Adolescent gender dysphoria in Italy: reflections on triptorelin, consent, and care

Since 2018, the Italian National Committee for Bioethics (CNB) has endorsed the off-label use of triptorelin, a gonadotropin-releasing hormone agonist (GnRHa), for managing adolescent gender dysphoria (GD). Administered to suppress puberty, triptorelin provides adolescents time to explore their gender identity without the distress of developing secondary sexual characteristics. However, concerns persist regarding its long-term effects on bone density, brain development, and fertility. Ethical debates focus on the validity of informed consent in minors, given their cognitive and emotional immaturity, and the critical role of families in decision-making. The Italian medical-psychiatric model, requiring a formal GD diagnosis and multidisciplinary oversight, contrasts with the autonomy-centered informed consent model used elsewhere. This paper advocates for a hybrid approach, integrating strengths of both models to ensure safe, accessible, and individualized care. Further research is essential to clarify the efficacy and risks of triptorelin, ensuring evidence-based, fully informed decisions for adolescents with GD.