A recent wave of restrictive public policies across various countries, exemplified by Brazil’s latest medical guidelines, threatens to unravel the progress made in transgender healthcare and research, potentially causing significant setbacks for this vulnerable population. A compelling article published in the prestigious journal Nature Medicine by Brazilian researchers highlights the urgent need to reconsider these regressive measures and calls for evidence-based, ethically grounded care frameworks to remain intact.
In April 2025, Brazil’s Federal Council of Medicine (CFM) enacted Resolution No. 2,427, which substantially amends prior standards governing transgender healthcare. This new framework categorically bans the clinical use of hormone blockers in individuals under 18 years of age, raises the minimum age for cross-sex hormone therapy initiation from 16 to 18, and restricts gender-affirming surgeries exclusively to those who have reached 21 years. The implications extend beyond clinical practice, explicitly impeding research on hormone blockers in transgender youth, thereby constraining the generation of new scientific knowledge.
Hormone therapy protocols involve administrating sex hormones to align an individual’s physical characteristics with their gender identity, a practice established under the former CFM Resolution No. 2,265, enacted in 2020. Prior regulations enabled medical professionals to undertake such treatments with specific safeguards, boosting both therapeutic efficacy and patient safety. The new resolution’s prohibition creates a chilling effect on healthcare providers who fear legal or professional repercussions, ultimately disrupting access to essential medical care and fostering increased mental health risks, including heightened rates of depression, social isolation, and suicide among transgender youth.
The scientific underpinning for hormone blockers and cross-sex hormone therapy is robust, supported by longitudinal studies demonstrating low adverse event frequencies and minimal regret rates, with detransition observed to affect less than 2% of patients under proper clinical protocols. The pioneering Transdisciplinary Outpatient Clinic for Gender Identity and Sexual Orientation (AMTIGOS) at the University of São Paulo’s Hospital das Clínicas has been a beacon of comprehensive, evidence-based care, treating nearly 500 transgender minors across a decade. The disruption of such established care pathways threatens not only individual health outcomes but also the integrity of clinical research required to refine and improve treatment approaches.
Experts involved in the article, including psychiatrist Alexandre Saadeh and Professor Bruno Gualano, emphasize that gender diversity is a natural human variation transcending cultural and geographical boundaries. Efforts to restrict gender-affirming care infringe upon the principle of progressive autonomy embedded in Brazil’s Statute of the Child and Adolescent (ECA), which ensures youths’ involvement in healthcare decisions consistent with their evolving capacity. The current regulatory environment undermines this autonomy, stifling individualized care and eroding trust between patients, families, and healthcare providers.
Critically, the CFM justifies its resolution by citing similar policy shifts in countries like Sweden, Norway, Finland, England, and the United States, where puberty blockers and hormone therapies for minors have also faced increased scrutiny. However, in many of these settings, restrictions typically come with provisions for research and ongoing evaluation rather than absolute prohibitions. Brazil’s resolution uniquely quashes not only treatment but also investigative initiatives, thereby hampering the evidence base necessary for informed policymaking and clinical guidelines.
The exclusion of transgender youth from appropriate healthcare services due to political or ideological motives carries profound ethical consequences. Restrictive policies risk driving young people toward clandestine or unregulated medical avenues, including self-medication or consultation with unqualified practitioners, amplifying health disparities disproportionately affecting low-income populations. Such systemic barriers endanger the fundamental human right to health, potentially reversing important gains in social inclusion and well-being achieved through dedicated, multidisciplinary care.
AMTIGOS exemplifies a holistic model of care incorporating psychiatric evaluations and multidisciplinary interventions across speech therapy, psychology, social work, nutrition, and physical education, with active family engagement. Patients transition through the clinic’s services from initial screening to adulthood, embodying an integrative approach aligned with international standards. The rollback of these services reflects a broader global trend where political and ideological forces override medical expertise, a situation reminiscent of historical battles over health equity in fields ranging from HIV/AIDS to reproductive rights.
Beyond clinical implications, restrictions on transgender healthcare obstruct academic inquiry and scientific progression. The prohibition of hormone blockers for minors effectively nullifies the prospect of accruing longitudinal data required to evaluate safety, efficacy, psychosocial outcomes, and comorbidities such as eating disorders. Researchers like Gualano and nutritionist Bruna Caruso Mazzolani spearhead ongoing projects addressing these vital areas, with preliminary findings underscoring the dissatisfaction and concern among patients and their families about the imposed policy changes.
Brazil currently lacks comprehensive epidemiological data on its transgender population, especially younger cohorts, complicating public health planning and resource allocation. Estimates from the Botucatu School of Medicine suggest approximately 3 million Brazilians identify as transgender or non-binary, representing about 2% of adults, yet this remains an under-researched domain. The 2023 National Demographic and Health Survey’s inclusion of sexual orientation and gender identity metrics represents a hopeful step, yet its unpublished results leave a vital knowledge gap.
Global parallels further illustrate the ongoing debate over transgender healthcare. The United Kingdom’s National Health Service restricts puberty blockers to controlled research environments only, signaling caution but not wholesale prohibition. Conversely, several U.S. states, influenced by federal executive directives, have enacted bans on gender-affirming care for minors, sometimes defying endorsements by authoritative medical bodies advocating evidence-based protocols. These disparate policies generate a fragmented landscape laden with ethical challenges and jeopardize the health and rights of transgender individuals worldwide.
Ultimately, the Brazilian researchers urge the medical community, academic institutions, funding bodies, and scientific publishers to collectively reaffirm their commitment to evidence-based transgender care. They stress the necessity of decoupling medical policies from ideological interference in favor of grounded scientific principles and human rights. Upholding the dignity, autonomy, and health of transgender youth is a litmus test for society’s broader commitment to equity and justice, demanding immediate attention in the face of potentially regressive legislation.
Subject of Research: Transgender healthcare policies and their impact on medical treatment, research, and rights, with a focus on hormone therapy and healthcare regulations for transgender youth in Brazil and comparative international contexts.
Article Title: The global rollback of transgender care, science and rights
News Publication Date: 1-Jul-2025
Web References:
- Nature Medicine article: https://www.nature.com/articles/s41591-025-03805-5
- CFM Resolution No. 2,427 (2025): https://sistemas.cfm.org.br/normas/arquivos/resolucoes/BR/2025/2427_2025.pdf
- CFM Resolution No. 2,265 (2019): https://sistemas.cfm.org.br/normas/arquivos/resolucoes/BR/2019/2265_2019.pdf
- Trump Administration Executive Order: https://www.whitehouse.gov/presidential-actions/2025/01/protecting-children-from-chemical-and-surgical-mutilation/
- Botucatu School of Medicine Scientific Reports: https://www.nature.com/articles/s41598-021-81411-4
References:
Saadeh, A., Gualano, B., Mazzolani, B.C., et al. The global rollback of transgender care, science and rights. Nature Medicine (2025). DOI: 10.1038/s41591-025-03805-5
Keywords:
Transgender identity, hormone therapy, medical treatments, health care policy, transgender youth, puberty blockers, gender-affirming care, Brazil, public health, ethics, scientific research
