[:en]Dear Minister,
We hereby intend to bring to your attention several serious issues that prevent transgender people from exercising their right to health as recognized by Article 32 of our Constitution.
Already the subject of a specific parliamentary question presented by the Honorable Rossella Muroni (question no. 4/02468 of March 12, 2019), a first issue concerns the accessibility of hormone therapy. Hormone therapy is vital in protecting the psychological and physical integrity of transgender people: its interruption leads to an alteration in the balance between testosterone and estrogen, with devastating effects on the individual. The psychological trauma of those whose right to their personal identity is profoundly violated is thus followed, in cases where medical or surgical intervention is completed, by further serious physiological consequences.
Yet the Italian Medicines Agency (AIFA) has not guaranteed in recent years, nor does it currently guarantee, a uniform national distribution of the drugs essential for Hormone Replacement Therapy (HRT), to such an extent that the situation has gradually deteriorated to a point of actual unavailability of these drugs (especially testosterone-based drugs).
This inadequacy has therefore resulted in a real emergency situation: thousands of transgender people, in compliance with the sterilization of their reproductive organs as a conditio sine qua non until 2015 for the rectification of their registry documents, have been suddenly deprived of the consequent and necessary primary care.
Furthermore, the off-label use of the drugs in question has led AIFA to downgrade them to Group C: this seems to foretell further possible outcomes, such as the possibility of their sudden and arbitrary discontinuation by the pharmaceutical companies that produce them.
This possibility makes the exercise of a right enshrined in our Constitution in a manner that is anything but conditional, increasingly uncertain and haphazard.
The aforementioned downgrading, with the elimination of any previously guaranteed free national treatment, also entails an inevitable financial inability to access the therapy for a category of people who, widely stigmatized at the social level and discriminated against in accessing the world of work, often experience conditions of relative and, at times, absolute poverty (a very recent downgrading was made for the estrogen-based Progynova, now fully paid for by the user with a 300 % price increase). After consulting your response to the question by the Hon. Sportiello in the Social Affairs Committee of the Chamber of Deputies regarding access to Hormone Replacement Therapies and the drug Progynova (5/02969), our referring endocrinologists assert that there is no Group A drug with B17 estradiol valerate that could be equivalent to the drug Progynova in terms of efficacy, nor in terms of reimbursement. Since these are drugs with non-equivalent compositions, and therefore do not constitute the same therapy, we are contacting you again to express our great concern for our health.
A further complaint concerns the functioning and structure of the National Health Service's referral system for the medical transition process. To date, due to limited resources, transgender men and women are referred from facilities in their own cities, provinces, or regions to a few "specialized centers." Clients are often forced to undertake long journeys to meet specialized medical personnel, or, under the aforementioned conditions, undergo a complete relocation that allows them to be closer to these centers.
Nonetheless, as activists and, even more importantly, as citizens, we are convinced that "the essential levels of benefits relating to civil and social rights" referred to in Article 117, paragraph 2, letter m), must be guaranteed throughout the country, as the law itself states, and not, as current conditions demonstrate, in a patchy manner.
Furthermore, technical and bureaucratic issues remain: even after the registry changes have been made to one's documents, the new male or female tax codes are not recognized by the dedicated computer system. This means, among countless consequences, that a specific category of people are unable to receive, for example, preventive screening tests for certain cancers, which are provided to the rest of the population by the National Health Service.
Finally, we would like to draw your attention to the continuing lack of training among medical personnel regarding the specific conditions of patients with "unconventional" bodies, who are therefore exposed to the most unpredictable reactions (sometimes, it has been found with regret, serious discrimination).
If change is possible, we are aware of how much energy and resources are still essential for identifying good practices at the local level to lead to the adoption of consolidated practices certified at the national level as well as in the rest of Europe.
Trusting in your interest in the issues raised, we request a meeting that, we hope, will lead to possible and shared solutions.
We send you our warmest regards and look forward to hearing from you.
TRANS GROUP – Non-profit association of transgender people
The Great Hummingbird – Volunteer association committed to the intersection of differences
AGEDO Bologna – Association of Parents, Relatives, and Friends of LGBTQ People
ARCIGAY – Italian LGBTI+ Association
Trans Network National by ARCIGAY
Lenford Network – LGBTI Rights Advocacy[:]
