MercoPress. South Atlantic News Agency

Brazil more restrictive on gender reassignment procedures

Overdiagnosis in the past few years has been cited as one of the reasons for changing the medical guidelines

A resolution by Brazil's Federal Council of Medicine (CFM) revising ethical and technical guidelines for treating individuals with gender dysphoria was published in Wednesday's issue of the Diário Oficial da União (Official Gazette). The measure introduces key changes, such as banning hormone therapies for individuals under 18 as well as gender reassignment surgeries.

The CFM emphasized the importance of evidence-based changes and highlighted potential risks of treatments, including cardiovascular issues and overdiagnosis among minors. The new regulations do not affect those already undergoing therapy.

The new text defines gender incongruence as a marked and persistent disagreement between the gender experienced by an individual and their assigned sex, without necessarily implying suffering.

Gender dysphoria, on the other hand, is defined by the document as severe discomfort or suffering caused by gender incongruence.

The text prohibits doctors from prescribing hormone blockers to treat gender incongruence or gender dysphoria in children and adolescents.

“The prohibition does not apply to clinical situations recognized by medical literature, such as precocious puberty or other endocrine diseases, in which the use of hormone blockers is scientifically indicated.”

In addition, cross-sex hormone therapy (administration of sex hormones to induce secondary characteristics consistent with the patient's gender identity) will now only be allowed for people aged 18 or over.

According to the publication, patients who opt for cross-sex hormone therapy must:

- Start a medical assessment, with emphasis on psychiatric and endocrinological monitoring for at least one year before starting hormone therapy;

- Obtain a cardiovascular and metabolic evaluation with a favorable medical opinion before starting treatment;

- Not have a serious psychiatric illness, other than dysphoria, or any other illness that would contraindicate cross-sex hormone therapy.

The resolution also restricts access to gender reassignment surgery for transgender people before the age of 18 and, in cases where the procedure implies a potential sterilizing effect, before the age of 21.

“The gender affirmation surgical procedures provided for in this resolution may only be carried out after prior monitoring of at least one year by a medical team,” the document mentioned.

Services that carry out this type of surgical procedure must register patients and ensure that this information is made available to the regional medical councils of the jurisdiction in which they are based.

In cases of regret or so-called de-transition, the text stipulates that the doctor must offer welcome and support, assessing the physical and mental impact and, where necessary, redirecting the patient to appropriate specialists.

According to the CFM, transgender individuals who retain organs corresponding to their biological sex should seek preventive or therapeutic care from an appropriate specialist. “Transgender men who retain female biological organs should be seen by a gynecologist. Transgender women with male biological organs should be seen by a urologist,” the resolution stressed.

The new rules do not apply to people who are already using hormone therapy or puberty blockers.

CFM President José Hiran Gallo emphasized that the resolution was unanimously approved by the plenary of the entity. “All 28 councillors present approved this resolution,” he said.

Gynecologist Rafael Câmara, a council member for the state of Rio de Janeiro and one of the resolution's rapporteurs, pointed out that this is a topic in which evidence and facts change all the time. “It's natural for these resolutions to be changed,” he added.

When dealing with the prohibition of cross-sex hormone therapy for children under 18, he recalled that the previous CFM resolution established 16 as the minimum age for administering sex hormones for this purpose.

“It's not something innocuous,” he said, citing risks such as an increase in cardiovascular and liver diseases, including cancer; reduced fertility; baldness and acne, in the case of testosterone; and thromboembolic problems and breast cancer, in the case of estrogen.

Regarding hormone blockers, the physician pointed out that the use of this type of therapy to suppress puberty in children and adolescents is the subject of frequent discussion and questioning.

Câmara recalled that in April last year, the UK abolished the use of sex blockers. According to him, Finland, Sweden, Norway, and Denmark, “countries with strong health systems and progressive tendencies”, have also banned the therapy.

“Exposure to sex hormones is important for bone strength, proper growth, and the development of sexual organs,” he said, citing compromised bone density, altered height, and reduced fertility among the consequences.

The doctor stressed that the ban on the use of blockers does not apply to clinical situations recognized by medical literature in which their use is scientifically proven, including precocious puberty and endocrine diseases.

Câmara also cited the increase in reports of transition regret and even sexual de-transition since 2020, which has led several countries to revise their protocols for dealing with gender incongruence and dysphoria.

Another point he highlighted is overdiagnosis, especially among minors. “More children and adolescents are being diagnosed with gender dysphoria and thus taken for treatment. Many, based on studies, in the future might not be trans, but simply gays and lesbians.”

“Studies show that, a few years ago, the tendency, when there were diagnosed cases [of gender dysphoria], was to try to make sure the child didn't maintain [the condition]. Today, the tendency is to have a confirmation bias. If a 4-year-old child says they're trans, many services end up maintaining or encouraging it.” (Source: Agencia Brasil)