Examining the training needs and perspectives of Italian general practitioners on transgender and gender diverse healthcare: Insights from a national survey Matteo Marconi, Luisa Brogonzoli, Angela Ruocco, Elisa Sala, Sara D’Arienzo, Martina Manoli, Maria Teresa Pagano, Alessandra Daphne Fisher, Rosaria Iardino, Rosa Pedale, Ignazio Grattagliano, Claudio Cricelli, Marina Pierdominici International Journal of Transgender Health, 2026 Introduction General practitioners (GPs) play a crucial role in supporting transgender and gender diverse (TGD) individuals by providing healthcare, information, and referrals. However, a major challenge arises from the insufficient training of healthcare professionals in TGD healthcare. The lack of research on the training needs of GPs in this area further exacerbates the issue. To address this gap, we conducted a national survey aimed at Italian GPs to assess their knowledge and attitudes toward the health of TGD individuals. Methods A total of 631 GPs participated in an anonymous cross-sectional survey conducted in Italy from January 2021 to June 2022. Results In accordance with the questions about gender identity and gender affirming pathway, between 23.9% and 79.1% of GPs responded correctly. Less than half of them provided correct responses about the need for cancer prevention. Overall, the younger the age, the more likely it was to answer TGD health questions exactly. Most GPs (90.7%) believed that TGD people experience differences in healthcare access compared to the cisgender population and 37.4% agreed that TGD people experience transphobia in a healthcare context. The implementation of specific training programs and the development of evidence-based guidelines were identified by almost half of respondents as the most urgent measures to enhance TGD healthcare. Only 5.9% of GPs attended training courses on TGD healthcare, yet 97% acknowledged the utility of education in this field. Conclusions The outcomes of our study pave the way for developing strategies to improve GPs’ training in TGD health, ensuring that TGD people receive competent and sensitive healthcare.
Testosterone and KPC-Kp gut colonization: is there a link? Maria Teresa Pagano, Alessandra Oliva, Elena Ortona, Claudio Maria Mastroianni, Maria Cristina Gagliardi Journal of Sex and Gender Specific Medicine, 2025 KPC-producing Klebsiella pneumoniae (KPC-Kp) accounts for a significant proportion of hospital-acquired infections and is a major concern particularly in healthcare settings like intensive care units (ICU), due to the multitude of invasive procedures and medical devices used, the prolonged antibiotic therapy, and the critical conditions of these patients. Intestinal colonization by KPC-Kp is a risk factor for developing subsequent nosocomial infection and for this reason it is crucial to screen for KPC-Kp colonization as well as potential related factors. Sex hormones play an important role in various physiological processes including the immune response and through their modulation they can affect host-microbe interactions and the microbiota.
Sex differences in lipid profile and response to statin treatment in pediatric patients affected by familial hypercholesterolemia Isabella Tarissi De Jacobis, Elisabetta Straface, Elena Inzaghi, Camilla Cittadini, Maria Bartuli, Maria Teresa Pagano, Annalisa Grandin, Paola Sabrina Buonuomo European Journal of Pediatrics, 2025 Differences between males and females in lipid profile are observed in distribution and trajectory during pediatric age and are more pronounced in hereditary lipid disorders such as familial hypercholesterolemia when absolute cholesterol levels are higher from birth onwards. A retrospective observational study was undertaken to explore the sex differences in lipid profiles of pediatric patients affected by heterozygous form of familial hypercholesterolemia (FH) and treated with statins. A cohort of 322 pediatric patients, aged 2-17 years, diagnosed with heterozygous FH and regularly followed in Rare Disease and Medical Genetics Unit of the Bambino Gesù Children's Hospital of Rome (Italy) from 2015-2024, was enrolled in this study. A subgroup of 112 patients, aged 8-17 years, was treated with statins. For all patients, the lipid profile was assessed at diagnosis. For patients treated with statins, the lipid profile was assessed at diagnosis and after 1 year of statin therapy. Differences between males and females in lipid profile were observed in the subgroup of patients aged 8-17 years. Females had significantly (p < 0.05) higher TC, LDL-C and TG plasma values than males, and clinically they respond better to statin treatment. CONCLUSION: Personalized therapy, accounting for these differences, could enhance treatment outcomes and optimize long-term cardiovascular health in affected children. WHAT IS KNOWN: • Familial hypercholesterolemia (FH) is characterized by elevated plasma level of total cholesterol from the birth. • If left untreated, FH can lead to premature atherosclerotic cardiovascular disease, and young female with FH are at high risk of developing it. • FH girls have higher levels of TC, LDL-C, and TG plasma values levels than boys in a previous study and this may contribute significantly to the total lifelong cholesterol burden in FH women. WHAT IS NEW: • Significant sex differences in lipid profile were confirmed in heterozygous FH (HeFH) patients aged 8-17 years: females had significantly higher TC, LDL-C and TG plasma values than males. • Early statin treatment in children with FH, and girls in particular, may impact cholesterol burden in FH patients.
Stratified analysis of health and gender-affirming care among Italian transgender and gender diverse adults Matteo Marconi, Angela Ruocco, Jiska Ristori, Stefania Bonadonna, Rosario Pivonello, Maria Cristina Meriggiola, Giovanna Motta, Francesco Lombardo, Maddalena Mosconi, Alessandro Oppo, Silvia Federici, Luca Bruno, Nunzia Verde, Alessandra Lami, Chiara Michela Crespi, Martina Manoli, Paola Matarrese, Carmela Santangelo, Luciana Giordani, Maria Teresa Pagano, Cristiana Barbati, Sara D’Arienzo, Alessandra Daphne Fisher, Marina Pierdominici Journal of Endocrinological Investigation, 2025
Gender-affirming hormone therapy and autoimmunity: new insights from a 3-year follow-up study Matteo Marconi, Gloria Riitano, Alessandra Daphne Fisher, Carlotta Cocchetti, Maria Teresa Pagano, Antonella Capozzi, Agostina Longo, Sara D’Arienzo, Linda Vignozzi, Maurizio Sorice, Elena Ortona, Marina Pierdominici Clinical and Experimental Immunology, 2025 Gender-affirming hormone therapy and autoimmunity: new insights from a three-year follow-up study
Dietary Habits, Physical Activity and Body Mass Index in Transgender and Gender Diverse Adults in Italy: A Voluntary Sampling Observational Study Carmela Santangelo, Matteo Marconi, Angela Ruocco, Jiska Ristori, Stefania Bonadonna, Rosario Pivonello, Maria Cristina Meriggiola, Francesco Lombardo, Giovanna Motta, Chiara Michela Crespi, Maddalena Mosconi, Alessandro Oppo, Silvia Federici, Luca Bruno, Nunzia Verde, Alessandra Lami, Emanuela Bologna, Rosaria Varì, Maria Teresa Pagano, Luciana Giordani, Paola Matarrese, Flavia Chiarotti, Alessandra Daphne Fisher, Marina Pierdominici Nutrients, 2024 Transgender and gender-diverse (TGD) individuals continue to experience harassment and discrimination across various aspects of life, significantly impacting their physical and mental health. The scarcity of data on their general health, particularly regarding dietary habits, remains a challenge in developing effective healthcare strategies for this population. To address this gap, we analyzed selected dietary habits, physical activity (PA), and body mass index (BMI) among Italian TGD adults compared to the Italian general population (IGP). An online anonymous survey was conducted via the Computer Assisted Web Interviewing technique from June 2020 to June 2021. Participants were enrolled through clinical centers and TGD organizations. Data from 959 TGD adults were analyzed using chi-squared tests and logistic regression models. Key findings indicated that approximately 70% of TGD individuals consumed fewer servings of fruit and vegetables (FV) than recommended (five or more servings per day). Although red meat consumption was lower overall, a greater percentage of TGD individuals reported consuming more than three servings per week. Additionally, 58% of TGD participants indicated that they did not engage in any PA, compared to 36% of the IGP. Notably, significant differences in BMI were identified, with higher rates of overweight and obesity among TGD individuals assigned female at birth. These results underscore the urgent need for tailored nutritional guidelines and inclusive public health strategies to meet the specific health needs of the Italian TGD population. Expanding access to targeted interventions could contribute to improving overall well-being in this marginalized group.
The Role of Sex Differences in Bone Health and Healing Elena Ortona, Maria Teresa Pagano, Lavinia Capossela, Walter Malorni Biology, 2023 Fracture healing is a long-term and complex process influenced by a huge variety of factors. Among these, there is a sex/gender disparity. Based on significant differences observed in the outcome of bone healing in males and females, in the present review, we report the main findings, hypotheses and pitfalls that could lead to these differences. In particular, the role of sex hormones and inflammation has been reported to have a role in the observed less efficient bone healing in females in comparison with that observed in males. In addition, estrogen-induced cellular processes such as autophagic cell cycle impairment and molecular signals suppressing cell cycle progression seem also to play a role in female fracture healing delay. In conclusion, it seems conceivable that a complex framework of events could contribute to the female bias in bone healing, and we suggest that a reappraisal of the compelling factors could contribute to the mitigation of sex/gender disparity and improve bone healing outcomes.
Human Monocyte-Derived Dendritic Cells Are the Pharmacological Target of the Immunosuppressant Flavonoid Silibinin Maria Teresa Pagano, Katia Fecchi, Marina Pierdominici, Elena Ortona, Daniela Peruzzu International Journal of Molecular Sciences, 2022 Silibinin, a natural polyphenolic flavonoid, is known to possess anti-inflammatory, anticancer, antioxidant, and immunomodulatory properties. However, the effects of Silibinin on the maturation and immunostimulatory functions of human dendritic cells (DC) remain to be elucidated. In this study, we have attempted to ascertain whether Silibinin influences the maturation, cytokine production, and antigen-presenting capacity of human monocyte-derived DC. We show that Silibinin significantly suppresses the upregulation of costimulatory and MHC molecules in LPS-stimulated mature DC and inhibits lipopolysaccharide (LPS)-induced interleukin (IL)-12, IL-23, and TNF-α production. Furthermore, Silibinin impairs the proliferation response of the allogenic memory CD4 T lymphocytes elicited by LPS-matured DC and their Th1/Th17 profile. These findings demonstrate that Silibinin displays immunosuppressive activity by inhibiting the maturation and activation of human DC and support its potential application of adjuvant therapy in the treatment of autoimmune diseases.
Anti-Inflammatory Effects of 1,25(OH)2D/Calcitriol in T Cell Immunity: Does Sex Make a Difference? Daniela Peruzzu, Maria Luisa Dupuis, Marina Pierdominici, Katia Fecchi, Maria Cristina Gagliardi, Elena Ortona, Maria Teresa Pagano International Journal of Molecular Sciences, 2022 Hypovitaminosis D is involved in various inflammatory, infectious and autoimmune diseases such as rheumatoid arthritis and multiple sclerosis. Moreover, the active form of vitamin D, calcitriol, has been shown to modulate the immune response, playing an anti-inflammatory effect. However little is known about the mechanisms underlying this anti-inflammatory effect and the potential sex differences of calcitriol immune regulation. Hence, the aim of this study was to investigate whether calcitriol could act differently in modulating T cell immunity of age-matched male and female healthy donors. We analyzed the effects of calcitriol in T lymphocytes from healthy women and men on the expression levels of the vitamin D receptor (VDR) and pro- and anti-inflammatory cytokine production. We showed that a treatment with calcitriol induced a significant increase in the VDR expression levels of activated T lymphocytes from male and female healthy subjects. Moreover, we found that calcitriol significantly reduced the expression level of pro-inflammatory cytokines IL-17, INF-γ and TNF-α in the T lymphocytes of both sexes. Notably, we observed that calcitriol induced a significant increase in the expression level of anti-inflammatory cytokine IL-10 only in the T lymphocytes from female healthy donors. In conclusion, our study provides new insights regarding the sex-specific anti-inflammatory role of calcitriol in T cell immunity.
Synergy Between Vitamin D and Sex Hormones in Respiratory Functionality of Patients Affected by COVID-19 Daniela Peruzzu, Maria Teresa Pagano, Marina Pierdominici, Anna Ruggieri, Andrea Antinori, Gianpiero D’Offizi, Nicola Petrosillo, Fabrizio Palmieri, Pierluca Piselli, Evangelo Boumis, Stefania Notari, Emanuele Nicastri, Chiara Agrati, Giuseppe Ippolito, Maria Cristina Gagliardi, Maria Rosaria Capobianchi, Elena Ortona, and Frontiers in Pharmacology, 2021
Vitamin D and Sex Differences in COVID-19 Maria Teresa Pagano, Daniela Peruzzu, Anna Ruggieri, Elena Ortona, Maria Cristina Gagliardi Frontiers in Endocrinology, 2020
