Ten-year experience of a referral center for transgeneder and gender diverse children and adolescents in north-east of Italy

Background: In 2015, the APEVAGE clinic (Ambulatorio Pediatrico per la Varianza di Genere, Pediatric Clinic for Gender Variance) was established at the Institute for Maternal and Child Health “Burlo Garofolo” in Trieste. It is one of the few Italian centers dedicated to transgender and gender-diverse (TGD) childrens and adolescents. The clinic is run by a multidisciplinary team, including pediatric endocrinologists, psychologists, child psychiatrists, bioethicists, as required by Italian regulations for prescribing and reimbursing triptorelin. Additionally, the clinic provides access to a fertility specialist. Methods: Data were collected from individuals referred to the clinic from 2015 to 2024. Results: Eighty individuals have been evaluated, with referrals increasing over time (up to 21 new cases in 2022), showing no differences by assigned sex at birth (P = 0.432). The median age at first visit was 15.3 years (IQR 13.6–16.4; minimum 4.8 years), increasing significantly over the years (P=0.035). Thirty-one individuals (39%) were diagnosed with gender dysphoria (GD) according to DSM-5 criteria (required by Italian regulations for the prescription and reimbursement of triptorelin). Of these, 14 (45%) were referred directly to adult endocrinologists due to their proximity to 18 years of age. The remaining 15 (48%) started triptorelin at a median age of 16.7 years (IQR 16.0–17.2; minimum 14.5 years), with no significant differences between assigned sex at birth: 8 transitioned to gender-affirming hormone therapy (GAHT) after a median of 6 months (IQR 5–6; minimum 3) on triptorelin in pediatrics, 2 initiated GAHT directly with adult endocrinologists, 5 are still on triptorelin, either due to age below 16 or having started treatment recently. Two individuals recently diagnosed with GD are considering their next steps. Fertility preservation was discussed with 26 individuals with GD (83%), of whom 5 (16%) chose to conserve their gametes (3 assigned female at birth, 2 assigned male at birth). Conclusions: The APEVAGE clinic provides essential care for TGD minors, reflecting a growing demand for specialized services in Italy. Most individuals with GD began treatment with triptorelin, with many transitioning to GAHT. Fertility preservation discussions were integral, with a subset opting for gamete conservation. These findings highlight the importance of multidisciplinary care and the need for early access to services to support TGD youth effectively.