Trans limbo
Brazil's plan to accelerate the gender medicalisation of minors has come to a halt
Second thoughts
The populist-Left Lula government in Brazil has reportedly shelved a contentious transgender health program that would have lowered the age thresholds for hormones and surgery such as double mastectomy.
Under the program known as PAES Pop Trans, taxpayer-funded hormones now restricted to adults would be available from the age of 16 and the threshold for trans surgery would drop from 21 to 18, while experimental puberty blockers would be provided to minors outside clinical trials.
The shorthand PAES Pop Trans—Specialised Health Care Program for the Trans Population—refers to the Portuguese title Programa de Atenção Especializada à Saúde da População Trans.
On June 19, the newspaper Jornal de Brasilia quoted anonymous officials from the Ministry of Health claiming that publication of the program—a long-standing demand of LGBTQ lobbies—had been suspended “due to the Lula administration’s fear of becoming a target of right-wing lawmakers”.
On the record, however, a ministry spokesman cited unresolved litigation as an obstacle. Activists have filed a Supreme Court challenge to new, more cautious restrictions on hormonal and surgical transition of young people imposed in April by a resolution of the Federal Council of Medicine, which regulates and licenses doctors.
The council’s unanimously adopted resolution, which cited England’s Cass review, bans new treatment with puberty blockers for gender-distressed minors, lifts the minimum age for cross-sex hormones to 18, and prohibits trans surgery that potentially sterilises until age 21.
The sex-realist women’s group MATRIA welcomed news that the PAES Pop Trans program had been suspended. One of the group’s directors, Clarice, told GCN—
“The fact that the government decided not to proceed with this program is a significant development that, along with the new resolution from the Federal Council of Medicine, protects minors from unnecessary medical interventions.
“We hope this is the start of a new approach to policies in Brazil, based on science and not the demands of activists.”
She said the activist-driven program was the result “of a very shady process that MATRIA has been denouncing since 2024. It happened inside our Ministry of Health, but didn’t follow the basic rules the government has to follow”.
Bruna Benevides, the sailor-turned-president of the National Association of Transvestites and Transsexuals (ANTRA), told Jornal de Brasilia that there was “no acceptable justification” for failing to publish the ordinance (portaria) to enable PAES Pop Trans; this ordinance had been ready for more than a year.
Benevides, who identifies as a woman, said the delay contributed to “the worsening of barriers to access to health care for transvestites and trans people, especially the youngest.
“Publishing the ordinance is, at this moment, a necessary political and institutional response commensurate with the symbolic and concrete violence we are facing.”
Maritime campaign: ANTRA activist Bruna Benevides, who enlisted in Brazil’s Navy at age 17, allegedly faces expulsion for being a trans woman
Not by the book
In early March this year, following MATRIA’s application under Access to Information law, the newspaper Gazeta do Povo reported “several irregularities involving uncontrolled spending, irregular appointments to positions and a lack of scientific basis” in the development of PAES Pop Trans.
The ambitious government program was to provide lifelong cover for trans-identified adults and young people in the public health system, with the cost expected to reach R$152 million ($US27.4m) by 2028.
Gazeta do Povo said the irregular appointment of members to a working group to design PAES Pop Trans made it difficult to scrutinise their conflicts of interest, and there had been no preparatory summary of the scientific evidence.
“Experts consulted warn that without this prior assessment [of the evidence base for gender medicalisation], there is a greater risk that resources will be invested in an initiative without sufficient evidence of effectiveness, which would increase the risk of waste and the need for late corrections to minimise negative impacts,” the newspaper said.
Brazil’s health system faces serious challenges—about 70 per cent of people have at least one chronic disease by age 60—and difficult choices about trade-offs in priorities and funding. Productivity growth in the economy has stagnated.
“MATRIA is alert to ideological movements that seek to overturn the [Federal Council of Medicine’s April 8] resolution prohibiting medical transition for minors.
“We are [involved as a ‘friend of the court’] in the case currently before the [Supreme Court], where we have presented technical and scientific evidence, unlike the initial petition filed by trans activist organisations, the content of which is based on argumentative juggling and postmodern neologisms.”—MATRIA, statement, 27 June 2025
Legal liability
In late March, drawing on the official documents it obtained, MATRIA’s lawyer sent a 13-page denunciation of the PAES Pop Trans process to Health Minister Alexandre Padilha and 15 other Brazilian authorities, including the Federal Public Prosecutor’s Office and the National Council for the Rights of Children and Adolescents.
The MATRIA document said that, “Instead of due process, a shortcut was taken in decision-making [for PAES Pop Trans] which, in the name of urgency, abandoned prudence and legal compliance—exposing children and adolescents, individuals without full capacity to consent, to interventions with potentially permanent effects on fertility, bone maturation, psychological structure, and bodily identity.”
It warned that these irreversible medical interventions “may, in theory, constitute criminal offences under Article 129 of the Penal Code, especially in the serious and very serious forms of bodily injury (paragraphs 1 and 2), since they involve the possibility of causing permanent functional impairment, loss of reproductive capacity, lasting psychological damage, deformity or even risk to life.”
And MATRIA also argued that any official embrace of the PAES Pop Trans program “constitutes tacit acceptance of risk and, therefore, generates strict liability on the part of the Brazilian state for the physical, psychological, existential, and reproductive damages caused to the children and adolescents subjected to such interventions.”
GCN has sought comment from Brazil’s Ministry of Health.
The Lulu government has demonstrated good judgement in keeping with the global trend. Multiple nations known for their high standard of health services including the UK, Denmark, Sweden, Finland, Norway and 25 States in the US have backtracked on the provision of the ‘Affirmative Model of Gender Care’, including the UK, Denmark, Sweden, Finland and Norway and 25 States in the US and there can be little doubt that the trend will continue.
Good call Brazil!
It's a shame that only the threat of legal liability was able to bring about a more cautious approach to the medicalization of gender distress. The probability of real harm to minors didn't seem to be much of an incentive -- it's only the possibility of being sued that caught the attention of government officials.