Abstract
To ensure that public health services provide comprehensive and inclusive health care to the general population, it is important for countries to estimate how many of their citizens experience gender dysphoria and wish to receive specialized hormone treatment or gender-affirming surgery. The aim of this study was to estimate the prevalence of individuals with gender dysphoria seeking transgender health care in a public teaching hospital in southern Brazil. In this retrospective follow-up study, we analyzed the medical records and sociodemographic data of individuals aged > 15 years living in Rio Grande do Sul, Brazil, that enrolled in a specialized program to receive hormone therapy and gender-affirming surgery between 2000 and 2018. This study is the first to attempt estimating the prevalence of gender dysphoria in Rio Grande do Sul; it describes novel data on the clinical profile of individuals with gender dysphoria treated in a public hospital specialized in providing transgender health care. Prevalence estimates were calculated based on statewide annual population data in the study period. Of 934 identified individuals, 776 (601 trans women and 175 trans men) were included in this study. The overall prevalence of individuals with gender dysphoria was 9.3 per 100,000 individuals (95% CI: 8.6 to 9.8). Meanwhile, there were 15 trans women per 100,000 people (95% CI: 14 to 16) and 4.1 trans men per 100,000 people (95% CI: 3.5 to 4.8). There was a progressive increase in the number of people seeking hormone therapy and gender-affirming surgery during the study period. Future research is needed to determine the size of the trans population in other regions of Brazil and to expand the knowledge regarding gender dysphoria to allow for the development of effective public policies for people with gender dysphoria.
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References
Aitken, M., Steensma, T. D., Blanchard, R., VanderLaan, D. P., Wood, H., Fuentes, A., Spegg, C., Wasserman, L., Ames, M., Fitzsimmons, C. L., ... Zucker, K. J. (2015). Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria. Journal of Sexual Medicine, 12(3), 756–763. https://doi.org/10.1111/jsm.12817
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). American Psychiatric Association.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Press.
Arcelus, J., Bouman, W. P., Van Den Noortgate, W., Claes, L., Witcomb, G., & Fernandez-Aranda, F. (2015). Systematic review and meta-analysis of prevalence studies in transsexualism. European Psychiatry, 30(6), 807–815. https://doi.org/10.1016/j.eurpsy.2015.04.005
Bauer, G. R., & Scheim, A. I. (2013). Sampling bias in transgender studies. The Lancet Infectious Diseases, 13(10), 832. https://doi.org/10.1016/S1473-3099(13)70242-1
Becerra-Fernández, A., Rodríguez-Molina, J. M., Asenjo-Araque, N., Lucio-Pérez, M. J., Cuchí-Alfaro, M., García-Camba, E., Pérez-López, G., Menacho-Román, M., Berrocal-Sertucha, M. C., Ly-Pen, D., & Aguilar-Vilas, M. V. (2017). Prevalence, incidence, and sex ratio of transsexualism in the autonomous region of Madrid (Spain) according to healthcare demand. Archives of Sexual Behavior, 46(5), 1307–1312. https://doi.org/10.1007/s10508-017-0955-z
Boehmer, U. (2002). Twenty years of public health research: Inclusion of lesbian, gay, bisexual, and transgender populations. American Journal of Public Health, 92(7), 1125–1130. https://doi.org/10.2105/ajph.92.7.1125
Brasil. Ministério da Saúde, Diário Oficial da União. (2008). Diretrizes Nacionais para o Processo Transexualizador no Sistema Único de Saúde (Portaria nº 1.707). Retrieved from http://bvsms.saude.gov.br/bvs/saudelegis/gm/2008/prt1707_18_08_2008.html.
Brasil. Ministério da Saúde, Diário Oficial da União. (2013). Redefine e amplia o Processo Transexualizador no Sistema Único de Saúde (Portaria nº 2.803). Retrieved from http://bvsms.saude.gov.br/bvs/saudelegis/gm/2013/prt2803_19_11_2013.html.
Instituto Brasileiro de Geografia e Estatística. (2013). Estimativas da população residente nos municípios brasileiros com data de referência em 1º de julho de 2013. Retrieved from https://www.ibge.gov.br/cidades-e-estados/rs.html.
Instituto Brasileiro de Geografia e Estatística, Diretoria de Pesquisas, Coordenação de Trabalho e Rendimento. (2018). Pesquisa nacional por amostra de domicílios contínua - PNAD contínua: educação 2018. Retrieved from https://biblioteca.ibge.gov.br/visualizacao/livros/liv101657_informativo.pdf.
Instituto Brasileiro de Geografia e Estatística, Diretoria de Pesquisas, Coordenação de Trabalho e Rendimento. (2019). Pesquisa nacional por amostra de domicílios contínua 2012–2019. Retrieved from https://biblioteca.ibge.gov.br/visualizacao/livros/liv101707_informativo.pdf.
Clark, T. C., Lucassen, M. F., Bullen, P., Denny, S. J., Fleming, T. M., Robinson, E. M., & Rossen, F. V. (2014). The health and well-being of transgender high school students: Results from the New Zealand Adolescent Health Survey (Youth’12). Journal of Adolescent Health, 55(1), 93–99. https://doi.org/10.1016/j.jadohealth.2013.11.008
Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., Fraser, L., Green, J., Knudson, G., Meyer, W. J., ... Zucker, K. (2012). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. International Journal Transgenderism, 13(4), 165–232. https://doi.org/10.1080/15532739.2011.700873
Collin, L., Reisner, S. L., Tangpricha, V., & Goodman, M. (2016). Prevalence of transgender depends on the “case” definition: A systematic review. Journal of Sexual Medicine, 13(4), 613–626. https://doi.org/10.1016/j.jsxm.2016.02.001
Collins, P. H. (2000). Black feminist thought: Knowledge, consciousness, and the politics of empowerment. Routledge.
Costa, A. B., da Rosa Filho, H. T., Pase, P. F., Fontanari, A. M., Catelan, R. F., Mueller, A., Cardoso, D., Soll, B., Schwarz, K., Schneider, M. A., & Gagliotti, D. A. (2018). Healthcare needs of and access barriers for Brazilian transgender and gender diverse people. Journal of Immigrant and Minority Health, 20(1), 115–123. https://doi.org/10.1007/s10903-016-0527-7
Costa, A. B., Fontanari, A. M., Jacinto, M. M., da Silva, D. C., Lorencetti, E. K., da Rosa Filho, H. T., Mueller, A., de Garcia, C. G., Nardi, H. C., Koller, S. H., & Lobato, M. I. (2015). Population-based HIV prevalence and associated factors in male-to-female transsexuals from Southern Brazil. Archives of Sexual Behavior, 44(2), 521–524. https://doi.org/10.1007/s10508-014-0386-z
de Vries, K. M. (2015). Transgender people of color at the center: Conceptualizing a new intersectional model. Ethnicities, 15(1), 3–27. https://doi.org/10.1177/1468796814547058
Dhejne, C., Öberg, K., Arver, S., & Landén, M. (2014). An analysis of all applications for sex reassignment surgery in Sweden, 1960–2010: Prevalence, incidence, and regrets. Archives of Sexual Behavior, 43, 1535–1545. https://doi.org/10.1007/s10508-014-0300-8
Conselho Federal de Medicina (CFM). (1997). Dispõe sobre a cirurgia de transgenitalismo (Resolução CFM nº 1.482/97). Retrieved from http://www.portalmedico.org.br/resolucoes/cfm/1997/1482_1997.htm.
Ehrbar, R. D., & Gorton, R. N. (2010). Exploring provider treatment models in interpreting the standards of care. International Journal of Transgenderism, 12, 198–210. https://doi.org/10.1080/15532739.2010.544235
Flores, A. R., Brown, T. N. T., & Herman, J. L. (2016). Race and ethnicity of adults who identify as transgender in the United States. The Williams Institute. Retrieved from https://williamsinstitute.law.ucla.edu/publications/race-ethnicity-trans-adults-us/.
Flores, A. R., Herman, J. L., Brown, T. N. T., Wilson, B. D. M., & Conron, K. J. (2017). Age of individuals who identify as transgender in the United States. The Williams Institute. Retrieved from https://williamsinstitute.law.ucla.edu/publications/age-trans-individuals-us.
Fontanari, A. M., Costa, A. B., Aguiar, B., Tusset, C., Andreazza, T., Schneider, M., da Rosa, E. D., Soll, B. M., Schwarz, K., da Silva, D. C., & Borba, A. O. (2016). Reduced serum concentrations of brain-derived neurotrophic factor (BDNF) in transsexual Brazilian men. Neuroscience Letters, 630, 109–113. https://doi.org/10.1016/j.neulet.2016.07.034
Goodman, M., Adams, N., Corneil, T., Kreukels, B., Motmans, J., & Coleman, E. (2019). Size and distribution of transgender and gender nonconforming populations: A narrative review. Endocrinology and Metabolism Clinics of North America, 48, 303–321. https://doi.org/10.1016/j.ecl.2019.01.001
Judge, C., O’Donovan, C., Callaghan, G., Gaoatswe, G., & O’Shea, D. (2014). Gender dysphoria—Prevalence and co-morbidities in an Irish adult population. Frontiers in Endocrinology, 13(5), 87. https://doi.org/10.3389/fendo.2014.00087
Lobato, M. I., Koff, W. J., Schestatsky, S. S., Chaves, C. P., Petry, A., Crestana, T., Amaral, J. T., Onófrio, F. D., Salvador, J., Silveira, E., & Henriques, A. A. (2007). Clinical characteristics, psychiatric comorbidities and sociodemographic profile of transsexual patients from an outpatient clinic in Brazil. International Journal of Transgenderism, 10, 69–77. https://doi.org/10.1080/15532730802175148
Lobato, M. I., Soll, B. M., Brandelli Costa, A., Saadeh, A., Gagliotti, D. A., Fresán, A., Reed, G., & Robles, R. (2019). Psychological distress among transgender people in Brazil: Frequency, intensity and social causation—An ICD-11 field study. Brazilian Journal of Psychiatry, 41(4), 310–315. https://doi.org/10.1590/1516-4446-2018-0052
Meier, S. C., & Labuski, C. M. (2013). The demographics of the transgender population. In A. K. Baumle (Ed.), International handbook on the demography of sexuality (pp. 289–327). Springer Press.
Olson, J., Schrager, S. M., Belzer, M., Simons, L. K., & Clark, L. F. (2015). Baseline physiologic and psychosocial characteristics of transgender youth seeking care for gender dysphoria. Journal of Adolescent Health, 57(4), 374–380. https://doi.org/10.1016/j.jadohealth.2015.04.027
Pang, K. C., de Graaf, N. M., Chew, D., Hoq, M., Keith, D. R., Carmichael, P., & Steensma, T. D. (2020). Association of media coverage of transgender and gender diverse issues with rates of referral of transgender children and adolescents to specialist gender clinics in the UK and Australia. JAMA Network Open, 3(7), e2011161. https://doi.org/10.1001/jamanetworkopen.2020.11161
Proctor, K., Haffer, S. C., Ewald, E., Hodge, C., & James, C. V. (2016). Identifying the transgender population in the medicare program. Transgender Health, 1(1), 250–265. https://doi.org/10.1089/trgh.2016.0031
Reisner, S. L., Poteat, T., Keatley, J., Cabral, M., Mothopeng, T., Dunham, E., Holland, C. E., Max, R., & Baral, S. D. (2016). Global health burden and needs of transgender populations: A review. Lancet, 388(10042), 412–436. https://doi.org/10.1016/S0140-6736(16)00684-X
Reisner, S. L., Vetters, R., Leclerc, M., Zaslow, S., Wolfrum, S., Shumer, D., & Mimiaga, M. J. (2015). Mental health of transgender youth in care at an adolescent urban community health center: A matched retrospective cohort study. Journal of Adolescent Health, 56(3), 274–279. https://doi.org/10.1016/j.jadohealth.2014.10.264
Shields, J. P., Cohen, R., Glassman, J. R., Whitaker, K., Franks, H., & Bertolini, I. (2013). Estimating population size and demographic characteristics of lesbian, gay, bisexual, and transgender youth in middle school. The Journal of Adolescent Health, 52(2), 248–250. https://doi.org/10.1016/j.jadohealth.2012.06.016
Silva, D. C., Fontanari, A. M., De Garcia, C. C., Costa, A. B., Brambila, M., Schwarz, K., Bridi Filho, C., Schneider, M. A., Soll, B., & Lobato, M. I. (2017). Gender identity program: The scope of health treatment of transsexuals in Brazil. Journal of Sexual Medicine, 14, 342. https://doi.org/10.1016/j.jsxm.2017.04.616
Silva, D. C., Schwarz, K., Fontanari, A. M., Costa, A. B., Massuda, R., Henriques, A. A., Salvador, J., Silveira, E., Rosito, T. E., & Lobato, M. I. (2016). WHOQOL-100 before and after sex reassignment surgery in Brazilian male-to-female transsexual individuals. Journal of Sexual Medicine, 13(6), 988–993. https://doi.org/10.1016/j.jsxm.2016.03.370
Soll, B. M., Robles-García, R., Brandelli-Costa, A., Mori, D., Mueller, A., Vaitses-Fontanari, A. M., Cardoso-da-Silva, D., Schwarz, K., Abel-Schneider, M., Saadeh, A., & Lobato, M. I. (2017). Gender incongruence: A comparative study using ICD-10 and DSM-5 diagnostic criteria. Revista Brasileira de Psiquiatria, 40(2), 174–180. https://doi.org/10.1590/1516-4446-2016-2224
Valentine, S. E., & Shipherd, J. C. (2018). A systematic review of social stress and mental health among transgender and gender non-conforming people in the United States. Clinical Psychology Review, 66, 24–38. https://doi.org/10.1016/j.cpr.2018.03.003
Vanderlaan, D. P., Blanchard, R., Zucker, K. J., Massuda, R., Fontanari, A. M., Borba, A. O., Costa, A. B., Schneider, M. A., Mueller, A., Soll, B. M., & Schwarz, K. (2017). Birth order and androphilic male-to-female transsexualism in Brazil. Journal of Biosocial Science, 49(4), 527–535. https://doi.org/10.1017/S0021932016000584
Wiepjes, C. M., Nota, N. M., de Blok, C. J., Klaver, M., de Vries, A. L., Wensing-Kruger, S. A., de Jongh, R. T., Bouman, M. B., Steensma, T. D., Cohen-Kettenis, P., & Gooren, L. J. (2018). The Amsterdam Cohort of Gender Dysphoria Study (1972–2015): Trends in prevalence, treatment, and regrets. Journal of Sexual Medicine, 15(4), 582–590. https://doi.org/10.1016/j.jsxm.2018.01.016
Winters, S., & Conway, L. (2011). How many trans people are there? A 2011 update incorporating new data. Retrieved from https://www.transgenderasia.org/paper-how-many-trans-people-are-there.htm.
World Health Organization (WHO). (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. Retrieved from https://apps.who.int/iris/handle/10665/37958.
World Health Organization (WHO). (2020). Europe brief—Transgender health in the context of ICD-11. Retrieved from https://www.euro.who.int/en/health-topics/health-determinants/gender/gender-definitions/whoeurope-brieftransgender-health-in-the-context-of-icd-1.
Zucker, K. J. (2017). Epidemiology of gender dysphoria and transgender identity. Sexual Health, 14(5), 404–411. https://doi.org/10.1071/SH17067
Acknowledgements
The authors would like to thank Mrs. Rita de Cássia Souza de Oliveira for administrative support, the Medical File and Health Information Service (SAMIS), the Information Technology Management Coordination (CGTI), especially analyst Maria Tereza Pons and the Fundo de Incentivo à Pesquisa e Eventos (FIPE)—Hospital de Clínicas de Porto Alegre (HCPA).
Funding
This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brazil (CAPES)—Finance Code 001 and Fundo de Incentivo à Pesquisa e Eventos (FIPE)—Hospital de Clínicas de Porto Alegre (HCPA).
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Silva, D.C., Salati, L.R., Fontanari, A.M.V. et al. Prevalence of Gender Dysphoria in Southern Brazil: A Retrospective Study. Arch Sex Behav 50, 3517–3526 (2021). https://doi.org/10.1007/s10508-021-02036-2
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DOI: https://doi.org/10.1007/s10508-021-02036-2