Trans fear not getting coverage for sex change after plans win

Thalita, 21, is anxious. The young transsexual from São Paulo seeks, in court, that a health operator pays for her transgenitalization surgery — alteration of Organs genital organs —, which she has been waiting for for years.

She and several other trans people feel insecure after a decision by the STJ (Superior Court of Justice) that changes the understanding of the ANS (National Supplementary Health Agency) list of procedures.

On the 8th, the ministers of the STJ decided that the list should be exhaustive, exempting health plans from paying for procedures not included in it. Previously, the list was seen as an example, opening loopholes for users to seek the cost of procedures outside it in court.

Transgenitalization is not part of the ANS list and, with the current understanding, can be promptly denied. Although the decision of the STJ ministers is not binding, it tends to be followed by judges across the country.

Thalita, who has been on hormone treatment since the age of 18 and has been in psychological care for a longer time, fears the consequences of the STJ’s decision.

“I was optimistic that the trial would look at the trans community. I feel a dire need to be able to love myself more. I can’t live and face my past every day. See that even though I’ve changed my documentation and am in the process of hormonal and psychological therapy, I will never be satisfied”, declares the young woman. “I’m afraid that this anguish will take even longer to heal. I can’t afford the full cost of the surgery privately.”

Lawyer Claudia Ramos, a member of the Sexual and Gender Diversity Commission of the OAB-SP (Brazilian Bar Association) and a member of the Mães pela Diversidade collective, says that it has never been easy to get health care providers to pay for sex reassignment surgery, but the Judiciary, many times, accepted the requests. Now, she assesses, the tendency is for these procedures to be denied and hope is in the STF (Federal Supreme Court).

“[A decisão do STJ] it is an injury to the Constitution, which enshrined the principle of human dignity as one of the fundamental principles of the democratic rule of law. And, in the event of damage to the constitutional text, the STF may be called upon to address the issue. It’s the light we see at the end of the tunnel.”

She explains that some trans people have so-called gender dysphoria, a persistent dissatisfaction or discomfort with sexual characteristics that refer to the gender assigned at birth. “These people can develop a depression, a feeling of total unhappiness and inadequacy.”

In Brazil, clinics charge BRL 45,000 for the procedure. The SUS (Unified Health System) also performs, free of charge, sex reassignment surgery, but the wait is the main obstacle.

In São Paulo, according to information from the state’s Public Defender’s Office, a trans person can be in line for up to 18 years.

The São Paulo State Department of Health states that 284 gender-affirming surgical procedures have been performed in the SUS since 2019, including sex reassignment surgeries, hysterectomy (uterus removal), reconstructive breast plastic surgery and masculinizing mastectomy. When asked about the waiting list in the state, the secretary did not respond.

Amid so much uncertainty, Thalita reports emotional distress. “Being [o procedimento de redesignação] extremely expensive and the public health system so slow, my struggle [na Justiça] it becomes distressing. It’s not just about anxiety or aesthetics, it’s a massive emotional drain,” she says.

Sought for three times and questioned on the subject, Abramge (Brazilian Association of Health Plans) did not comment until the publication of the report.

The ANS only confirmed that the procedure is not part of its coverage list.