Experiences and narratives of mandatory psychological assessment in Trans and Nonbinary people: An Italian qualitative analysis.

Background: This study adopts a qualitative methodological framework to investigate the overall experiences of institutional gender affirmation pathway (GAP) with a focus on the narratives of mandatory psychological assessment in Trans and Nonbinary (TNB) people in Italy, who face daily discrimination, social prejudice, episodes of violence, and victimization. In the Italian context, psychological assessment is a prerequisite to receive a diagnosis of gender dysphoria, which is essential to access hormone therapy, surgical interventions, and legal change of name and gender marker.

Methods: The study employed a qualitative methodological design, since it allows a deep and flexible exploration of participants' experiences and perspectives. Specifically, the data collection technique consisted of semi-structured interviews with N = 21 participants. The corpus of data was analyzed consistently with thematic analysis and reflexive thematic analytic approach, for identifying, analysing and reporting patterns in data, allowing the corpus of data to be examined in terms of their principal themes, using both theory-driven (top-down) and bottom-up analytical strategies.

Results: Through the reflexive thematic approach, we generated two themes, further divided into sub-themes. The first theme is "Being trans + in our society" and it is composed by the following sub-themes: "personal experiences of identity affirmation"; "minority stress and transphobia"; "supportive familiar and working contexts", "institutional gender affirmation process"; "resilience and self-determination". The second theme, "Experiences of mandatory psychological assessment" is divided in: "disrespectful experiences"; "affirming and supportive interactions"; "to take better care". The results highlight how TNB individuals often experience significant stress related to their minority status and face discrimination in healthcare settings. Furthermore, there is a lack of individualization in the approach by healthcare providers and a shortage of knowledge about gender sensible topics among them. This study therefore highlights an insufficient provision of effective psychological support and the need to adopt more inclusive approaches, dismantling the pathologizing dimension of the diagnostic process for TNB people.

Conclusions: It is therefore crucial to promote awareness programs on gender identity issues to foster a more welcoming and informed environment in healthcare settings.

Trial registration: The study has been approved by the Ethics Committee of the University of Padua with unique number D120DC6FDC5DF2694CF281D76B2CDB41 and protocol number 5003.