Examining the training needs and perspectives of Italian general practitioners on transgender and gender diverse healthcare: Insights from a national survey

Figures & data

Table 1. Demographics.

	n (%)
Age
<30-year old	27 (4.3)
30- to 40-year old	157 (24.9)
41- to 50-year old	68 (10.8)
>50-year old	379 (60.1)
Italian geographic area in which you work
Northern Italy	358 (56.7)
Center Italy	117 (18.5)
Southern Italy and Islands	156 (24.7)
City in which you work
Large municipality (>250,000 inhabitants)	123 (19.5)
Medium municipality (5000 − 250,000 inhabitants)	373 (59.1)
Small municipality (<5000 inhabitants)	135 (21.4)
What is the number of people you assist?^a
<600	39 (6.3)
600–900	46 (7.5)
901–1200	75 (12.2)
1201 − 1500	253 (41.0)
>1500	204 (33.1)
To your knowledge, are there TGD people among your patients?
Yes	209 (33.1)
No	309 (49.0)
I don’t know	113 (17.9)
If yes, in your opinion, how many could they approximately be?^b
1–5	176 (84.2)
6–10	20 (9.6)
11–20	5 (2.4)
21–30	1 (0.5)
>30	5 (2.4)
I don’t know	2 (1.0)

Data are shown as absolute numbers (n) and percentages (%).

^aNumber of General Practitioners (GPs) respondents, 617 out of 631. The data obtained were grouped according to arbitrary categories.

^bOnly GPs who stated having TGD patients were included in the sample (209 out of 631). The data obtained were grouped according to arbitrary categories. TGD, transgender and gender diverse people.

Table 2. Knowledge.

Question	Right answer n (%)	Wrong answer n (%)	I don’t know n (%)
Who is a transgender person?	253 (42.6)	333 (56.1)	8 (1.3)
Who is a cisgender person?	310 (52.2)	58 (9.8)	226 (38.0)
Are all TGD people gay or lesbian?	470 (79.1)	35 (5,9)	89 (15.0)
What is meant by gender affirming pathway?	365 (61.5)	191 (32.1)	38 (6.4)
Do all TGD people undergo a medical gender affirming pathway?	435 (73.2)	30 (5.1)	129 (21.7)
Are the expressions “gender dysphoria” and “gender incongruence” synonyms?	254 (42.8)	115 (19.4)	225 (37.8)
Do all TGD people experience gender dysphoria?	202 (34.0)	106 (17.9)	286 (48.1)
Should transgender men who have undergone chest surgery be screened for breast cancer?	238 (40.1)	153 (25.8)	203 (34.1)
Should transgender women who have undergone vaginoplasty be screened for prostate cancer?	214 (36.0)	212 (35.7)	168 (28.3)
In Italy, is a diagnosis of gender dysphoria/gender incongruence by a mental health professional essential to access hormonal therapy within the NHS?	275 (46.3)	46 (7.7)	273 (46.0)
In Italy, is a diagnosis of gender dysphoria/gender incongruence by a mental health professional essential to access gender affirming surgical procedures?	325 (54.7)	34 (5.7)	235 (39.6)
In Italy, is it essential to undertake gender affirming surgical procedures for the legal change of name and gender?	142 (23.9)	227 (38.2)	225 (37.9)
In Italy, does the legal recognition of the name and gender also involve the change of the personal health card?	342 (57.6)	42 (7.1)	210 (35.3)

Data are shown as absolute numbers (n) and percentages (%). TGD, transgender and gender diverse people; NHS, National Health System.

Table 3. Impact of age on GPs’ knowledge.

Question	Age of GPs
	OR [95% CIs]	p
Who is a transgender person?	0.59 [0.50–0.71]	<.001
Who is a cisgender person?	1.08 [0.82–1.42]	.562
Are all TGD people gay or lesbian?	0.33 [0.16–0.69]	.003
What is meant by gender affirming pathway?	1.07 [0.90–1.27]	.438
Do all TGD people undergo a medical gender affirming pathway?	0.40 [0.21–0.77]	.006
Are the expressions “gender dysphoria” and “gender incongruence” synonyms?	0.85 [0.69–1.05]	.146
Do all TGD people experience gender dysphoria?	0.84 [0.67–1.05]	.128
Should transgender men who have undergone chest surgery be screened for breast cancer?	1.05 [0.87–1.26]	.603
Should transgender women who have undergone vaginoplasty be screened for prostate cancer?	0.75 [0.63–0.90]	.002
In Italy, is a diagnosis of gender dysphoria/gender incongruence by a mental health professional essential to access hormonal therapy within the NHS?	0.78 [0.54–1.10]	.157
In Italy, is a diagnosis of gender dysphoria/gender incongruence by a mental health professional essential to access gender affirming surgical procedures?	0.95 [0.66–1.38]	.800
In Italy, is it essential to undertake gender affirming surgical procedures for the legal change of name and gender?	1.06 [0.90–1.25]	.483
In Italy, does the legal recognition of the name and gender also involve the change of the personal health card?	0.99 [0.71–1.38]	.973

Logistic regression models were used to assess the effect of the selected categorical variable [age (continuous)] in correctly answering questions. Significant p-values are shown in bold. OR, odds ratio; 95%CIs, 95% confidence intervals; TGD, transgender and gender diverse people; NHS, National Health System.

Table 4. Stigma.

	n (%)
In your opinion, do TGD people experience differences in health care compared to the cisgender population?
Yes	572 (90.7)
No	59 (9.3)
In your opinion, what actions should be taken urgently to improve the management of TGD people by GPs? (maximum 2 answers allowed)
Specific training on TGD people health	465 (47.5)
Development of specific evidence-based guidelines	396 (40.5)
Inclusion of gender identity in medical records	112 (11.5)
Other	5 (0.5)
Please state your level of agreement with the following statements regarding the barriers that TGD people face accessing the NHS
TGD people are often afraid or anxious about accessing healthcare
Strongly agree	100 (15.8)
Agree	317 (50.2)
Neither agree nor disagree	174 (27.6)
Disagree	28 (4.4)
Strongly disagree	12 (1.9)
TGD people often feel that healthcare professionals do not respect their gender identity and/or expression
Strongly agree	110 (17.4)
Agree	305 (48.3)
Neither agree nor disagree	153 (24.2)
Disagree	50 (7.9)
Strongly disagree	13 (2.1)
TGD people often experience transphobia or hatred in a healthcare context
Strongly agree	52 (8.2)
Agree	184 (29.2)
Neither agree nor disagree	253 (40.1)
Disagree	118 (18.7)
Strongly disagree	24 (3.8)

Data are shown as absolute numbers (n) and percentages (%). TGD, transgender and gender diverse people; NHS, National Health System.

Table 5. Training experience.

	n (%)
Have you ever attended training courses on TGD health?
Yes	37 (5.9)
No	594 (94.1)
If yes, how did you receive this training?
As part of my mandatory professional development	9 (22.5)
Voluntary activity	23 (57.5)
As part of my mandatory formal education program	5 (12.5)
Other	3 (7.5)
In your opinion, training on TGD health is:
Fundamental	222 (35.2)
Useful	395 (62.6)
Useless	14 (2.2)
In what way would it be most useful for a GP to receive training?
As part of my mandatory professional development	404 (40.0)
Voluntary activity	267 (26.4)
As part of my mandatory formal education program	330 (32.7)
Other	9 (0.9)

Data are shown as absolute numbers (n) and percentages (%). TGD, transgender and gender diverse people.

Table 6. The impact of training experience on knowledge.

	Without training (n = 594)			With training (n = 37)
Question	Right answer n (%)	Wrong answer n (%)	I don’t know n (%)	Right answer n (%)	Wrong answer n (%)	I don’t know n (%)	p
Who is a transgender person?	253 (42.6)	333 (56.1)	8 (1.3)	24 (64.9)	13 (35.1)	0 (0)	.008
Who is a cisgender person?	310 (52.2)	58 (9.8)	226 (38.0)	25 (67.6)	2 (5.4)	10 (27.0)	.069
Are all TGD people gay or lesbian?	470 (79.1)	35 (5,9)	89 (15.0)	31 (83.8)	1 (2.7)	5 (13.5)	.493
What is meant by gender affirming pathway?	365 (61.5)	191 (32.1)	38 (6.4)	20 (54.1)	16 (43.2)	1 (2.7)	.370
Do all TGD people undergo a medical gender affirming pathway?	435 (73.2)	30 (5.1)	129 (21.7)	36 (97.3)	0 (0)	1 (2.7)	.001
Are the expressions “gender dysphoria” and “gender incongruence” synonyms?	254 (42.8)	115 (19.4)	225 (37.8)	16 (43.2)	11 (29.7)	10 (27.0)	.962
Do all TGD people experience gender dysphoria?	202 (34.0)	106 (17.9)	286 (48.1)	19 (51.4)	10 (27.0)	8 (21.6)	.031
Should transgender men who have undergone chest surgery be screened for breast cancer?	238 (40.1)	153 (25.8)	203 (34.1)	23 (62.2)	4 (10.8)	10 (27.0)	.008
Should transgender women who have undergone vaginoplasty be screened for prostate cancer?	214 (36.0)	212 (35.7)	168 (28.3)	19 (51.4)	12 (32.4)	6 (16.2)	.060
In Italy, is a diagnosis of gender dysphoria/gender incongruence by a mental health professional essential to access hormonal therapy within the NHS?	275 (46.3)	46 (7.7)	273 (46.0)	26 (70.3)	2 (5.4)	9 (24.3)	.005
In Italy, is a diagnosis of gender dysphoria/gender incongruence by a mental health professional essential to access gender affirming surgical procedures?	325 (54.7)	34 (5.7)	235 (39.6)	27 (73.0)	3 (8.1)	7 (18.9)	.030
In Italy, is it essential to undertake gender affirming surgical procedures for the legal change of name and gender?	142 (23.9)	227 (38.2)	225 (37.9)	18 (48.6)	11 (29.7)	8 (21.6)	.001
In Italy, does the legal recognition of the name and gender also involve the change of the personal health card?	342 (57.6)	42 (7.1)	210 (35.3)	27 (73.0)	2 (5.4)	8 (21.6)	.065

Data are shown as absolute numbers (n) and percentages (%). Significant p-values are shown in bold. TGD, transgender and gender diverse people; NHS, National Health System.

Table 7. The impact of previous educational experiences on the GPs’ opinion about training.

	Without training (n = 594)	With training (n = 37)	p
	n (%)	n (%)
In your opinion, training on TGD health is:
Fundamental	197 (33.2)	25 (67.6)	<.001
Useful	385 (64.6)	11 (29.7)	<.001
Useless	13 (2.2)	1 (2.7)	.855
In what way would it be most useful for a GP to receive training?
As part of my mandatory professional development	378 (39.9)	26 (41.3)	.826
Voluntary activity	254 (26.8)	13 (20.6)	.260
As part of my mandatory formal education program	307 (32.4)	23 (36.5)	.502
Other	8 (0.8)	1 (1.6)	.503

Data are shown as absolute numbers (n) and percentages (%). Significant p-values are shown in bold. TGD, transgender and gender diverse people.

Data availability statement

Data are available upon reasonable request. The authors had full access to all of the data in the study. Aggregated data that underlie the results reported in this article are available on request to the corresponding author.