Challenges of the Transsexualization Process in the Brazilian Unified Health System (SUS): The Judiciary's Role in Addressing the Demand

Abstract

Objective: To analyze judicial decisions related to demands for gender transition procedures through the Brazilian Unified Health System (SUS). Methodology: A documentary exploratory study utilizing judicial decisions from the São Paulo State Court of Justice, the Rio de Janeiro State Court of Justice, and the Federal Supreme Court issued between 2000 and 2023. The term "gender dysphoria" was used to identify relevant decisions, followed by the selection of cases addressing the authorization of procedures under the Gender Transition Process in SUS. Results: The initial research identified 71 judicial cases, of which 9 involved demands relevant to the focus of this study. A significant portion of the rulings included requests for gender-affirming surgery and hormone therapy/medications. Financial and institutional shortcomings were the primary reasons for the judicialization of procedures (hormonal therapy and surgeries) related to the gender transition process. It was inferred that the rulings were based on the right to comprehensive healthcare, supported by the 1988 Federal Constitution, and upheld the rights outlined in the regulations governing the Gender Transition Process under SUS. Conclusion: Judicial decisions reaffirmed the clear and unquestionable right to healthcare, invoking regulations and constitutional provisions to ensure the State's obligation to act. In this regard, a tailored approach by health managers responsible for the regulation, control, and evaluation of authorized service units is recommended to reduce the gaps that hinder the provision of transgender healthcare services.

Submitted: 08/14/24| Revision: 10/21/24| Approved: 10/21/24