Lack of health protocol and parental support harms transition of trans children

Eduardo (not his real name) is a happy child.

The 13-year-old boy likes to ride his bike, play volleyball with friends and go to the beach on the north coast of São Paulo, where he lives with his family. When he grows up, he wants to be a libero on a professional volleyball team or study marine biology.

Eduardo is also a trans boy. “I don’t think I’m different from other friends at my school,” he says. He knows he’s a boy “since he was one year old”, and he counts on his parents’ support to live his gender identity freely.

About three years ago, she started taking puberty blockers, which prevent the development of secondary sexual characteristics, such as breast growth and the onset of menstruation. The drug is also used to delay the effects of sex hormones in children diagnosed with precocious puberty.

“Without the block, I would feel uncomfortable with feminine characteristics. Maybe I would have difficulty in practicing some sports”, says Eduardo. The family asked to remain anonymous for fear of being the target of judicial persecution, which could jeopardize the child’s access to medical care.

Most trans children and adolescents face difficulties in having their medical needs met. The absence of a federal protocol, the unpreparedness of medical teams and the lack of support from parents are the biggest obstacles for transsexuals under the age of 18 to access health services in Brazil.

Fúria (not her real name), 21, ran away from her parents’ house in Paraná and came to São Paulo at age 18. She buys hormones at the pharmacy even without a prescription, and takes it on her own so that her body has more feminine traits. She says that, if she had conditions and the support of her parents, she would have started her transition at the age of 12.

A resident of Casa Florescer, a reception center for trans women and transvestites in Bom Retiro, central São Paulo, Fúria learned to self-hormonize with older transvestites. The practice, when done without medical supervision, increases health risks, such as thrombosis and liver problems.

“I don’t care about the risks. Being a transvestite and living on the street, we end up letting go of our health”, he says. She avoids the SUS (Unified Health System) because of the delay in scheduling appointments and the recurring lack of hormones at the posts.

The performance of pubertal block and hormoneization in trans children and adolescents is not prohibited in Brazil, but suffers from a lack of regulation. The CFM (Federal Council of Medicine), by means of a 2019 resolution, indicates blockers from the first signs of puberty, and hormonalization from the age of 16. Body modification surgeries are prohibited for anyone under the age of 18.

On the other hand, the Ministry of Health does not recommend the procedures for underage trans patients. The decision is based on a 2013 ordinance. “It is up to the medical team of each location to indicate the appropriate procedures for each case”, says the folder, through its press office.

The report found only six SUS establishments across the country that offer pubertal block or hormone therapy for transgender people in this age group. The North and Midwest regions are unassisted.

Seeking care through private offices is also a challenge. There are frequent reports of doctors refusing to see trans patients. And, while body modification surgeries have mandatory coverage by health plans, the same does not apply to blocking and hormonalization, informs the ANS (National Supplementary Health Agency), in a note.

Performing these procedures can help to avoid disorders such as depression and anxiety, explains psychiatrist Alexandre Saadeh, coordinator of Amtigos (Transdisciplinary Gender Identity and Sexual Orientation Outpatient Clinic), linked to the Psychiatry Institute of the Hospital das Clínicas da USP (University of São Paulo). Paul). The unit is a pioneer in the country in serving trans children and adolescents.

The lack of assistance can also exacerbate gender dysphoria, as is the acute discomfort that some trans people feel in relation to their own bodies, a condition that can lead to self-mutilation and suicide attempts in more severe cases. It is worth remembering that not all trans people perform medical interventions.

“The blockage is fully reversible and, when properly monitored, has few risks,” says Saadeh.

“Hormonization is partially reversible, that is, one part, when suspended, follows biology, the other will need other medical interventions. That’s why the importance of careful monitoring and the most accurate diagnosis possible to not put the teenager in this situation. “

A study by the Trans Youth Project, an entity that serves trans children and adolescents in the United States and Canada, points out that, five years after the transition, only 2.5% of the participants returned to identify with the gender they were assigned at birth.

Psychologist Ricardo Barbosa, coordinator of the Comprehensive Health Clinic for Transvestites and Transsexuals at the STD/Aids Reference and Training Center in the state of São Paulo, explains that municipal and state departments must follow the regulations of the Ministry of Health.

“I have no doubt that there should be a review of the ordinance [de 2013 da pasta]. Care lines should be created aimed at this segment of the trans population [menores de 18 anos]. But this has to come from a federal regulation”, says Barbosa.

He also states that health professionals must be prepared to serve the trans population. It is common for this group to experience embarrassment in health facilities, such as being called by their registered name instead of their social name, and being asked impertinent questions about their bodies.

Even when trans youth find a unit that serves them, the lack of parental support is an obstacle. Healthcare facilities require authorization from a legal guardian to treat patients under the age of 18.

Actress from Recife, Anne Mota, 23, had her mother’s support when she decided to start transitioning at age 16. Mota played a trans teenager who starts taking hormones and seeks to be accepted at school in the movie “Alice Júnior” (2019, available on Netflix).

“Starting hormone therapy in adolescence allowed me to develop a better relationship with my body,” he says. Mota recalls that when a trans youth does not have access to health care or parental support, “he ends up taking hormones on his own, which is very dangerous.”

Eduardo, who intends to continue taking puberty blockers, hopes that being a trans person “does not influence anything” in his life as an adult. “Why can’t a child identify himself the way he wants to? Why does a genitalia have to define everything about him?”