Starting the transition in Italy

Starting the gender transition in Italy can seem like an opaque and discouraging process. Information is fragmented, pathways vary from region to region, and healthcare bureaucracy does not help. This guide exists to offer a clear map: step by step, from the initial idea to the concrete beginning of the medical pathway. You do not need to know everything in advance. You just need to know where to start.

First of all: there is no single way to transition

Transition is a personal journey. Some people want hormone therapy and surgical procedures, others want only a change of documents, and still others choose an exclusively social transition — changing their name, pronouns, and how they present themselves — without any medical intervention. None of these choices is more or less valid than the others [1]. Transition is not a staircase with a mandatory starting point and endpoint: it is a set of decisions that each person makes based on what feels necessary for their well-being.

This guide focuses on the practical steps for those who wish to undertake a medical pathway in Italy, but the information about centers and resources is also useful for those who are still exploring their gender identity.

Step 1: the first contact

Contacting your general practitioner

The general practitioner (GP) is often the first point of contact with the healthcare system [4]. They can issue a referral for a specialist appointment at a gender identity center or direct you to the relevant local services. Not all GPs are familiar with these pathways, but they are obliged to provide a referral if requested.

If your GP is not aware of the reference centers or is uncooperative, you can contact the specialized centers directly, many of which accept patients even without a referral.

Contacting a specialized center directly

The most direct route is to contact one of the centers affiliated with ONIG (National Observatory on Gender Identity) or one of the public facilities mapped on Infotrans.it, the institutional portal created by the National Institute of Health (ISS) and UNAR [6]. These centers have multidisciplinary teams — psychologists, endocrinologists, psychiatrists, surgeons — specifically trained to accompany people on the gender affirmation pathway.

The first contact generally happens by phone or email. An intake interview is scheduled, during which initial information is collected and the center’s pathway is explained. This first meeting is not binding: it serves to get to know each other.

What to bring to the first appointment

No special documents are needed for the first interview. It is helpful to bring your health card and an identity document. If you already have psychological reports or previous medical records, you can bring them, but they are not a requirement.

Step 2: psychological assessment

What it is for

Italian protocols, in line with ONIG standards and WPATH SOC 8 recommendations [1][2], provide for a psychological assessment phase. It is important to clarify what this phase is not: it is not an exam to “prove” you are trans, it is not a process to obtain authorization, and it is not intended to question the person’s identity.

The psychological assessment has three main objectives:

1. Supporting the person in a conscious exploration of their pathway, helping them clarify desires, expectations, and fears.
2. Verifying the absence of untreated psychiatric conditions that could interfere with decision-making capacity (for example, active psychosis or severe untreated dissociative disorders). The presence of conditions such as depression or anxiety — extremely common in trans people due to minority stress — is not a reason for exclusion [1].
3. Drafting a psychodiagnostic report attesting to the condition of gender incongruence, which will be necessary to access hormone therapy and, subsequently, for legal rectification [10].

How it works

The assessment consists of a series of individual sessions with a psychologist or psychotherapist, generally on a weekly or biweekly basis. Some centers also include sessions with a psychiatrist and the administration of psychodiagnostic tests. It is not an interrogation: these are conversations about personal history, the relationship with one’s body, relationships, and expectations regarding transition.

How long it takes

The duration of the psychological phase varies significantly from center to center. In some centers the pathway lasts 6-8 months, in others it can reach 12 months or more. There is no fixed time established at the national level: it depends on the protocols of the individual center, the complexity of the individual situation, and, transparently, the workload of the teams. This is understandably frustrating, but the good news is that the psychological phase is not wasted time: it is an opportunity to build a relationship with the professionals who will follow the pathway in the long term.

What if I do not get along with the professional?

It happens. Not all therapeutic relationships work, and that is not a failure. You can ask to switch professionals within the same center or turn to another center. If you already have a relationship with a private psychologist specializing in gender identity, their report may be accepted by some centers as a substitute for or complement to the internal assessment.

Step 3: the main centers in Italy

Italy has a network of public centers offering gender affirmation pathways within the National Health Service [3][6]. Here are the main ones, with essential information for first contact.

Rome - SAIFIP (San Camillo-Forlanini)

The Service for Alignment between Physical Identity and Psychological Identity has been active since 1992 and is one of the most historic centers in Italy. It offers psychological assessment, individual and group psychotherapy, endocrinological and surgical support. It also has a Peer Navigator service, meaning people who have completed the pathway and help those starting out.

• Address: Maroncelli Pavilion, San Camillo-Forlanini Hospital
• Information desk: Monday 2:00-5:00 PM, Wednesday 9:00-11:00 AM
• Phone: 06 58703700 / 06 58702527
• Email: saifip@scamilloforlanini.rm.it

Turin - CIDIGEM (Molinette)

The Interdepartmental Center for Gender Dysphoria at the Citta della Salute e della Scienza University Hospital in Turin is a reference center for the Northwest. It offers psychological, endocrinological, and surgical support, including support groups for adolescents and parents.

• Address: Via Cavour 31, Turin
• Phone: 011 6333692
• Email: cidigem@cittadellasalute.to.it

Bologna - MIT Clinic

The Trans Identity Movement (MIT) in Bologna runs a clinic that operates in partnership with ONIG and offers psychological support, accompaniment for the hormonal pathway, and legal assistance. It is also a community and advocacy reference point.

• Address: Via Polese 22, Bologna
• Phone: 051 271666
• Hours: Monday-Thursday 10:00 AM-6:00 PM, Friday 10:00 AM-2:00 PM

Milan - Niguarda

The gender affirmation service at Niguarda Hospital is the reference center for Lombardy. It operates as an ONIG center and offers complete multidisciplinary pathways [3].

• Address: Piazza Ospedale Maggiore 3, Milan
• Phone: 02 64442034 / 02 64442176
• Hours: Monday-Friday 9:00 AM-3:00 PM

Naples - Federico II

Federico II University in Naples hosts a service dedicated to gender identity within the Department of Neurosciences, with psychological and clinical support.

• Address: Via S. Pansini 5, Naples
• Phone: 081 7463458

Bari - Policlinico

The Bari Policlinico offers a Day Hospital service for gender identity pathways, with a team that includes psychiatrists, psychologists, and endocrinologists.

• Address: Piazza Giulio Cesare 11, Bari
• Phone: 080 5478543 / 080 5594021

Other centers

In addition to the centers listed, active services exist in Florence (AOU Careggi), Padua (Con-Te-Stare association, ONIG center), Trieste, Palermo, and other cities. The complete and updated map is available on Infotrans.it and on the ONIG website [3][6].

Step 4: hormone therapy

How to access it

Once the psychological assessment phase is complete and the psychodiagnostic report is obtained, the next step — for those who desire it — is starting hormone replacement therapy (HRT). Within public centers, the prescription is made by the center’s endocrinologist, based on the psychological report and after a thorough medical evaluation including blood tests, hormonal profile, liver and kidney function, lipid profile, and other parameters [5][8].

HRT consists of the administration of testosterone (for transmasculine people) or estrogens and antiandrogens (for transfeminine people). Medications are available in various forms: intramuscular injections, transdermal gel, patches, tablets. The choice depends on the person’s preferences and the medical evaluation [5].

What to expect in the first months

Changes are not immediate. Hormone therapy acts gradually, and the first visible effects generally appear after 2-3 months [5][8]. For a detailed description of the physical changes, we refer to the article dedicated to medical transition. In summary:

• Testosterone: voice deepening (3-12 months), facial and body hair growth (6-12 months), fat redistribution, increased muscle mass, cessation of menstruation (2-6 months).
• Estrogens and antiandrogens: breast development (3-6 months, with full growth in 2-3 years), softer skin, reduced body hair growth, fat redistribution, decreased spontaneous erections.

Monitoring

HRT requires regular medical monitoring, especially in the first months [8]. Blood tests are performed periodically (every 3-6 months at the beginning, then annually) to check hormone levels and monitor liver function, blood parameters, and lipid profile. This monitoring is essential for the safety and effectiveness of treatment.

Costs: public and private

Public pathway (NHS)

Since October 1, 2020, thanks to AIFA rulings no. 104272/2020 and no. 104273/2020, hormonal medications for gender transition are fully covered by the National Health Service across all of Italy [7][12]. This means that, with a diagnosis of gender incongruence issued by a specialized multidisciplinary team, testosterone, estrogens, antiandrogens, and GnRH analogues are free.

Specialist appointments at public centers are subject to standard NHS co-pays (generally between 25 and 40 euros per visit, unless income-based exemptions apply). Blood tests for monitoring are also covered by the NHS with co-payment.

Gender-affirming surgical procedures (mastectomy, vaginoplasty, phalloplasty, and others) can be performed under the NHS at centers that offer them, with only the co-pay. However, waiting lists for surgery can be very long, even several years.

Private pathway

Those who choose the private pathway — due to waiting times, choice of professional, or other reasons — should consider the following approximate costs:

• Psychological sessions: 60-120 euros per session (weekly or biweekly)
• Private endocrinology visit: 100-200 euros
• Hormonal medications (without NHS coverage): 30-80 euros per month, depending on the type and dosage
• Private blood tests: 50-150 euros for a complete panel

It is important to know that the two pathways are not mutually exclusive: many people start the psychological phase privately to shorten timelines, and then access the NHS for hormone therapy and surgery.

The timeline: how long does it take

There is no single answer, because timelines depend on the center, the region, and the individual situation. Here is a realistic estimate based on the most common experiences:

Phase	Estimated time
First contact and waiting list	1-6 months
Psychological assessment	6-12 months
Start of hormone therapy	After the psychological report
First visible effects of HRT	2-6 months from the start
Legal rectification (court)	6-24 months from filing the petition

In total, from first contact to the start of hormone therapy, 8-18 months may pass in the public pathway. Timelines are significantly reduced in the private pathway. From first contact to legal rectification, the complete pathway can take 2-4 years, but it is important to remember that each phase brings concrete benefits: you do not need to wait for the end of the pathway to feel better.

Minors and adolescents

Puberty blockers

For adolescents at the beginning of pubertal development (Tanner stages 2-3, generally between ages 10 and 13), Italian protocols — in line with WPATH SOC 8 recommendations and Endocrine Society guidelines [1][8] — provide for the possibility of prescribing GnRH analogues (commonly called “puberty blockers”). These medications temporarily suspend pubertal development, giving the young person more time to explore their identity without the distress caused by unwanted bodily changes. The effect of blockers is reversible: if discontinued, puberty resumes normally [9].

Hormone therapy for adolescents

Cross-sex hormone therapy (testosterone or estrogens) is generally available starting at age 16, with the consent of parents or those exercising parental responsibility [8][9]. In some centers, it may be started at ages 14-15 in specific cases, always with the support of the multidisciplinary team and family consent.

Where to go

Not all adult centers also treat minors. The main pediatric and adolescent centers include SAIFIP in Rome, CIDIGEM in Turin, AOU Careggi in Florence, and the Niguarda Hospital service in Milan [9]. The updated list of centers for minors is available on the ONIG website.

The role of the family

Family involvement is an important part of the pathway for minors [1][9]. Many centers offer dedicated sessions for parents and support groups for families. The goal is not to convince parents but to build an informed dialogue. If the family is not supportive, centers can still offer listening and guidance to the minor, and associations such as AGEDO (Association of Parents of Homosexuals) and GenderLens offer specific resources for family members.

Common fears (and honest answers)

“What if I change my mind?”

This is an understandable fear, and it should be taken seriously. The reality is that the percentage of people who stop transitioning for reasons related to gender identity is very low (estimates vary between 1% and 5%, depending on the studies and the definition used). The psychological assessment phase also serves this purpose: to explore calmly, without rush. Nobody starts hormone therapy at the first appointment. And if at some point you feel the need to stop, that is your right. It is not a failure.

“I am not trans enough”

There is no right way to be trans. You do not need to have known “since forever” that you were born in the wrong body. You do not need to hate your body. You do not need to match a stereotyped image. Gender incongruence manifests in different ways for different people [1], and the exploration process is an integral part of transition itself. If you are reading this guide, you probably already have every reason to contact a center.

“I am afraid of others’ judgment”

Social judgment is real and can be painful. It makes no sense to minimize it. But it is also true that many people, once they start the pathway, report finding more acceptance than they expected — and above all finding a profound relief in finally living consistently with their identity. The support of a group, an association, or even just a trusted person can make an enormous difference.

“I cannot afford it”

The public pathway through the NHS is free or nearly so (with only co-pays). Hormonal medications have been covered by the NHS since 2020 [7][12]. If waiting times are a problem, many associations offer support with guidance and access to services. Free legal aid is available for legal expenses related to rectification, for those within income limits [10].

What to do if you live far from a center

Not everyone lives in Rome, Turin, or Milan. If the nearest center is hours away, here are some practical strategies:

• Teleconsultation: after the pandemic, many centers and private professionals offer psychological sessions via video call. They do not replace the entire pathway, but they can significantly reduce the number of trips needed.
• Combining public and private: you can start the psychological pathway with a private professional in your city (as long as they specialize in gender identity) and then present the report to a public center to access HRT through the NHS.
• Local associations: even in smaller cities, there are often LGBTQ+ help desks or associations that can offer guidance, listening, and accompaniment. The list of associations is available on Infotrans.it [6].
• Consolidating appointments: when you need to travel, it is helpful to ask the center to schedule multiple appointments on the same day or on consecutive days.

The distance from centers remains a structural problem of the Italian system, but it should not become a reason to give up on the pathway.

The importance of community

Starting the transition can be a moment of great solitude, especially if you do not know any other trans people. Getting in touch with the community — through associations, support groups, online forums, or simply meeting other people who have gone through a similar path — can make a decisive difference. Not to receive medical advice (that is what professionals are for), but to feel less alone, to share experiences, to see that it is possible.

The main national associations include MIT (Trans Identity Movement), Azione Trans [11], Arcigay and its local chapters, and AGEDO for family members. Many of these offer free listening help desks.

Where to start, concretely

If you have read this far and are wondering what the next step is, here is a concise list:

1. Identify the nearest center by consulting the Infotrans map or the ONIG website [3][6].
2. Call or write to schedule a first appointment. You do not need a diagnosis or absolute certainty.
3. Talk to your GP, if you feel comfortable, to get a referral.
4. Contact an association in your area for support and guidance.
5. Do not rush: the pathway is yours, and there is no right or wrong timeline.

The very act of seeking information is already a step. It does not matter if you do not have all the answers today. What matters is that in Italy there are professionals, centers, and resources designed to accompany you — and that you have the right to access them.