Being a transgender man today in Italy.
Two years have passed, amongst the people in limbo, like Dante said referring to one of the worst sins. But there’s no sin here, there’s only a bureaucracy that takes more than two years to recognise transgender people. This is considered wrong and an act of discrimination!
I met Elia, 24, near the coast of Latina not far from Rome. He started his path of transition almost two years ago; a year since he started taking testosterone. Elia suffers from gender dysphoria, he perceives himself as a man trapped in a woman’s body and has decided to go down the difficult path of changing his gender.
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Since he was a child, he felt like he was living in a body that didn’t belong to him, trapped by rules, clothes, habits, expectations and not fitting in to the ideas imposed by others. Elia didn’t know who he was anymore. He didn’t understand why he felt so different from others and why they made him feel like something was wrong with him.
He couldn’t find any answers, he didn't know how to talk about something he couldn’t fully comprehend. As adolescence approached, his discomfort towards his body increased. He couldn’t go to the seaside without feeling anxious about showing his body; he felt detached from his body and no longer recognised it as a part of him. Today, when Elia is at the beach, he wears a t-shirt, as his journey of transition continues. Even though his body does not fully represent him, he realises his body does belong to him and is worthy.
He looked for answers to his doubts online: he found vague, wrong, unfair, offensive answers. He talked to psychologists, he read books, thought a lot, always alone, looking for a reason. He didn’t know what trans people were and thought they were selling their bodies. Then online he found Teo, a transgender like him, FtoM(female to male)- from being a woman he became a man. Teo gave Elia the strength, the inspiration, the help and especially the answers to the questions: who am I? Why am I different? Today, Elia and Teo know each other in real life, and they are, like Elia, said, “something crazy that makes me laugh”- they idolise one another.
“I’d like to live the adolescence I haven’t lived, that’s how I live now on my path of transition. I’ve been forced to go through a very hard adolescence; since I was a child, I felt and I knew I was different. Nowadays, there is a debate on this topic and on these drugs that affect teenage development, but not many people are talking about it.”
What happens today in Italy to a transgender person?
Elia told me his experience, that started from Googling “what should I do to become a transgender person?”. But first he wanted to point out that, in order to be considered a trans person, you don’t need to start a transition journey. Not all trans people take hormones and want to undergo a medical procedure to change their bodies, but they should know that they are equally valid as humans. Society reflects an idea of transgender people that does not represent everyone, because every individual is different. Elia, for example, has longer hair and loves to wear nail polish, but that won’t make him less trans. It’s simply Elia.
The transition path starts with a psychological evaluation from specific experts on gender dysphoria; they should be experts because it’s fundamental to be sure that the person who wants to undergo this transition path really suffers from gender dysphoria and not something else (like borderline personality or bipolar disorder). It’s a path which involves hormones and surgical procedures, where there’s no way back.
The psychological evaluation period varies from person to person, starting from a minimum of six months. Then you need to pass a test in order to be sure that the person is really dysphoric and to get the approval in order to keep going.
In Italy, the cost of this evaluation depends on which region you are in - for some of them it’s free. In Rome, each session costs €30 and you could attend it once or twice a week.
And here we have a crucial problem: bureaucracy. In theory, once you’ve done the evaluation and the test, you should get the result that gives you the certificate of your status, in a short time, but it’s not like that. Elia had to wait for 4 months - “unlucky him,”he said, because there was summer break in between. In the end he was kept in suspense for 4 more months. And he discovered he was not the only one that experienced an inexplicably long waiting.
Finally he got the results: positive. The next stage was a medical evaluation; but the rules are a blur and there is a lack of accurate information - Elia didn’t expect that. Medical evaluation is fundamental, especially from an endocrinologist, if you want to start hormonal therapy. That’s how another long procedure started, waiting many months for a hospital date.
One year has passed, one tough year, especially from a psychological point of view (and add it to all those years where he had to find his own identity), and finally Elia got all the paperwork he needed to start taking testosterone and see his body transform. To be clear, if a transgender person wants to go from male to female, we are not talking about testosterone but oestrogen; the path you need to start is the same. In order to get the medical and psychological certificate, the forecasted cost will be around €500 (if you fit in, you could get an exemption).
If you want to, the last step in this path is the operation. In Italy, you should take testosterone for at least 6 months before accessing the waiting list for the operation and it could take many years to get everything done. Phalloplasty in Italy is part of the state-run health care but many techniques are not available in Italy or suitable for everyone. If you are looking for a specific technique and you do it in another country, this may cost you up to €30.000.
At this point I thought that the hardest part was behind us, but Elia told me about the strange case of testosterone in Italy.
There are different kinds of testosterone, in different formats. It’s fundamental to follow the instructions from the endocrinologist, not only about the dose but also the specific name and kind of drug, besides the timing for the administering. These hormones have a big physical impact on your body, but also on the psychological side, and will be very careful and meticulous in getting this treatment. Despite AIFA (the national association which provides drugs in Italy) says that testosterone is available throughout Italy, many pharmacies in the south of Italy don’t have it and try to avoid requesting more. Some of them refused to sell it or order it when Elia asked to and they invented excuses about the prescription (that was totally fine).
So maybe there’s an emergency linked to the drug distribution and Elia suspects it’s something related to the south of the country, because he received many messages from other transgender people from the north that say there’s no problem in getting testosterone. Maybe the issue is linked to distribution and to profit. In fact, testosterone is very expensive, but the price varies from place to place, rising and falling from €45 to €100 for the same kind. And this is a drug you have to take for your entire life.
This doesn’t seem a good enough reason for drugstores to stock up to guarantee Elia and many other people the supply they need. This problem forced Elia to change the kind of testosterone twice and stop the treatment for a few days. If you were met with the same issue, please write a direct message to Elia, who is trying to find out what’s going on and solve the problem.
However, there is some positive change we can celebrate. From the 1st of October 2020, all around Italy, drugs for gender transitions changed classification and became free for anyone who has gender dysphoria or gender incongruity diagnosis.
Elia now has a certificate of transition. He started to acquire masculine traits and everyone calls him Elia, the name he chose. But, after many years, he will still be Nobody to many people. In Italy, people like Elia are legally “in limbo”, still linked to the legal identity they had when they were born. Documents do not match the identity Elia has now, his driving license still has the name and photo from when he was 18. How should he drive? Travel? Vote? How should he live these years and work? Transgender people experience heavy discrimination, because too often people hide behind legal quibbles and the longest bureaucratic timing in order to not give these people the identity they chose and have the right to claim.
Elia also wrote two books linked to his experience and after finding written on his car one night “f*cking trans you’re dead” (before he came out). He created the program “Amore e Movimento” (“Love and Movement”) to fight transphobia with education and love. A project that he’s trying to spread as much as possible and would like to bring to schools, not only to educate kids but also to help people who found themselves in a place where he was, not more than 6 years ago.
“I’ll remember forever this image: at the seaside, a mother covered his son’s eyes (he was smiling at me) after she knew I was a trans man”.