamentary committee