GEN_ Film Review: Taking Control of Medicine

GEN_ is a non-judgemental look at people – and one maverick doctor – taking gender affirmation and reproductive health into their own hands.

But behind these big, abstract ideas are people’s very real lives – not to mention the scientific wherewithal to make these unconventional lives possible – and even in the face of such hate, the pursuit of happiness and personal fulfilment is paramount. While not everyone may want to change their gender (radically or subtly) or have a child, the drive to live one’s only life as the best version of one’s self is a universal one.

Following this opening, the vast majority of GEN_ unfolds in the offices of Dr Maurizio Bini in Milan’s Niguarda public hospital. Dr Bini is a frank and warm presence, aware he is working at a fraught time with rising right-wing sentiment on the air and in public offices – not to mention pressure from cosmetic markets to standardise, commodify, and ‘improve’ bodies – but undeterred in his mission to support patrons seeking the likes of gender affirming surgeries, hormone treatment, and in vitro fertilisation to help them realise their true selves and optimal lives. Niguarda is one of Italy’s few public hospitals offering this cutting-edge care, and concrete science backs up Dr Bini’s suggestions and treatments. While he might be a maverick in the system, he is an orthodox practitioner.

The fly-on-the-wall vignettes that comprise most of GEN_, strung together with a script by Matarrese and Donatella Della Ratta, explore a range of human experiences and emotions with sympathy, truthfulness, and zero judgement. Dr Bini’s openness and knowledge encourages his patients to be direct with their desires. Sometimes these conversations solely focus on the medical issue at hand; other times, they expand to musings on modern life. One time, a patient wonders what the state does if a person “does not exist” – if, by this radical act of self-love and authenticity, their lived experience becomes more difficult in terms of mundane bureaucracy. While these conversations are filmed with faces often in full view, the camera picks up subtleties of gesture in hands and backs when sensitive matter requires it; the film is raw, but not exploitative. 

While the structure of GEN_ quickly becomes rote, with soft, steady music marking scene transitions with no dramatic impetus, the conversations and ethics at play remain captivating throughout. With the film’s clarity in not confusing gender affirmation with elective “cosmetic” surgery and in respecting those taking their future children’s traits and sex into their own hands, it covers many scenarios in its 104-minute run time. Dr Bini’s professional opinions are never questioned (perhaps correctly – he clearly outlines his scientific knowledge to back up his treatments and suggestions, and most viewers will not come from this background).

And while he is clearly fighting back against right-wing ideas of gender and family planning, some conversations raise questions that the film skates over to their detriment. In one section, a couple expresses a preference for a lighter-skinned child; it does not make a difference to them, the woman stresses, but – with a nod to their lived experiences – it will make things easier for their child in this world. Unpacking systemic racism is well beyond the scope of this documentary, but the conversation highlights the difference in gender self-determination and in vitro fertilisation: one affects only the patient’s life, and the other has repercussions for someone not yet born. The film steadfastly refuses to judge, to its merit, but the structure and scope of one documentary film feels like a starting point rather than an end to the conversation. 

With reproductive and transgender healthcare alarmingly under attack in the United States and (to a lesser degree) the United Kingdom, GEN_ is an important look at a good doctor’s work against increasingly oppressive odds. While it cannot take down an entire political system or dismantle the commodification of bodies under modern capitalism, there is hope for a kinder future here.

GEN_ had its World Premiere at the Sundance Film Festival on January 24, 2025.