In a resolution published on Wednesday (16) in the Federal Official Gazette, the Federal Council of Medicine (CFM) vetoed hormonal therapies to children under 18 and changed the minimum age for gender transition surgery to 21 years.
THE Resolution No. 2,427/2025 Reviews technical criteria for the care of people with gender dysphoria, a condition characterized by discomfort or suffering between gender identity and sex attributed to birth.
The publication deals with three main points: a prohibition of cross hormone therapy to under 18 ; the veto for gender reassignment surgery with potential sterilizing effect for under 21 years and the Prohibition of prescription hormonal blockers for treatment of gender dysphoria in children and adolescents.
Cross hormone therapy is a treatment characterized by the administration of sex hormones to induce secondary characteristics consistent with the patient’s gender identity. Puberty hormonal blockers are drugs that postpone or interrupt physical changes characteristic of puberty, being used for the relief of gender dysphoria.
The resolution was criticized by associations linked to the LGBTQIAP+community, such as the National Association of Transvestites and Transsexuals (Antra) and the Mothers Association for Diversity, which consider updates a “setback” in relation to the rights of access to health conquered by the transgender population.
Decisions also worry experts. Tayane Muniz Fighera, coordinator of the Department of Female Endocrinology, Andrology and Transgenderity of the Brazilian Society of Endocrinology and Metabology (SBEM), speaks to CNN Regarding the risk of the prohibition to increase the search for alternative hormonal treatments without adequate scientific evidence and without medical follow -up.
“What we see in practice is that many of these people come to us with a longtime hormone abuse story because they could not find the welcome of a professional who, in fact, managed to provide proper care. They do not stop doing the treatment, because the dysphoria brings a lot of suffering to these people, but they end up doing wrong,” says Fighera.
Another concern is about the mental health of the transgender population. From the point of view of Emmanuel Nasser, gynecologist and obstetrician specializing in the care of the LGBTQIAP+population, the resolution may have a significant impact on the mental health of patients.
“We are talking about social isolation, increased school evasion, increased refractory depression index, increased suicidal ideation or even consummation of self-termination, as well as self-mutilation. Therefore, we are talking about an absurd impact on their mental health, either by depriving them from accessing hormonal technologies from 16 years old, and from whether these children access the hormonal block.” Nasser to CNN .
What were the previous guidelines and what has changed?
The new resolution revokes the previous guidelines of the Resolution No. 2,265/2019published in January 2020 in the Federal Official Gazette. Previously, cross hormone therapy was allowed from the age of 16, since it began after puberty and experimental in research protocols.
With the new resolution, therapy is prohibited before the age of 18 and should be done after psychiatric and endocrinological follow -up for at least one year, and after cardiovascular and metabolic assessment with favorable medical opinion.
In addition, the previous standard allowed surgical gender affirmation procedures from 18 years. Now surgery is prohibited before age 21 when they imply potential sterilizing effect, and can only be performed after prior monitoring of at least one year per medical team.
Finally, the 2019 resolution allowed hormonal block therapy in adolescents from puberty in research protocols, in university and/or reference hospitals for the Unified Health System (SUS). Now the practice is prohibited for all children and adolescents, except in early puberty situations or other endocrine diseases where the use of hormonal blockers is scientifically indicated.
“What we did earlier, as interventions, was to postpone puberty, because we understand that psychic suffering, called dysphoria, appears precisely when the secondary characters, such as body contours, breasts, menstruation or facial, appear. This ends up acting like a trigger for these sufferings,” Nasser explains. “Until the old resolution, this was done in a research model. In Sao Paulo, for example, which is the richest and most populous state in the country, only one center made the Puberal blockade. And this was done following rigorous criteria,” he adds.
Fighera also adds that, once the treatment began, the patient had monitored health data, such as bone mineral density data, growth speed and blood tests, making adjustments in hormone therapy when necessary. “There was a series of criteria that were strictly followed to do this treatment [em adolescentes]”He says.
Despite the changes, the provisions of the new CFM resolution do not apply to people who have already started hormone therapy or puberty blockade.
What does CFM say?
In a press conference held on Wednesday (16), one of the resolution rapporteurs, Raphael Câmara, argued that it would be “very difficult” the measure to lead to the expansion of the use of hormones on its own, without follow-up.
“The way they obtain these substances, which do not have in pharmacies, the difficulty is much greater. We do not believe this will happen. Obviously, punctual cases can happen, but this will not happen greatly,” he says.
During his presentation, Câmara stated that the resolution based on scientific evidence that would show an increase in the number of regrets in relation to the gender transition process, and cases of attempted reversal of the transition process.
On the other hand, the rapporteur stated that the norm also took into account research that shows otherwise, that the regret index is low. According to Chamber, there is a “overdiagnosis” of trans people, which would lead to a high regret index in relation to the process.
“More children and adolescents are being diagnosed with gender dysphoria and treatment. Many children who could not be trans, but simply gay and lesbians in the future,” he said.
The doctor admitted, however, that there is no response on the subject, because existing studies have no robust evidence. “Sometimes the lack of evidence requires prudence,” he said. According to him, studies have been analyzed that show from a 2% rate of regret to research that indicates up to 40%.
Doctors who fail to comply with resolution will be punished, says CFM
Also at the press conference, the president of CFM, Hiran Gallo, said that doctors who fail to comply with the resolution of the agency will be punished with measures such as warning, censorship, suspension or even revocation of registration.
“It is a standard of the Federal Council of Medicine that has to be fulfilled,” said Gallo.
MPF determines legality of the standard
The Federal Public Prosecution Service (MPF) instituted on Monday (14) a procedure to investigate the legality of the CFM resolution.
The procedure was opened by the MPF from a complaint from the entity and a technical note of the National Association of Transvestites and Transsexuals (Antra). Associations point out that trans young people have access to therapeutic procedures such as Puberal blockade and cross hormization supported by Resolution No. 2,265/2019, which remains valid.
Regional Attorney for Citizen Rights in Acre, Lucas Costa Almeida Dias, gave a period of 15 days for the CFM to provide information on the technical and legal grounds that underpinned the decision. He cites decisions of the Federal Supreme Court that go in the opposite direction and recalls that the World Health Organization (WHO) failed to consider transsexuality a disease.
*With information from Paula Ferreira and Gabriel Damasceno, from Estadão Content
Study: Hormonal therapy reduces risk of depression in transgender
This content was originally published in veto to hormone therapy for trans worries doctors; Understand on CNN Brazil.
Source: CNN Brasil
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