Gianluca Matarrese’s GEN_, which just premiered in the World Cinema Documentary Competition at Sundance, employs an absorbingly intimate vérité style to explore the fascinating work of Dr. Maurizio Bini. On the cusp of retirement, Bini runs a department in Milan’s publicly-funded Niguarda hospital which offers both fertility and gender-affirming care treatments free of charge. Matarrese, and his co-writer Donatella Della Ratta, effectively cut through the noise of the politicization of both of these areas of medical treatment to bring us the human stories behind the legislation, damaging rhetoric and sensationalized media headlines.
The film opens with what appears to be a cosmic scene taking in the vastness of outer space, a sense that is enhanced by Michelle Lunna Alexa’s atmospheric sound design incorporating radio static and electronic beeps evoking NASA mission control. It soon becomes clear though that what we are in fact being presented with is something no less remarkable, human cells under the microscope as the delicate laboratory work of in vitro fertilization (IVF) is carried out.
A neutral description of how the artificial insemination procedure is conducted is interrupted by an increasingly unsettling soundscape of voices stating things like, “Trans minors do not exist” and “These ideas have been bombarded by the LGBTQ+++ propaganda – crazier than ever”. A snippet of a news report informs us of a Missouri state law banning all forms of gender-affirming care for minors. Watching this opening section of the film, it is hard not to think of last week’s inaugural address declaration—”As of today, it will henceforth be the official policy of the United States government that there are only two genders: male and female”—along with the President’s subsequent continuing slate of executive orders.
Matarrese succinctly establishes the political climate in Italy under the right-wing government of prime minister Giorgia Meloni when it comes to targeting LGBTQ rights and fertility treatment. Thankfully, the cacophony of politics and opinion soon subsides, giving way to a serene pastoral scene as we follow Dr. Bini into the forrest near his home to forage for mushrooms. Speaking with a patient who is a fellow mushroom enthusiast later in the film, Dr. Bini shares that one thing he likes about mushrooms is that most people are not aware that there are males and females, unlike the obsession that many have with policing gender when it comes to humans. On his drive to work, we hear Meloni’s charged words on the radio stating, “We are all born of one man and one woman…the uterus is not for sale.”
Vital to the film’s success is the astonishing access that Matarrese has managed to secure, having been granted permission to take his camera inside Dr. Bini’s office along with the consent of his patients to allow their confidential, often deeply personal conversations to be recorded and shared with the public. The majority of the running time is spent observing Dr. Bini’s consultations during which we meet an array of patients seeking IVF treatment or gender-affirming care. We learn that the combination of the two practices in one department was only meant to be a temporary measure, but Dr. Bini explains that it ended up working so well that it has continued, proving to be “the right niche”, as he puts it.
Early on, we meet an older cisgender heterosexual couple who have come to Dr. Bini following three miscarriages. He assures them that he will help despite the fact that the woman is about to hit the newly legislated age limit set by the Italian government for IVF of 46 . With Dr. Bini stating, “We don’t care, we’ll do it anyway”, and going on to add, “If there are any consequences, I’ll be the one to deal with that”. Dr. Bini’s work butting heads with the government’s regulation is a recurring theme throughout, exemplifying what he is up against in a field that has become so politicized by a government keen to tell people what they are allowed to do with their own bodies, rather than leaving it to a doctor’s judgement.
After his department has been subject to an inspection, Dr. Bini sums things up as a clash between healthcare professionals with their “humanistic, empathetic approach” and the government’s “legal, bureaucratic vision”, adding that “legislation should not stand in the way of human variety”.
Dr. Bini is a compassionate realist and handles his patients with care and concern. He is also frank and says what it on his mind, making clear that as the doctor he in charge and will make decisions based on his own knowledge and experience, not what his patients ask for or think they need. For instance, when a trans woman shares that she would like to have facial feminization surgery, he refocuses her attention. “I’ll be your guide”, he gently asserts. “You don’t have a correct perception of your body, you’re fine like that. Very, very, very fine. Many biological women would kill to look like you.” Before going on to encourage her to focus on the vaginoplasty that she has requested which he thinks is a good idea for her.
When a non-binary patient shares that they are still trying to decipher how they identify when it comes to their gender, they go on to suggest that they might be more feminine because they do housework. Dr. Bini quickly interrupts them saying, “You’re all about stereotypes”, which seems to immediately defuse his patient’s stress. With a lively sense of humour, he is quick to put even his most anxious patients at ease and we see a series of troubled expressions transform into beaming smiles during their consultations as he gives guidance and reassurance. The relief and joy that he brings to his trans patients and potential parents is palpable, along with the enormity of the impact he is having on their lives. Getting to the point of seeing Dr. Bini has been a long road for many of them, with one patient sharing that for her gender-affirming care is “a matter of life or death”.
Dr. Bini takes the time to attempt to reconcile families, wanting the parents of his adult trans patients to at least be informed about what is happening medically even if they can’t accept their children’s decisions. When one adult patient shares that his adoptive parents are not supportive of his transition—which is devastating to him as it feels like another abandonment after been given up for adoption—Dr. Bini calls his mother and invites her to meet him. While we see accepting parents of trans minors accompanying their children to appointments, with Dr. Bini observing that in contrast to previous generations, many parents have shifted their priorities to their child’s wellbeing and happiness rather than asserting their own opinions of how they should be upon them.
We see Dr. Bini’s dedication throughout and he is never on “auto-pilot” as he warns his successor, Dr. Parazzoli, can happen for doctors when they are continually doing the same job over several deacades. That devotion is apparent as we see him halt construction workers whose jackhammers are causing the hospital building to vibrate while IVF lab work is going on.
Giorgia Villa’s editing allows each scene space to breathe, building an unhurried pace that gives us time to get to know Dr. Bini and his patients while also helping to take the sensationalism out of these areas of work. Matarrese is listed in the credits as both a sound recordist and camera operator and one assumes that he was the solo crew member in Dr. Bini’s consulting room, resulting in non-intrusive and relatively static camerawork that doesn’t draw attention to itself. Matarrese never uses music to manipulate the viewer, while Cantautoma’s jazzy score often feels like a breath of fresh air that evokes Dr. Bini’s upbeat spirit. In one striking sequence, the music is courtesy of a professional musician’s viola playing in Dr. Bini’s surgery, with the doctor sharing that he thinks “the embryos will like it” and that he hopes it will make them “cling more tightly”.
The prefix GEN_, which gives the film its title, stands in for various terms which are briefly formed as they complete the word during the opening credits, including: “genesis”, “genitals”, “genealogy”, “generation”, “genetics” and “genomes”. It helps to convey the expansive nature of Bini’s work which takes in questions of when life itself begins and when it should be preserved as perceived by science, politics, and religion. At one point, Dr. Bini shares that he has written an article taking issue with the way the Italian government, which is storing Ukrainian embryos to keep them safe during the conflict there, is not doing the same for fertility centres in Gaza. It is a concern that is typical of the compassion of this man whose respect and professional fondness for his patients, and satisfaction in his work, radiates from him. Along with his commitment to doing what he thinks is right as he treats those in his care with dignity as individuals.
Here in the United States, the ACLU is currently tracking 245 anti-LGBTQ bills, 43 of which aim to restrict gender-affirming care, while the Human Rights Campaign reports that of August 2024 39.4% of trans youth were living in the 26 states that have already passed bans on gender-affirming care for minors. With its gentle observational lens, GEN_ is a powerful assertion that such personal healthcare decisions, that have a monumental effect on an individual’s life, should be left between a doctor and their patient.
By James Kleinmann
GEN_ world premiered at the Sundance Film Festival 2025 where it will screen again in-person in Park City, Utah on January 31st at 2:45pm MST and February 2nd at 10:20am MST. The film is also available to stream nationwide on-demand via the festival’s online platform from January 30th until February 3rd. For more details and to purchase tickets visit the Sundance Film Festival website. Read more LGBTQ+ highlights at Sundance 2025.
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