Transgender Healthcare Access Faces Hurdles as Complaints Rise in Brazil
A growing number of transgender and gender non-conforming individuals in Brazil are facing significant obstacles in accessing necessary healthcare, with health plans frequently denying coverage for gender affirmation procedures. The struggle highlights a critical gap in understanding and empathy within the healthcare system, and a concerning trend of legal battles for basic medical rights.
A 29-year-old executive secretary, identified as Guga de Souza, has been attempting to secure coverage for mammoplasty, facial surgery, and sexual reassignment for three years, only to be repeatedly denied by her health plan. The plan maintains it has no obligation to cover these procedures, a position recently upheld by a judge who argued there was no immediate threat to de Souza’s life, despite her having been in transition since 2018.
“With each negative, my mental health gets worse. I’ve tried to take my own life,” de Souza stated, emphasizing the critical nature of these procedures. “I am accompanied by a psychiatrist and endocrinologist; it is not a whim. It is a medical necessity.” Her case underscores the profound emotional toll caused by denial of care.
However, not all cases end in denial. Rafaela*, a 32-year-old legal assistant, successfully fought for and won the right to silicone implantation after an arduous year and a half legal process. In addition to the authorization for the procedure, she was awarded $12,000 in moral damages. “Health plans need to understand what gender dysphoria is. Lack of preparation, but especially empathy,” she explained.
The regulatory agency overseeing private health plans in Brazil confirmed that sexual reassignment surgery is not currently included in the list of mandatory health procedures. However, certain related procedures, such as mastectomy and hysterectomy, are covered when deemed medically necessary by a physician.
Data released by the agency reveals a concerning increase in complaints. In 2024, 96 complaints related to the transsexualizing process were registered, and as of June 2025, that number has already reached 63. The agency advises individuals facing issues with their health plans to first contact the operator directly and, if unresolved, to file a formal complaint.
“ANS develops several initiatives and programs focused on the qualification of health care in the supplementary sector, with the objective of promoting continuous improvements in the care provided to beneficiaries by health insurance operators,” a statement from the agency reads. Despite these initiatives, the rising number of complaints suggests a significant gap remains between policy and practice, leaving vulnerable individuals to navigate a complex and often discriminatory system.
*Name has been changed to protect privacy.
