Italy has become the latest country where the affirmative model of gender care for minors is facing internal professional pushback — following the UK’s Cass Review, Sweden’s and Finland’s national reversals, and shifting US federal guidance. Unlike those countries, however, the challenge in Italy has come from within the medical profession itself rather than from government or health authorities. The country’s Paediatric Society has stood by the guide so far, emphasising that it is intended for educational use rather than as a clinical guideline.
A guide published by the Italian Paediatric Society (SIP) and the Cultural Association of Paediatricians (ACP), titled Beyond the Gaze (“Oltre lo sguardo”), has sparked backlash within the Italian medical community. The affirmation-only guide advises paediatricians to affirm children’s self-declared gender identities without judgment, directs paediatricians to refer teenagers to gender clinics, and includes a case study of social transition for a three-year-old.
Details of the case indicate the child is biologically male but is referred to in the guide by the pseudonym pairing “Alan-Anna.” The child shows a preference for play, clothing, and social roles typically associated with females, and asks to be called Anna — a request the family accepts. At this point, the paediatrician provides references to specialist centres, associations, and informational materials. The guide presents this as an example of “gender variance.”
According to the guide, the formal “alias career” — the administrative process allowing a child to be identified at school by a name other than their legal one, along with corresponding uniform and bathroom accommodations — is activated later, at the point of primary school enrolment, not at age three itself. Some public criticism of the case, including how it was characterised in early reporting, blurred this distinction. SIP and ACP have since clarified that the case is anonymised but real, and that the paediatrician depicted does not define the child’s identity or order the alias career, but listens to the family and refers them to qualified professionals. The two societies also acknowledged that the guide’s narrative summary of the case “may have invited interpretations different from the authors’ intentions.”
Marina Terragni, Head of Italy’s Independent Authority for Children and Adolescents, said the affirmation pathway described was “unthinkable” and “would merit attention from the Italian health authorities.” She warned that social transition, as a response to a period of uncertainty she called “an extremely common experience in the lives of children and adolescents,” has “all too often proved to be a point of no return, the starting point for so-called ‘affirmative therapy,’ which progresses from puberty blockers to cross-sex hormones and surgery by the age of 16.”
Terragni pointed to a rise in “critical reflection” on the affirmative approach internationally, and a shift toward caution elsewhere in Europe, where current advice prioritises “a holistic approach and a thorough psychological assessment to rule out any psychiatric co-morbidities.”
What the guide says
The SIP guide states that “social affirmation” of children “is reversible and has no medical implications; it is the only intervention recommended for the prepubertal period.” Although the guide does not explicitly mention puberty blockers or cross-sex hormones, the specified responsibilities of paediatricians include referring adolescents to specialised gender clinics. An accompanying technical document states paediatricians are not expected to “make specialist diagnoses or to determine treatment pathways,” but to “refer without judging, exaggerating or downplaying requests for help.”
SIP president Renzo Agostiniani has dismissed the label of the guide as ideological, clarifying it as a practical resource for paediatricians encountering situations beyond their university training. SIP and ACP emphasise that the guide is intended for informational and educational purposes, not as a formal clinical guideline, which is why it omits major systematic reviews like the UK’s Cass Review. Agostiniani also stated that the society is open to revising the document if “well-founded observations” are presented.
Critics argue that this distinction downplays the guide’s practical impact. It continues to influence referral pathways for actual patients, and the lack of any modeled alternatives to affirmation—such as watchful waiting, differential diagnosis, or exploring co-occurring conditions—essentially predetermines an outcome for a young child whose identity, self-concept, and body awareness are still unpredictable and developing at this stage.
Backlash from medical community
In response to the guide, more than 500 practitioners signed a petition on 22 July 2026 calling on the Paediatric Society to rethink its guidance. The petition, titled First, Do No Harm: Science Beyond the Gaze, is also being sent to Italy’s Health Minister, Professor Orazio Schillaci. Signatories included child neuropsychiatrists, physicians, bioethicists, nurses, midwives, psychiatrists, psychologists, psychotherapists and paediatricians, alongside more than 500 additional signatories from the general public.
A member of the parents’ group GenerAzioneD, which helped organise the petition, said: “To date, in Italy, critical stances towards the affirmative approach to gender dysphoria in children and adolescents have been largely isolated and individual. This is the first document signed by such a significant number of healthcare professionals who, by giving their full names, are taking a public stand.”
The group added that “the signatories are calling on the Italian Paediatric Society to reconsider the guidance in the light of the most recent systematic reviews of the international literature and the shift in approach currently being observed in a growing number of European countries.”
GenerAzioneD argue that the guide’s three-year-old case study excludes real clinical alternatives to social affirmation, transforming what should be an observation and exploration phase into a fixed process — highlighting that at age three, time, clinical observation, and watchful waiting are themselves therapeutic methods.
An evidence gap
The guide omits several recent major evidence reviews, such as the UK’s Cass Review, Sweden’s and Finland’s national reviews, and the US HHS Gender Dysphoria Report, which all found limited evidence for paediatric gender-affirming care. These reviews emphasize caution in social and medical transitions for children. However, it references the WPATH 2022 standards of care, which removed minimum age requirements for hormone therapy and surgery. These standards have been heavily scrutinized following the 2023 leak of internal documents, known as the “WPATH Files,” where clinicians associated with the organization expressed uncertainty about the evidence and risks involved in treatments for children and minors.
This response from the medical community is rare and significant: it marks the first time a large, publicly known group of Italian health professionals has diverged from their professional societies in support of the affirmative model. This reflects a wider trend of internal medical dissent that has already impacted policy changes in the UK, Sweden, and Finland. Italy is following a similar course, and while the struggle continues, it is encouraging to see more doctors and health professionals opposing the gender ideology infiltrating paediatric medicine.
*Written by FF staff writers*
