Knowledge, Clinical Experience and Perceived Competence in Gender Dysphoria Care: Preliminar Results of a Survey of Physicians in the Marche Region

Abstract

Introduction

The American Psychiatric Association defines Gender Dysphoria (GD) as a psychiatric diagnosis that refers to the psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity. Physicians play a crucial role in supporting people experiencing this psychological distress, by providing healthcare, information, and referrals. To ensure this support, both practitioners and specialists must possess specific knowledge and skills.

Objective

To assess physicians’ knowledge in GD, their clinical experience, and their perceived competence in managing patients with DG.

Methods

The data were collected by a web-based survey performed between May and July 2025. All physicians working in Marche Region in 2025 were invited to participate. The survey consisted of an anonymous questionnaire containing open and closed-ended questions, covering four areas of interest: information on the participants’ professional role, clinical experience with patients with GD, specific training on DG, institutional support for DG management. Variables were summarized using frequencies and percentages. Associations were evaluated using Chi-square or Fisher’s Exact test, when appropriate. Statistical analyses were conducted using R.

Results

A total of 553 physicians took part in the survey (16.4% of the target population), 55.2% were general practitioners or pediatricians (42.9% and 12.3%, respectively), 45.8% had been working for more than 20 years, 54.4% had experience with people exhibiting GD, and 71% of these reported having encountered no more than 5 such individuals during the course of their professional practice. Among physicians with experience with GD cases, about 60% reported the presence of comorbidities, in particular symptoms of anxiety, depression and other disorders, in their patients.

Considering only the complete questionnaires (n=442), 87% did not feel prepared to manage complications resulting from hormone therapies, 81% believed they had not received specific training on GD during their medical education and professional practice, 74% did not feel supported by their colleagues and their institution in managing patients with DG, and 85% were unaware of a specific facility for patients wishing to begin treatment. Physicians with more than 10 years of professional practice were more likely to have clinical experience with patients with GD (p = 0.009). In turn, physicians with previous GD-related clinical experience reported significantly higher perceived competence in managing these patients (p=0.001).

Conclusion

This survey revealed substantial gaps in physicians’ knowledge, training, and perceived preparedness regarding the management of patients with gender dysphoria in the Marche Region. Most respondents reported clinical exposure, insufficient training, lack of institutional support, and poor awareness of referral services. General practitioners and paediatricians may play a pivotal role because of their involvement in first contact and long-term care. Although the findings should be interpreted considering the low response rate and the self-reported nature of the data, they suggest the need for structured educational initiatives and improved healthcare pathways to support the management of patients with GD.