Gender affirmation: aligning the body with the mind

Gender affirmation is a true act of recognizing one’s identity. For transgender individuals, it is a path of rebirth. A way to live authentically without the burden of a forced identity. Giulia Lo Russo, a specialist in plastic, reconstructive, and aesthetic surgery at the Day Surgery Center Maurizio Bufalini in Florence, emphasises how, through surgery, it is possible to «Strengthen an identity for a person born in the wrong body who has realised they need to align their body with their mind. No longer trying to align the mind with the body as before. Helping everyone, including the individuals themselves, understand that they can free themselves and embark on this path».

A multidisciplinary approach for transgender individuals

At the core of this discipline is a multidisciplinary approach. Plastic surgeons are accustomed to collaborating in various fields. This is equally true for transgender individuals who, despite not having a pathology, require closely coordinated medical and surgical care.

«Transgender people start as early as possible to be heard, to be recognized. They consult a psychologist who is an expert in recognizing this essentially identity-related reality – explains Lo Russo -. Then, if deemed necessary, they proceed to an endocrinologist for potential blocking therapy or, if older, may start hormones analogous to the desired gender. Finally, in Italy, to access surgery, a transgender person must obtain a court ruling. This is presented to a judge who decides whether or not to permit the surgical path, which is obviously nearly irreversible».

For example, intervening in trans women involves a series of procedures requiring a multidisciplinary team. From the plastic surgeon for breast augmentation and facial feminization to the maxillofacial surgeon, otolaryngologist, phoniatrist, speech therapist, and urologist. «Many professionals need to collaborate. In Italy, for several years now, there has been SIGIS. It is a society that brings together all these figures», says the doctor.

Raising awareness about gender affirmation

Educating and raising public awareness on transgender issues is of paramount importance. Breaking down prejudices and promoting a culture of tolerance and support are fundamental steps to allowing anyone to pursue this path safely and with dignity. In terms of communication, universities lag behind medical students and the general population, despite strong interest among young doctors.

«Personally, I think I have done a lot of communication on this topic. In my clinical practice, I often feel the desire to share certain stories – continues the doctor -. I’m not an influencer, but I have seen that, in recent years, this has helped many people at the family level recognize this dimension».

Recognition, especially of trans men and boys, has been significantly delayed, reflecting a lack of representation and adequate understanding. Doctors and society, in general, need training in cultural sensitivity and appropriate language use. «Communication, knowing how to express oneself, must become common practice, especially for doctors but also for everyone, as something very well known. However, there is still much work to be done», says Lo Russo.

This field of surgery is constantly evolving. Compared to just ten years ago, the differences are widely observable. The age of those deciding to embark on this type of journey has decreased. Fewer people are often left misunderstood and alone. The procedure for creating a male chest, which involves removing the mammary gland while preserving and reshaping the overlying skin tissues, is quick, superficial, and not very painful.«For me, it’s an honour. After a week, when the bandages are removed, patients look at themselves and, in addition to being very happy, are healed and doing well», concludes Lo Russo.