RESUMO
OBJECTIVE: To synthesize scientific evidence to characterize health care for transvestites and transsexuals in Brazil. METHODS: This is a systematic review, conducted from July 2020 to January 2021 and updated in September 2021, whose protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO) platform, under code CRD42020188719. The survey of evidence was carried out in four databases and eligible articles were evaluated for methodological quality, and those with a low risk of bias were included. RESULTS: Fifteen articles were selected and the findings were grouped into six categories according to their thematic approaches: Possibilities to transform health care; Transvestiphobia and transphobia: violations inside and outside the Brazilian Unified Health System (SUS); Professional unpreparedness to care for transvestites and transsexuals; Search for health care alternatives; Right to health for transvestites and transsexuals: utopia or reality?; The Transsexualization Process: advances and challenges. CONCLUSIONS: There is evidence that health care for transvestites and transsexuals in Brazil is still exclusive, fragmented, centered on specialized care and guided by curative actions, resembling the care models that preceded the SUS and which have been heavily criticized since the Brazilian Sanitary Reform.
Assuntos
Transexualidade , Travestilidade , Humanos , Brasil , Atenção à Saúde , Transexualidade/terapiaRESUMO
El término transgénero hace referencia a aquellas personas cuya identidad de género (masculino -femenino) difiere del sexo (hombre mujer). La persona transgénero presenta un conflicto entre la identidad sexual y su condición biológica, debido a que esta última, ya está ajustada a unas características que están dadas desde el nacimiento. Una de las mayores dificultades que presentan es en la feminización de voz, debido a que esta es percibida como la del género opuesto. Por ello, usualmente realizan cambios vocales sin una técnica adecuada, recurriendo principalmente a tratamientos quirúrgicos u hormonales, desconociendo la terapia fonoaudiológica como una alternativa para mejorar su calidad vocal e interacción social. Dado lo anterior, el objetivo de este trabajo fue determinar la efectividad de la intervención fonoaudiológica para la feminización de la voz en una persona Transgénero MTF (Male to Female). Se utilizó un diseño descriptivo, cuantitativo, usando un diseño longitudinal de serie de estudio de caso de reversión ABA. La intervención se estructuró, principalmente, en tres apartados: evaluación inicial, intervención y reevaluación final. Los resultados mostraron una variación significativa en las cualidades acústico-perceptuales de la voz, la que presentó mayores características de una voz femenina, con modificaciones en el patrón fonorespiratorio y en la postura. En conclusión, la intervención fonoaudiológica fue efectiva debido a que se lograron cambios que permitieron lograr una voz más femenina en la persona tratada.
The term transgender denotes a person whose gender identity (male-female) is different from their sex (men-women). A transgender person presents a contradiction between sexual identity and biological condition, because the latter is determined by certain given characteristics since birth. One of the most difficult issues is the feminization of the person's voice (in the case if male to female), since it is perceived as being in the opposite end of gender. For this reason, usually male to female transgenders engage in vocal changes without appropriate techniques, resorting mostly to surgical procedures or hormonal treatments and ignoring speech and language therapy as an alternative to improve their vocal quality and social interaction. Therefore, the main goal of this work was to determine the effectiveness of the phoniatric intervention in order to produce the feminization of the voice in a transgender individual MTF. The methodology used is a quantitative, descriptive, using a longitudinal design of ABA reversion case study series. The intervention was structured in three main sections: initial evaluation, intervention and final re-evaluation. The results showed a significant variation in the acoustic perceptual qualities of the voice, with a more feminine voice involving modifications in the phonorespiratory pattern and in the posture. In conclusion, the phoniatric intervention was effective because achieved changes led to a more feminine voice.
Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Transexualidade/terapia , Treinamento da Voz , Fonoaudiologia/métodos , Feminização , Pessoas Transgênero/psicologia , Autoimagem , Qualidade da VozRESUMO
Voice is an important gender marker in the transition process as a transgender individual accepts a new gender identity. The objectives of this study were to describe and relate aspects of a perceptual-auditory analysis and the fundamental frequency (F0) of male-to-female (MtF) transsexual individuals. A case-control study was carried out with individuals aged 19-52 years who attended the Gender Identity Program of the Hospital de Clínicas of Porto Alegre. Vocal recordings from the MtF transgender and cisgender individuals (vowel /a:/ and six phrases of Consensus Auditory Perceptual Evaluation Voice [CAPE-V]) were edited and randomly coded before storage in a Dropbox folder. The voices (vowel /a:/) were analyzed by consensus on the same day by two judge speech therapists who had more than 10 years of experience in the voice area using the GRBASI perceptual-auditory vocal evaluation scale. Acoustic analysis of the voices was performed using the advanced Multi-Dimensional Voice Program software. The resonance focus and the degrees of masculinity and femininity for each voice recording were determined by listening to the CAPE-V phrases, for the same judges. There were significant differences between the groups regarding a greater frequency of subjects with F0 between 80 and 150 Hz (P = 0.003), and a greater frequency of hypernasal resonant focus (P < 0.001) in the MtF cases and greater frequency of subjects with absence of roughness (P = 0.031) in the control group. The MtF group of individuals showed altered vertical resonant focus, more masculine voices, and lower fundamental frequencies. The control group showed a significant absence of roughness.
Assuntos
Acústica , Julgamento , Procedimentos de Readequação Sexual , Acústica da Fala , Percepção da Fala , Medida da Produção da Fala/métodos , Pessoas Transgênero , Transexualidade/terapia , Qualidade da Voz , Adulto , Brasil , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores Sexuais , Processamento de Sinais Assistido por Computador , Transexualidade/fisiopatologia , Transexualidade/psicologia , Adulto JovemRESUMO
RESUMEN La Organización Mundial para la Salud y la American Psychological Association consideran que la transexualidad es una patología y plantean la adecuación sexogenérica para el ajuste biopsíquico de las personas trans. Mediante el análisis discursivo de la experiencia, en este estudio se describen los procesos de medicalización y performatividad del género en su relación con la salud de un grupo de mujeres trans de la Ciudad de México, para lo cual se desarrolló un estudio cualitativo en el que se realizaron, en el año 2015, diez entrevistas semiestructuradas. Como parte de la medicalización, la patologización de la transexualidad generó sufrimiento psíquico; por su parte, la adecuación sexogenérica también implicó riesgos adicionales. Se puede concluir que, en las mujeres trans, la violencia y la exclusión resultan las principales experiencias que explican los problemas de salud más relevantes por lo que se sugiere disminuir la discriminación, así como avanzar en intervenciones médicas más seguras.
ABSTRACT The World Health Organization and the American Psychological Association consider transsexuality a pathology and suggest sex-gender reassignment for the biopsychic adjustment of trans people. Through the discursive analysis of experience, this study describes the processes of medicalization and gender performativity in relation to the health of a group of trans women from Mexico City. For this purpose, a qualitative study was conducted in which 10 semi-structured interviews were carried out in 2015. As part of medicalization, the pathologization of transsexuality generated psychic suffering; on the other hand, sex-gender reassignment also entailed additional risks. It is possible to conclude that in trans women, violence and exclusion constitute the primary experiences explaining their foremost health problems. Therefore, it is suggested that it is necessary for discrimination be reduced and for advancements to be made in safer medical interventions.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Transexualidade/psicologia , Procedimentos de Readequação Sexual/psicologia , Medicalização , Pessoas Transgênero/psicologia , Preconceito/psicologia , Transexualidade/terapia , Saúde da População Urbana , Entrevistas como Assunto , Pesquisa Qualitativa , MéxicoRESUMO
OBJECTIVES: The aim of the study was to verify the answers to the transsexual voice questionnaire for male-to-female transsexual (TVQMtF) people given to individuals who participated in the Gender Identity Program (PROTIG) at the Hospital de Clínicas de Porto Alegre, Brazil, in relation to some of their demographic characteristics, visual-perceptual evaluations of the face, laryngeal prominence, and auditoryperceptual judgments of voice. METHODS: In this cross-sectional study, 47 transsexual women aged between 18 and 50 responded to the (TVQMtF). The demographic data and perceptual ratings were selected from the PROTIG database. RESULTS: Among all participants, 55.32% had completed secondary education, and 72.34% had not undergone a sex reassignment surgery; 4.2% of subjects did not use hormones, 23.40% had undergone speech therapy, the average number of years of experience in the female role was 13.98 years, and the participants had been definitively cross-dressing for 5-34 years. Most of the participants had low scores on the (TVQMtF), and significant differences in the total score were observed in accordance with age (higher scores were observed among those <30 years and ≥40 years old) and visual-perceptual evaluations of the face (higher scores were observed in the individual evaluated with masculine face). There were no significant correlations between the total score obtained by the participants and the other demographic variables. CONCLUSIONS: Although most of the participants had low scores on the (TVQMtF), some individuals were still experiencing distress due to being perceived as being of the opposite sex or were dissatisfied with their voices.
Assuntos
Percepção Auditiva , Disforia de Gênero/psicologia , Inquéritos e Questionários , Pessoas Transgênero/psicologia , Transexualidade/psicologia , Qualidade da Voz , Adolescente , Adulto , Brasil , Estudos Transversais , Feminino , Feminilidade , Disforia de Gênero/diagnóstico , Hormônios Esteroides Gonadais/uso terapêutico , Humanos , Masculino , Masculinidade , Pessoa de Meia-Idade , Satisfação do Paciente , Autoimagem , Procedimentos de Readequação Sexual , Transexualidade/diagnóstico , Transexualidade/fisiopatologia , Transexualidade/terapia , Resultado do Tratamento , Percepção Visual , Qualidade da Voz/efeitos dos fármacos , Treinamento da Voz , Adulto JovemRESUMO
The World Health Organization and the American Psychological Association consider transsexuality a pathology and suggest sex-gender reassignment for the biopsychic adjustment of trans people. Through the discursive analysis of experience, this study describes the processes of medicalization and gender performativity in relation to the health of a group of trans women from Mexico City. For this purpose, a qualitative study was conducted in which 10 semi-structured interviews were carried out in 2015. As part of medicalization, the pathologization of transsexuality generated psychic suffering; on the other hand, sex-gender reassignment also entailed additional risks. It is possible to conclude that in trans women, violence and exclusion constitute the primary experiences explaining their foremost health problems. Therefore, it is suggested that it is necessary for discrimination be reduced and for advancements to be made in safer medical interventions.
La Organización Mundial para la Salud y la American Psychological Association consideran que la transexualidad es una patología y plantean la adecuación sexogenérica para el ajuste biopsíquico de las personas trans. Mediante el análisis discursivo de la experiencia, en este estudio se describen los procesos de medicalización y performatividad del género en su relación con la salud de un grupo de mujeres trans de la Ciudad de México, para lo cual se desarrolló un estudio cualitativo en el que se realizaron, en el año 2015, diez entrevistas semiestructuradas. Como parte de la medicalización, la patologización de la transexualidad generó sufrimiento psíquico; por su parte, la adecuación sexogenérica también implicó riesgos adicionales. Se puede concluir que, en las mujeres trans, la violencia y la exclusión resultan las principales experiencias que explican los problemas de salud más relevantes por lo que se sugiere disminuir la discriminación, así como avanzar en intervenciones médicas más seguras.
Assuntos
Medicalização , Procedimentos de Readequação Sexual/psicologia , Pessoas Transgênero/psicologia , Transexualidade/psicologia , Adolescente , Adulto , Feminino , Humanos , Entrevistas como Assunto , Masculino , México , Pessoa de Meia-Idade , Preconceito/psicologia , Pesquisa Qualitativa , Estresse Psicológico , Transexualidade/diagnóstico , Transexualidade/terapia , Saúde da População Urbana , Adulto JovemRESUMO
The social weight of transsexual groups has been and continues to be crucial in many aspects regarding transsexuality, from the progressive elimination of discrimination to influence in the legislative branch. This paper especially discusses a classic demand of these groups, comprehensive medical treatment of transsexual people within the National Health System. Thus, progress in the development of an adequate healthcare system for these groups, their treatment in the legal systems of Spain in general and of some of its autonomous communities with more noteworthy laws (especially in Andalusia, an autonomous community that has been pioneering in this regard, as well as the Basque Country and Navarre) and remaining challenges will be observed in this work. The article will also take particular note of the substantial developments that the publication of the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders has established in this area.
Assuntos
Serviços de Saúde para Pessoas Transgênero/legislação & jurisprudência , Disparidades em Assistência à Saúde/legislação & jurisprudência , Programas Nacionais de Saúde/legislação & jurisprudência , Pessoas Transgênero/legislação & jurisprudência , Transexualidade , Feminino , Direitos Humanos , Humanos , Masculino , Espanha , Transexualidade/diagnóstico , Transexualidade/terapiaRESUMO
Transsexual subjects are individuals who have a desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomic sex, and a wish to have surgery and hormonal treatment to make one's body as congruent as possible with one's preferred sex. They seek to develop the physical characteristics of the desired gender, and should undergo an effective and safe treatment regimen. The goal of treatment is to rehabilitate the individual as a member of society in the gender he or she identifies with. Sex reassignment procedures necessary for the treatment of transsexual patients are allowed in our country, at Medical Services that have a multidisciplinary team composed of a psychologist, a social worker, a psychiatrist, an endocrinologist and surgeons (gynecologists, plastic surgeons, and urologists). Patients must be between 21 to 75 years old and in psychological and hormonal treatment for at least 2 years. Testosterone is the principal agent used to induce male characteristics in female transsexual patients, and the estrogen is the chosen hormone used to induce the female sexual characteristics in male transsexual patients. Based on our 15 years of experience, we can conclude that testosterone and estradiol treatment in physiological doses are effective and safe in female and male transsexual patients, respectively.
Assuntos
Estrogênios/uso terapêutico , Cirurgia de Readequação Sexual , Testosterona/uso terapêutico , Pessoas Transgênero/psicologia , Transexualidade/terapia , Brasil , Feminino , Serviços de Saúde para Pessoas Transgênero/legislação & jurisprudência , Humanos , Masculino , Cirurgia de Readequação Sexual/legislação & jurisprudência , Cirurgia de Readequação Sexual/psicologia , Transexualidade/classificaçãoRESUMO
Transsexual subjects are individuals who have a desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one’s anatomic sex, and a wish to have surgery and hormonal treatment to make one’s body as congruent as possible with one’s preferred sex. They seek to develop the physical characteristics of the desired gender, and should undergo an effective and safe treatment regimen. The goal of treatment is to rehabilitate the individual as a member of society in the gender he or she identifies with. Sex reassignment procedures necessary for the treatment of transsexual patients are allowed in our country, at Medical Services that have a multidisciplinary team composed of a psychologist, a social worker, a psychiatrist, an endocrinologist and surgeons (gynecologists, plastic surgeons, and urologists). Patients must be between 21 to 75 years old and in psychological and hormonal treatment for at least 2 years. Testosterone is the principal agent used to induce male characteristics in female transsexual patients, and the estrogen is the chosen hormone used to induce the female sexual characteristics in male transsexual patients. Based on our 15 years of experience, we can conclude that testosterone and estradiol treatment in physiological doses are effective and safe in female and male transsexual patients, respectively.
Transexualismo masculino refere-se ao indivíduo 46,XY com fenótipo masculino normal que deseja viver e ser aceito como membro do sexo feminino, já o transexualismo feminino refere-se ao indivíduo 46,XX com fenótipo feminino normal que deseja viver e ser aceito como membro do sexo masculino. Há 16 anos os procedimentos médicos clínicos e cirúrgicos necessários para o tratamento de pacientes transexuais estão autorizados e regulamentados no nosso país, desde que os Serviços onde forem realizados tais procedimentos contem com equipe multidisciplinar composta por psicólogo, assistente social, psiquiatra, endocrinologista e cirurgiões (ginecologistas, plásticos e urologistas). Para serem submetidos à cirurgia, os pacientes devem ter de 21 a 75 anos, devem ter realizado hormonioterapia por pelo menos um ano e psicoterapia por pelo menos dois anos. Os indivíduos transexuais buscam desenvolver características físicas pertencentes ao sexo desejado e devem ser submetidos a um regime de tratamento efetivo e seguro com o objetivo de reabilitá-los como membros da sociedade no gênero com o qual eles se identificam. A testosterona é o principal hormônio utilizado para induzir o desenvolvimento dos caracteres sexuais secundários masculinos nos transexuais femininos e o estrógeno é o hormônio utilizado para induzir os caracteres sexuais secundários femininos no transexual masculino. Com base na experiência do nosso serviço, podemos afirmar que doses fisiológicas desses hormônios são capazes de produzir os efeitos desejados sem causar efeitos colaterais importantes.
Assuntos
Feminino , Humanos , Masculino , Estrogênios/uso terapêutico , Cirurgia de Readequação Sexual , Testosterona/uso terapêutico , Pessoas Transgênero/psicologia , Transexualidade/terapia , Brasil , Serviços de Saúde para Pessoas Transgênero/legislação & jurisprudência , Cirurgia de Readequação Sexual/legislação & jurisprudência , Cirurgia de Readequação Sexual/psicologia , Transexualidade/classificaçãoAssuntos
Identidade de Gênero , Transexualidade , Feminino , Ginecologia , Humanos , Masculino , Transexualidade/diagnóstico , Transexualidade/terapiaAssuntos
Feminino , Humanos , Masculino , Identidade de Gênero , Transexualidade , Ginecologia , Transexualidade/diagnóstico , Transexualidade/terapiaRESUMO
Disorders of sex development (DSDs) are estimated to be prevalent in 0.1-2% of the global population, although these figures are unlikely to adequately represent non-white patients as they are largely based on studies performed in Europe and the USA. Possible causes of DSDs include disruptions to gene expression and regulation-processes that are considered essential for the development of testes and ovaries in the embryo. Gender dysphoria generally affects between 8.5-20% of individuals with DSDs, depending on the type of DSD. Patients with simple virilizing congenital adrenal hyperplasia (CAH), as well as those with CAH and severe virilization, are less likely to have psychosexual disorders than patients with other types of DSD. Early surgery seems to be a safe option for most of these patients. Male sex assignment is an appropriate alternative in patients with Prader IV or V DSDs. Patients with 5α-reductase 2 (5α-RD2) and 17ß-hydroxysteroid dehydrogenase 3 (17ß-HSD3) deficiencies exhibit the highest rates of gender dysphoria (incidence of up to 63%). Disorders such as ovotesticular DSD and mixed gonadal dysgenesis are relatively rare and it can be difficult to conclusively evaluate patients with these conditions. For all DSDs, it is important that investigators and authors conform to the same nomenclature and definitions to ensure that data can be reliably analysed.
Assuntos
Transtornos do Desenvolvimento Sexual/psicologia , Identidade de Gênero , Transexualidade/terapia , Hiperplasia Suprarrenal Congênita/diagnóstico , Hiperplasia Suprarrenal Congênita/genética , Hiperplasia Suprarrenal Congênita/psicologia , Hiperplasia Suprarrenal Congênita/terapia , Transtornos do Desenvolvimento Sexual/diagnóstico , Transtornos do Desenvolvimento Sexual/genética , Transtornos do Desenvolvimento Sexual/terapia , Feminino , Terapia de Reposição Hormonal , Humanos , Masculino , Cirurgia de Readequação Sexual , Desenvolvimento Sexual/genética , Transexualidade/diagnóstico , Transexualidade/etiologiaRESUMO
Introducción. La transexualidad es el deseo irreversible de pertenecer al sexo contrario del genéticamente establecido y asumir el correspondiente rol y de recurrir si es necesario a un tratamiento hormonal y quirúrgico dirigido a corregir esta discordancia. La revelación de esta identidad sexual esta ocurriendo cada vez más a edades más tempranas. Los profesionales que atienden adolescentes debieran estar preparados para atender adolescentes y jóvenes con identidad sexual transexual. El objetivo de este estudio fue Identificar dificultades experimentadas por adolescentes y jóvenes transexuales y en que ámbitos se encuentran estas dificultades. Material y método: Se realizó un estudio cualitativo, con una muestra de adolescentes y jóvenes transexuales, femeninos y masculinos, consultantes en Cemera y de organizaciones que luchan por los derechos de las personas transexuales. Se realizaron entrevistas semi-estructuradas. Se utilizó el análisis temático de los datos. Los significados e interpretaciones que emergieron fueron constantemente verificados a través de análisis sucesivos. Resultados: Un total de 16 personas transexuales fueron entrevistadas. Los resultados muestran que las personas transexuales experimentan numerosas dificultades en el ámbito familiar, escolar, laboral, social, legal y salud, lo cual dificulta aún más el desarrollo de su identidad sexual, provocándoles además un gran sufrimiento. Conclusiones: Es importante considerar que los y las profesionales de la salud a menudo asumen la heterosexualidad en los adolescentes y jóvenes que atienden y por lo tanto están creando un setting de barreras para la atención de esta población específica e implícitamente la están discriminando.
Introduction: Transsexualism is the irreversible desire to belong to the opposite sex of the one that is genetically established and to assume the corresponding role and turn if necessary to a hormonal and surgical treatment directed to correct this conflict. The revelation of this sexual identity is happening at younger ages. Professionals who see adolescents should be also prepared o see adolescents and young people with a transsexual sexual identity. Objective: To identify the main difficulties experienced by adolescents and transsexual youth. Material and method: A qualitative study was carried out, with a sample of adolescents and transsexual youth, female and male, patients in Cemera and in the organizations that fight for the rights of transsexual people. Semi-structured interviews were executed. A thematic analysis of data was used. The meanings and interpretations which resulted were constantly verified by means of successive analyses. Results: A total of 16 transsexual people were interviewed. The results show that transsexual people experience numerous difficulties in the familiar, educational, work, social, legal and health areas, which makes the development of their sexual identity even more difficult, causing them great suffering. Conclusions: Health professionals frequently assume heterosexuality in adolescents and young people they see and, therefore, they are creating a setting of obstacles for the health care of this specific population and, as a consequence, they are implicitly discriminating it.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Comportamento do Adolescente , Relações Interpessoais , Transexualidade/psicologia , Chile , Entrevistas como Assunto , Pesquisa Qualitativa , Serviços de Saúde do Adolescente/ética , Serviços de Saúde do Adolescente/legislação & jurisprudência , Transexualidade/terapiaRESUMO
La frecuencia de consulta de personas que solicitan evaluación psiquiátrica y psicológica para cambio de sexo, ha aumentado. Se debe, pensamos, a que los resultados de la cirugía son cada vez mejores. La sociedad también ha contribuido a tolerar este trastorno. Los medios de información han hecho también lo suyo. A lo anterior, le sumamos un mejor enfoque de la sociedad, que tolera y ve con mejores ojos a estas personas. Ello ha motivado a escribir y dar a conocer las experiencias que ocurren en Chile, con el afán de colaborar a un mejor entendimiento del futuro de las personas aquejadas de este trastorno de la identidad sexual.
The frequency of consultation of people seeking psychiatric and psychological evaluation for sex change, has increased. It means we think that the results of surgery are getting better. The society has also contributed to tolerate this condition. The media have also been contributed for him. To this we add a better society approach, that tolerates and better judges to these people. This has led, who works on the subject, write and disseminate the experiences that occur in Chile, with the aim of collaborating with a better understanding and future of people suffering from the disorder of sexual identity.
Assuntos
Humanos , Transexualidade/diagnóstico , Transexualidade/psicologia , Transexualidade/terapia , Adaptação Psicológica , Comorbidade , Identidade de Gênero , Hormônios/uso terapêutico , Psicoterapia , Cirurgia de Readequação Sexual , Transexualidade/epidemiologia , Transexualidade/etiologiaRESUMO
The article aims to discuss transsexuality in the context of the Brazilian public health policies. Firstly, it questions the necessity of the diagnosis of Gender Identity Disorder as a condition of access to treatment in the public health service, searching to understand the historical construction of transsexuality as a pathological phenomenon. After that, it analyzes the debate on public health policies for transsexuals, considering the process of legalization of the reassignment surgery in the country, the resolutions of the Federal Council of Medicine and the constitution of representative forums of the Health Ministry, as well as professionals of the area and representatives of the social movement. Finally, considering the references available that emphasizes the critics on the analysis of transsexuality as a pathological phenomenon in the areas of the Public Health and Social Sciences, it intends to emphasize the importance of understanding the diversity of subjectivity's forms and genders construction considering transsexuality. In this context, it discusses the question of transsexuals autonomy and suggests public policies that, even following an assistance protocol, do not have as its only therapeutical reference the accomplishment of the diagnosis and the reassignment surgery.
Assuntos
Saúde Pública , Transexualidade , Brasil , Assistência Integral à Saúde , Humanos , Autonomia Pessoal , Transexualidade/diagnóstico , Transexualidade/terapiaRESUMO
INTRODUCTION: The diagnosis and the treatment of transsexualism, particularly during adolescence, generate considerable discussion among specialists. Many health and legal professionals have not yet reached a strong consensus on medical treatment for juvenile transsexuals. Hormonal therapy cannot only represent a medical procedure to adjust the somatic sex to the psychological gender, but can also be a reasonable means of preventing some juvenile transsexuals from engaging in undesirable and risky behavior. AIM: To report the cases of two transsexual adolescents who resorted to prostitution to afford hormonal medications when treatment was denied because of age criteria. RESULTS: Hormonal medications were not recommended by the endocrinology staff because specific laws regulating this medical procedure for juvenile transsexuals in Brazil are lacking. In response, these adolescents chose to use illegally obtained sex hormones to treat themselves. CONCLUSIONS: We propose "harm reduction" as a means of coping with this dilemma in some cases.
Assuntos
Ética Médica , Transexualidade/terapia , Adolescente , Feminino , Identidade de Gênero , Hormônios Esteroides Gonadais/uso terapêutico , Humanos , Masculino , Recusa em Tratar/ética , Trabalho Sexual , Transexualidade/psicologiaRESUMO
O artigo tem como objetivo discutir a transexualidade no contexto das políticas de saúde pública no Brasil. Para isto, num primeiro momento, problematiza-se a necessidade do diagnóstico de transtorno de identidade de gênero como condição de acesso ao tratamento na rede pública, buscando compreender de que forma se deu historicamente a patologização da transexualidade. Em seguida, analisa-se o debate sobre as políticas de saúde para transexuais, considerando o processo de legalização da cirurgia de transgenitalização no país, as resoluções do Conselho Federal de Medicina e os fóruns que se constituíram com representantes do Ministério da Saúde, profissionais da área e representantes do movimento social. Finalmente, tendo como referência trabalhos que se destacaram pela crítica à patologização da transexualidade nas áreas da saúde coletiva e das ciências sociais, pretende-se destacar a importância de compreendermos a diversidade de formas de subjetivação e de construção de gênero na transexualidade. Discute-se a questão da autonomia dos transexuais e sugerem-se políticas públicas que, embora sigam um protocolo de assistência, não tenham como única referência terapêutica a realização do diagnóstico e a cirurgia de transgenitalização.
The article aims to discuss transsexuality in the context of the Brazilian public health policies. Firstly, it questions the necessity of the diagnosis of Gender Identity Disorder as a condition of access to treatment in the public health service, searching to understand the historical construction of transsexuality as a pathological phenomenon. After that, it analyzes the debate on public health policies for transsexuals, considering the process of legalization of the reassignment surgery in the country, the resolutions of the Federal Council of Medicine and the constitution of representative forums of the Health Ministry, as well as professionals of the area and representatives of the social movement. Finally, considering the references available that emphasizes the critics on the analysis of transsexuality as a pathological phenomenon in the areas of the Public Health and Social Sciences, it intends to emphasize the importance of understanding the diversity of subjectivitys forms and genders construction considering transsexuality. In this context, it discusses the question of transsexuals autonomy and suggests public policies that, even following an assistance protocol, do not have as its only therapeutical reference the accomplishment of the diagnosis and the reassignment surgery.
Assuntos
Humanos , Saúde Pública , Transexualidade , Brasil , Assistência Integral à Saúde , Autonomia Pessoal , Transexualidade/diagnóstico , Transexualidade/terapiaRESUMO
Transexual é o indivíduo que se identifica como pertencente ao sexo oposto e experimenta grande frustaçao ao tentar se expressar através do seu sexo genético. No presente artigo os autores fazem uma revisao do transexualismo, abordando a sua etiologia, a importância do diagnóstico correto, os tratamentos hormonal e cirúrgico, além de iniciarem discussao sobre seus aspectos éticos, sociais e legais.