Current vs. Desired: Transforming the Gender-Affirming Path Through the Work of Trans, Non-binary, and Gender-Questioning Activists Within an Ecological Framework

Introduction: Due to medical, psychological, and social factors, Italian trans and gender-diverse (TGD) people encounter significant barriers in their gender affirming pathway (GAP), both in formal and informal settings. The minority stress model highlights how structural obstacles reinforce the marginalization of the TGD population in society, while activism becomes a strategy to cope and a source of resilience.MethodsThe research aims to investigate challenges in the GAP for TGD individuals, adopting an ecological perspective. Twenty-five Italian TGD activists were interviewed using semi-structured interviews with sections on personal experiences, relationships with professionals and the LGBTQIA + community, and activism. Data were collected in June-November 2021.ResultsFollowing an ecological approach, the results were organized into a multilevel systemic model. Overall, participants highlighted the rigidity of the actual institutional GAP, calling for a more tailored approach. The study suggests that the Italian institutional GAP system is detached from the TGD population's needs.ConclusionFrom participants' accounts, engaging with TGD individuals through bottom-up approaches can represent a turning point in addressing the TGD population's medical, psychological, and social needs throughout their GAP.Policy ImplicationsProfessionals involved in the pathway should play a role in supporting and listening to the needs of TGD people, aiming to reduce the structural and bureaucratic difficulties encountered within the GAP.