By Luciano Nascimento
Brazil’s Federal Council of Medicine (CFM) on Thursday (Jan. 9) issued a resolution changing the rules governing procedures directed at transgender people.
The new rules reduce the minimum age for gender reassignment surgery from 21 to 18 years old and stipulate that cross-sex hormone therapy must not be administered until the age of 16.
The move is believed to help monitor the health condition of trans people and train health agents whose job is to offer assistance to this segment of the population.
“This subject has been debated for 15 years. This resolution comes as an enhancement, a maturing of concepts. It deals mainly with the inclusion of the needs of these people in health care, encompassing treatments—like hormone treatment. It also bring surgical procedures up to date,” said CFM head Donizetti Giamberardino at a press conference.
“If no rules are made, you can end up causing a lot more harm and taking inappropriate attitudes, often with no scientific criteria,” he added.
Care for transgender individuals must be offered by a multidisciplinary team of doctors including a pediatrician, if the patient is younger than 18, a psychiatrist, an endocrinologist, a gynecologist, a urologist, a plastic surgeon, and more.
The text says that transgender children and adolescents must receive treatment from a medical team, with no hormone or surgical intervention (see below). An individual treatment plan must be adopted for any procedure.
The execution of surgical and hormone procedures in people diagnosed with some severe forms of psychotic disorders, personality disorders, mental retardation, and global developmental delay was banned.
The resolution also bans the use of hormone therapy procedures aimed at blocking hormones in transgender children and adolescents that have not yet reached puberty.
The procedure may be conducted following an evaluation by the medical team or when the child is entering puberty—a period that may vary from 8 to 13 years old for children with female biological sex, and 9 to 14 for children with male biological sex.
In such cases, after the assessment, patients may start taking a substance to inhibit the development of secondary sex characteristics associated with the gender the child or adolescent does not identify themselves as, like breasts, menstruation, a beard, or a deep voice.
Also, cross-sex hormone therapy—when blockers are coupled with hormone replacement—may be administered at 16 or above, experimentally.
From the age of 18 and above, the procedure now requires a special prescription by an endocrinologist, gynecologist, or urologist.
In the resolution, CFM also recognizes identity expressions such as “trans man” and “trans woman,” as well as “travesti” and other phrases linked to gender diversity.
Psychiatrist Leonardo Luz, rapporteur for CFM’s resolution, says the move brings the de-pathologization of transsexuality to the center of the debate and introduces world nomenclature to talk about the subject.
Among the terms updated are “gender incongruence”—used to indicate that an individual’s experienced gender does not match the sex assigned at birth—and “sexual affirmation,” for the hormone or surgical procedure, rather than “sexual reassignment.”
“The council adopts the world nomenclature of gender incongruence and is making strides in care from childhood to adult life and attempts to encourage other professional to seek training and promote education through medical residency programs so that we can have more centers for people who need this kind of assistance,” he declared.