The Gap in Endocrinological Care for Transgender and Gender-Diverse Individuals: An Italian Survey

Purpose: Transgender and gender-diverse (TGD) individuals have various medical needs, but limited healthcare professionals' expertise remains a major barrier to care. Data on the preparedness of Italian endocrinologists to provide TGD care are scarce. This study assessed Italian endocrinologists' knowledge, clinical practice, and educational needs in gender-affirming care. Methods: A nationwide survey developed by the Association of Medical Endocrinologists (AME), with support from the Italian Society for Gender, Identity and Health (SIGIS), was distributed to all AME members in 2023.Multivariable logistic regression identified factors associated with knowledge, self-reported ability to manage GAHT and interest in further education. Results: Overall, 703 endocrinologists completed the survey. Only 8.4% reported frequent clinical involvement with TGD patients, and fewer than 15% considered themselves able to initiate and monitor GAHT. Previous education in gender-affirming care was the strongest determinant of knowledge (OR 14.3) and self-reported ability to manage GAHT (OR 4.4). Younger age was associated with greater knowledge but not with perceived clinical competence. Nevertheless, 90.4% expressed interest in further education. Conclusions: Italian endocrinologists show substantial gaps in preparedness for transgender care. Structured education in gender-affirming care is strongly associated with greater knowledge and self-reported ability to manage GAHT, supporting the implementation of educational programs to improve access to competent endocrine care for TGD individuals.