Brazil's doctors hit the brakes

The Federal Council of Medicine has joined the international shift to caution on puberty blockers

Photo by Matheus Frade on Unsplash

Slow down

Brazil | The Federal Council of Medicine in Brazil has reportedly adopted a more cautious position on gender medicalisation of young people.

The council, the main professional association for doctors, has approved a resolution banning puberty blockers for gender-distressed minors, lifting the minimum age for cross-sex hormones to 18, and not allowing transgender surgery that sterilises until 21, according to an April 10 report in Folha de São Paulo.

Although a text of the April 8 resolution is yet to be released, the news has been confirmed by another media outlet, Gazeta do Povo, and welcomed by Brazil’s sex-realist women’s group MATRIA, which said the council of medicine had the power to remove the licence of doctors who practise contrary to the new cautious policy.

“We need to keep the pressure up so nothing happens to prevent the resolution from being officially published,” one of MATRIA’s directors, Clarice, told GCN.

“It comes at a crucial moment, as there is a lot of pressure on the Health Ministry to broaden ‘trans care’ in our public system and lower ages for hormones and surgeries.”

Brazil’s health system faces challenges and difficult choices about trade-offs. The average person can expect 61.8 years of healthy life. Productivity growth in the economy has stagnated.

On trend

In support of its April 8 resolution, the council of medicine noted the overseas trend towards similar cautious positions on medicalised gender change for minors and cited the UK’s restrictions following the Cass review. The resolution was adopted unanimously, Gazeta do Povo reported.

To justify its decision to raise the minimum age for trans surgery affecting reproductive capacity from 18 to 21, the council invoked a law of Brazil’s congress that allows tubal ligation and vasectomy from the age of 21, Folha de São Paulo reported. (This suggests trans double mastectomy would be available at 18.)

Under the new resolution, medical services that carry out trans surgery that can cause sterilisation must register patients and pass on the information to Regional Medical Councils.

In December, Brazil’s populist-left government under President Luiz Inácio Lula da Silva announced an activist-influenced Trans Population Health Care Program (PAES Pop Trans) supposed to be worth R$ 152 million ($US 25.9m) by 2028.

The program would allow early puberty blockers (at Tanner stage 2), cross-sex hormones at age 16 and trans surgery at 18.

However, the enforcement regulation for PAES Pop Trans has yet to be published, the program has already faced opposition, and it now looks “completely out of touch with what doctors are recommending,” Clarice said.

She said MATRIA, established in 2023, campaigns for “the rights of children and young people to a life without medical intervention disguised as ‘gender affirmation’,” as well as defending women’s sex-based rights.

The April 8 resolution from the council also stipulates sex-based access to medical specialists.

Folha de São Paulo reported that the text of the resolution “states that trans people who keep organs of their original biological sex must continue with preventive and therapeutic care with specialists in the corresponding field.

“This means that transmen with female reproductive organs should continue to see gynaecologists, while transwomen with male organs should see urologists.”

Clarice said the council’s April 8 resolution revoked one from 2019, which was broadly in line with the Lula government’s proposals, but limited puberty blockers to clinical trials.

She said that although Brazil’s Health Ministry sets higher age thresholds for hormones and surgery than the 2019 resolution of the council, it is the latter more relaxed regime that has typically been followed, even by doctors in the public health sector.

“There was, of course, good will from the government that has been going along with trans stuff for many years, so there was no interest in going after doctors who were using the [2019] resolution,” she said.

She suspected that doctors would follow the council’s new April 8 resolution “for fear of losing their licence to practice,” even if the government’s PAES Pop Trans program were implemented.

“There would certainly be a lot of court cases using one decision or the other, by both sides,” she said.

Clarice said MATRIA in the last two years had taken part in “many court cases, defended women persecuted, done advocacy with the government, politicians, medical bodies, ordered the first national opinion poll on trans issues, brought international books to Brazil (Helen Joyce’s and Jennifer Bilek’s) and a lot more.

“Women in our group come from every side of the political spectrum—[things are] very polarised in Brazil right now—and all walks of life,” she said.

“We hope our advocacy here can help implement protections for women and young people, through laws and the reversal of judicial decisions that allow for complete self-ID for all purposes and criminalise those who commit “transphobia”— recognising someone’s sex, basically.”