Italian Medical Study Waived Ethics To Perform Invasive Psychometrics on a Trans Man

The peer-reviewed study uses a loophole in Italian research regulations to skirt the ethical review processes, and reveals a very invasive transition gatekeeping process.

By Artemis T. Douglas

Oct. 16, 2025, the sexual health journal Sexes published a peer-reviewed study that detailed an in-depth and invasive set of procedures performed on a trans man in Italy who wished to medically transition. The study made this one trans man’s transition a case study, meaning they had a sample size of one.

As part of the clinical process to acquire HRT and eventually undergo masculinizing top surgery, the clinicians involved administered psychometric and physical fitness tests.

These tests included psychological scales for social desirability, bodily uneasiness, and human figure drawing, as well as clinical interviews to justify the transition. The physical tests were handgrip, chair standing, and upper body strength tests.  

Using this invasive battery of data gathering, they recorded and published the results of each test at three points throughout the man’s transition, pre and post-operative photos of his bare chest, and even the drawings he made as part of the human figure drawing test.

The researchers claimed the changes across the three human figure drawings “reflected the changes” found in the other psychometric body uneasiness scale they had their patient fill out at the same stages of his transition.

In the study’s disclosures, it is stated that the patient consented to having this information published. The method they used to obtain his consent was not published, and therefore, cannot be put under scrutiny.

Further, the researchers claimed that their study did not require ethical review because “it falls under normal clinical practice that does not require ethical approval according to the regulations of the Ethics Committee of the Calabria Region.”

To determine if such invasive measures are normal clinical practice across Italy, The Needle spoke to a source, who indicated that they are not.

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The source, who works for a community organization that helps transsexuals access medical transition in Italy, stated the following:

“First of all, a note: nothing relating to transition is mandated by law in Italy, except for the requirements for legal transition (name and gender marker change) and for any gender-affirming surgeries. Everything else, especially when it comes to medical transition, is the result of practices which have become standardised over the years.

So, with that out of the way: medical transition in Italy is a two-step process — a psychological / counselling phase, and then the actual medical transition phase. The psychological/counselling phase is a series of meetings with a psychologist or licensed therapist (not a psychiatrist: psychiatry, in Italy, doesn't factor into the transition process, unless the trans person has psychiatric comorbidities, e.g. bipolar disorder or something along those lines) which last from six months up to a couple years, in which the psychologist or therapist determines whether the person they are talking to has gender dysphoria and/or gender incongruence, based on the DSM-5 and/or ICD-11 standards. After that, the psychologist will sign a waiver, which is in effect an official diagnosis, stating their findings and in effect "authorising" the patient to seek medical treatment.

The medical transition phase is done under the supervision of an endocrinologist, which checks bloodwork, prescribes the appropriate form of HRT, oversees the process, and makes adjustments if necessary.

Then, after the patient has done their legal name and gender marker change, they can have gender-affirming surgeries (by law, genital surgery and top surgery for transmasc people can only be done with a court's authorisation, i.e. after legal transition, because they "destroy" healthy organs).

The hormones for HRT, as well as any surgeries, are covered and paid for by the Italian National Health Service.”

The source also confirmed that, in so far as they have personally experienced and are familiar with professionally, the invasive psychometrics that took place in the case study are not actually part of Italian standards for normal clinical practice.

"Psychometric testing and fitness tests are as far as I know not part of the standard psychological phase of transition in Italy. None of the psychologists who work with the charity I volunteer for do them (again, as far as I know), and I've been through the transition process myself and I didn't have to do any of those tests."

The Needle reached out to every author on the study for comment. Each declined to comment.

According to reporting by Investigate Europe and others, invasive transmedicalism, such as what happened to make this case study, is a long-standing norm across Europe.

Transmedicalism is the practice of gatekeeping transsexual medicine behind cissexual doctors, psychiatrists, and cruel rules meant to limit the number of practicing transsexuals– people who medically transition.

Traditionally, that meant decades of forced sterilization and being forced to choose between the right to proper, accurate identification and the right to the freedom to choose whether or not you have biological children.