The Italian Government is considering restricting the use of puberty-blocking drugs in transsexual minors. The Ministries of Health and Family have launched a joint technical table that will be completed in the coming days with multidisciplinary experts to study the use of triptorelin, a medication that blocks the production of sex hormones and is used to delay changes in puberty in transsexual adolescents.
The objective, as explained by the ministers in a statement, is to develop specific regulations, since currently in Italy there is a kind of legal vacuum regarding the use of these drugs for this specific indication, different from the one for which it was approved. . The heads of Health and Family, respectively Orazio Schillaci and Eugenia Roccella, have explained that they have made the decision to delve deeper into this issue, driven by new scientific literature and by “the experiences of other countries that, after having promoted a wide practice of these drugs, are reviewing their positions”, such as the United Kingdom, Sweden or Finland, which have recently limited this type of therapies. Although in any case these drugs are prescribed only by doctors, there is no binding protocol that establishes in which cases hormonal therapies can be prescribed for minors and how, according to some parliamentarians. There are only recommendations from different organizations such as the Italian Medicines Agency. The most recent are from 2018.
In recent months, the Ministry of Health, which has responded to the request of the National Bioethics Committee to reexamine the issue of the use of triptorelin in minors, has received reports from the main scientific societies involved in the issue of gender incongruence in adolescents. , an expression used by the WHO to refer to transsexuality without the pathological burden of gender dysphoria, which until 2018 was classified as a disease.
The use of hormone blockers in adolescents is the subject of controversy in several countries, in an issue in which scientific debate is often mixed with ideology. In Italy, where an ultraconservative coalition governs, harshly criticized in recent months by LGTBI associations, the debate on the use of these medications and the rights of
trans
minors are still incipient.
Triptorelin, a drug originally intended for the treatment of prostate cancer, was used in Italy until 2018 to block puberty in trans minors only when families fully covered the price of the drug. That year, the National Bioethics Committee accepted the use of the drug in trans adolescents only "under a criterion of prudence, in carefully selected situations that must be evaluated case by case" and taking into account a series of recommendations: that the diagnosis and the proposal of treatment came from a multidisciplinary and specialized team, that the treatment was limited to cases in which other psychiatric and psychotherapeutic interventions had been ineffective, and that it included signed consent from the minor and his parents. In 2019, the National Health System began to cover the full cost of the drug, despite the numerous criticisms it received, especially from the most conservative Catholic groups.
The Italian Society of Psychoanalysis has written to the Government to express its “great concern” and “strong perplexity” over the use of puberty blockers. "The diagnosis of 'gender dysphoria' in prepubertal age is based on the statements of the affected subjects and cannot be the subject of a meticulous evaluation while the development of sexual identity is still in progress," notes this association of professionals, the main and oldest in the sector in Italy, also recognized internationally. And he warns that "only a minority of minors who declare that they do not identify with their sex confirm this position in adolescence, after puberty." It also warns that "suspending or preventing the psychosexual development of a subject, while waiting for the maturation of a stable identity definition, contradicts the fact that this development is a central factor in the definition process."
The first step of the ministers has been to ask the regions, on which most of the responsibilities in health matters fall, to prepare reports to know in how many cases triptorelin has been prescribed and to carry out clinical monitoring. They have also asked the Italian Drug Agency to review the therapeutic indications for the administration of the drug in question. With the information obtained, the Executive will also study the elimination of triptorelin from the list of medications administered by the National Health Service.
Until now, the agency was limited to recommending that puberty blockers be provided in cases of gender incongruence under the control and monitoring of psychologists or psychiatrists.
The Government's initiative has become known just after the Florentine Careggi hospital, one of the few centers that care for minors with gender incongruence, has been the subject of a Health inspection. In addition, the prosecutor's office is also investigating the center's practices. Last December, Maurizio Gasparri, spokesman in the Senate for the conservative Forza Italia party, part of the government coalition, sent a parliamentary question in which he claimed that he had received information that triptorelin was administered in this hospital without respecting the procedures indicated by the Italian Drug Agency, which provide for a psychotherapeutic course before hormonal therapy.
The Ministry of Health has clarified that the inspection “does not have any punitive intention, but rather an on-the-ground knowledge of the guidelines that are being carried out.”
At 15 years old
The Careggi hospital has sent a detailed report to the ministry in which it talks about very small numbers and complex and supervised procedures. The regional administration of Tuscany, where the medical center is located, has contributed some data to the report: in 2022, the Regional Center for Gender Incongruence recorded 60 accesses and 18 prescriptions for puberty blockers; in 2023, the numbers rose to 150 and 26, respectively. The average age of people who access the service is 14.8 years, and of those who receive the drug, 15.2.
The report specifies that the drug is only administered to adolescents already in puberty, and not to children, and explains that at Careggi the psychological evaluation of minors who come to their consultation is not carried out in depth because a psychologist in another center in the region It evaluates over several sessions over a year whether the patient meets the diagnostic criteria for gender incongruence.
After the inspection at Careggi, the parents of the GenderLens association, which deals with “creative gender” and transsexual minors, have expressed their concern and fear that hormonal therapies and treatments will be interrupted and that their children, “who have finally found the right path”, may be abandoned. Some families have explained that they have already traveled to Spain to “make sure that, no matter what happens, they will be able to start hormonal treatments” there, to give their children “the peaceful future they deserve.”
The ministries involved have wanted to calm the families of trans minors and have assured that the concerns they have expressed are “completely unfounded” and have alleged: “Experts with high and recognized scientific qualifications will participate in the inter-ministerial technical table and will be able to provide cognitive elements to offering guarantees to minors and ensuring the appropriateness of therapies, elements that we are sure are important for everyone.” They have also reaffirmed that "it is not only necessary, but also urgent, to carry out a review of both the scientific literature and the procedural, regulatory and legislative changes that have occurred abroad" in reference to the countries that have restricted the use of puberty blockers.
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