Impacts of anti-trans discourses on gender-affirming care access in Brazil: family and provider views

Abstract Over the past decade, professional associations worldwide have endorsed gender-affirming care (GAC) for transgender and gender-diverse (TGD) youth, based on growing evidence of its benefits for mental health and well-being. Nonetheless, GAC has become a controversial topic, with rising anti-trans discourse targeting families, providers, and youth. To date, little research has explored the impact of these movements on access to care-especially in Latin America. This research examines two questions: (1) How does anti-trans discourse manifest in the experiences of parents of TGD youth and providers working with GAC? (2) How does it impact GAC access and provision? Data comes from an ethnographic study conducted at a transgender health care facility in a major Brazilian city (2023-2024), including 28 interviews (13 with family members of TGD youth ages 4-17 and 14 with providers) and 18 months of participant observation. A thematic analysis was conducted using a constructivist and interpretative lens. Findings show that anti-trans discourse is present in daily life, spread by professionals, institutions, and policymakers. It undermines the validity of transgender identity by reinforcing congruence between sex and gender, while discouraging affirming attitudes toward other diversities. For parents, it (i) makes it harder to challenge beliefs about their child's identity as a phase, (ii) increases guilt by linking gender nonconformity to poor parenting, and (iii) amplifies fear of regret. For providers, it (i) undermines trust in clinical assessments, (ii) reduces support from colleagues, and (iii) exposes services to scrutiny. Overall, anti-trans discourse fosters uncertainty, a sense of persecution, and hesitancy-affecting the ability to perceive needs, seek or provide care, and engage with GAC. Findings highlight how anti-trans narratives can erode support systems and shape health outcomes. Key messages • The research shows that anti-trans discourse has become a public health issue undermining the ability to seek and receive adequate support for families and youth. • There’s growing importance in opposing anti-trans discourse, particularly by protecting specialized services and increasing support for families and youth.