"I went for a year without hormone treatment" experiences of access and continuity of gender-affirming care among transgender and nonbinary migrants in Italy

This qualitative study explores access to and continuity of gender-affirming care (GAC) among transgender and nonbinary (TNB) migrants in Italy, focusing on hormone therapy pathways. Although Italy's National Health Service formally provides universal healthcare, access to GAC is shaped by decentralized service provision, legal requirements, and administrative procedures that may affect continuity of care. Guided by the gender minority stress framework and the administrative burden theory, this study examines how structural, institutional, and psychosocial factors shape access to and continuation of hormone treatment. Data were drawn from semi-structured interviews and one focus group with 16 TNB migrants living across northern, central, and southern Italy. Data were analyzed using reflexive thematic analysis. Findings show that access to GAC is a continuous and bureaucratically mediated process rather than a single point of entry into care. Administrative fragmentation, insurance costs, waiting times, and legal documentation requirements contributed to treatment delays and interruptions. Participants also reported misgendering, discrimination, and anticipated stigma in healthcare settings, which sometimes led to care avoidance. Community organizations played a key role in supporting healthcare navigation and continuity of care. These findings highlight how administrative burden and gender minority stress interact to shape inequitable access to GAC and treatment continuity among TNB migrants.