‘GEN_’ Review: An Endearing Italian Doctor’s Wondrous Crusade to Ensure ‘Human Variety’

It begins with spores. Mycelia. Soil. Proliferation. Slowly, rigorously, and with empathy, a rousing field emerges, in the hands of “GEN_’s” director Gianluca Matarrese (“The Last Chapter”), of the vast heterogeneity of our human desires; of our knowable subjectivities about gender, sexuality, and need for progeny; of the gap between interiority and phenotype, between what’s right and what’s permitted, and between a radically patient-focused health care ethos and the deathly catacombs of legality and bureaucracy.

Only a magician — or at least an intrepid, gaily garrulous medical interventionist — can traverse such divides, politically incendiary as they can be.

In mushroom pasture wanderer and esteemed late-career Doctor Maurizio Bini of Milan’s Niguarda public hospital, Matarrese and co-writer Donatella Della Ratta have found such a transformative figure. Bini, whose jocular banter is only upended by his ability to carefully listen and practically intervene, helps people struggling with fertility as well as with their gender transition. He brings these two almost entirely discrete groups of folks closer to their dreamt family situations, relationship arrangements, and sense of physical selves. He affirms them even if he disagrees with their preferences of methods. His reach is well beyond binaries. His grasp of national and European healthcare contexts is thorough.

Mataresse’s reverence for Bini is balanced, matter-of-fact, perhaps a tad bemused. The Italian director, also the main camera operator, is interested as much if not more in magnifying the patients and capturing the range of their emotions — their silent traumas and repressed frustrations, corner smiles and qualified satisfactions. The majority of the film, free of talking heads, occurs in Bini’s consultation room, which we depart only when Bini does, to the neighboring construction site where he scolds workers about how their jackhammering ruins his highly delicate IVF surgeries, to the conference room shared with his capable nursing staff, or to the operation room where he greets the local viola player he’s brought in to soothe a patient during a procedure. 

Some critics say Mataresse’s fly-on-the-wall gaze is reminiscent of Frederick Wiseman. While that isn’t inaccurate, there is a more participatory disposition in how Matarrese trains his camera — not dissimilar to Nicolas Philibert’s approach inside the French psychiatric facility in “At Averroes and Rosa Parks” — and how he frames most patient subjects in profile view. He invites the audience to imagine the full extent of patients’ countenance, while clocking sideways their guardedness and doubts when magician Bini’s opining occasionally lapses into the mode of avuncular both side-ism.

A chirpy, quirky score from Cantautoma, as though orchestrated by the bugs abuzz in the fungal pastures Bini wanders each morning, layers the smart portraiture work the film is doing with a rust-proof optimism: folk are inherently intelligent, professionals are inherently open to dialog, and all the suffixes of “GEN_,” which the title design unspools like a therapeutic thesaurus — genesis, genomics, genealogy, genitals — can and should be understood for their nuances.

And what nuances, what vicissitudes have we! The humdrum, the humor, and the humanity in the documentary’s two dozen or so consultations is palpable, enlivening. The patients themselves are so real, so grounded. I imagined them transplanted over the carousel of headshots in the opening titles of “Orange is the New Black,” wherein Regina Spektor’s lyrics implore us to “remember all their faces,  remember all their voices.” The diversity of Bini’s patients approaches life itself. 

‘GEN_’Bellota Films / Stemal Entertain

A Brazilian woman of darker complexion elects to have IVF with sperm from a Caucasian donor to obviate systemic discrimination, even as Bini comically exclaims that Brazilians come in all skin tones. An incarcerated Egyptian assigned female at birth (AFAB) expresses their determination to transition to male and be transferred to a men’s prison, even as Bini jubilantly slips into his rudimentary Arabic (he’s also proficient in Chinese, it turns out). A trans woman worries that her increasingly frequent morning “semi-boners” bother her boyfriend, even as Bini frothily exclaims, “What a beautiful word!” A trans man indecisively requests Minoxidil to increase his facial hair, to which Bini, slightly irritated by misconceptions surrounding the drug, says coolly, “Everyone gets the beard they deserve.” 

From thorny legislative issues surrounding gender transition treatment for minors to negotiating gender dysphoria in an adolescent twin, from listening deeply to a woman in her late forties traumatized by a cruel former OBGYN’s advice to hearing out non-binary folks still seeking validation from their birth parents, there isn’t a patient for whom Bini won’t pick up the phone, nor is there apparently an entire group of people for whom Bini won’t write a stern article, as he did when angered that the Italian government asked the hospital to house Ukrainian embryos (in fear of losing them to bombs) but did conspicuously nothing for ones from Gaza.

“GEN_” is not interested in rounding out or even overtly challenging its main subject. We know little about Bini’s personal life, other than that his wife is in Bolivia and his daughter in Colorado. We don’t exactly know why he is choosing to retire at this stage, but watching him dance solo at his farewell party, we can only conjecture about his wild youth. 

“GEN_” also eschews standard instincts for storytelling. Some documentarians might have chosen to complicate Bini’s expertise by showcasing another doctor’s different opinion, or follow a patient who would push back on a later visit. Nor does Mataresse explore the hospital’s organization or its unique place within Milan and Italy’s medical network with regard to its IVF and gender transition services. 

The most sustained exchanges that Bini has with his staff are with a nurse, but she isn’t developed as a character who has a clear conflict with Bini. In these infrequent instances, “GEN_” meanders away from its focused, pointillist assembly. It also ends on an underwhelming note. With Bini having put himself out to pasture, the field and the future feel abstract. Maybe this is what (re)generation means?

No doubt “GEN_” is revolutionary in the current political climate. The film is admirable in how it normalizes trans and non-binary subjects, affirms autonomy over bodies and untraditional methods of procreation, and argues decisively for the immense relevance of expert care to interpersonal and larger social well being. Another vital Sundance documentary, “Heightened Scrutiny,” follows a trans male attorney’s battle for the right to gender affirming care in the US, for what might end up being a landmark Supreme Court ruling expected in June 2025. 

The axes of orthodoxies might differ marginally or drastically nation to nation. “GEN_” is ultra clear eyed about the stakes everywhere. At one point, an exasperated Bini remarks, “Legislation shouldn’t stand in the way of human variety.” 

“Human variety.” The term stunned me because it’s a constitutional right as well as a biological and cultural underpinning that we never quite utter aloud using those very words. A demolition of human variety leaves in its wake just a single alternative: call it monopoly, call it autocracy, or simply call it degenerate.

Grade: B

“GEN_” premiered at the 2025 Sundance Film Festival. It is currently seeking U.S. distribution.

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