On November 12, the coalition of transmasculine organizations presented before the IACHR about the diverse realities of access to the right to healthcare of transmasculine people in the region.

Washington, D.C., November 20, 2024.- Within the framework of the 191st Regular Session of the Inter-American Commission on Human Rights (IACHR), representatives of transmasculine organizations in Latin America and the Institute on Race, Equality and Human Rights (Raza and Equality) exposed the multiple violations of access to the right to healthcare of transmasculine people in the region.

The interventions from Peru, Brazil, Ecuador and Bolivia highlighted the urgent need for States to have public policies and implement affirmative health systems that respect gender identity and comprehensively address the specific needs of the transmasculine population.

“The situation of transmasculinities is characterized by a profound disparity in the exercise of rights and all have found a difficulty regarding the health system and access to health services and treatments or surgeries for those people who require it” said Carlos Quesada, Executive Director of Race and Equality, an organization that works alongside this coalition.

The health system must respond to diverse experiences

Bruno Montenegro, representative of Fraternidad Trans Masculina Perú, emphasized that a trans man or a transmasculine person represents diverse and authentic experiences, which implies facing particular challenges in accessing the right to health: “we were assigned with the female gender, and we have “made a social and/or hormonal transition towards the male gender, with which we live our lives in all aspects,” he noted.

According to Montenegro, health personnel often lack adequate training, which results in humiliating and violent attention towards transmasculine people who, therefore, avoid going to medical services, exposing themselves to risks to their health.

“In Peru, the Technical Health Standard for trans people that provides support in hormoneization does not include trans men. Similarly, in Bolivia, the comprehensive care model for LGBTI people does not guarantee dignified and adequate care for transmasculinities, and lacks an effective dissemination strategy that allows its implementation. In Brazil and Ecuador, the situation is not very different; Despite some progress, the absence of specific public policies and the lack of health budget for awareness-raising and training processes aggravates the exclusion of our transmasculine population,” he reported.

Pathologization and its harmful effects

Dom Erick, from the Brazilian Institute of Transmasculinities – IBRAT, denounced the pathologization of transmasculine identities as a key factor in the perpetuation of stigma and violence. He cited the case of Peru, where in 2024 the classification of gender identity as a “mental disorder” according to the ICD-10 was maintained, in contradiction to the decision of the World Health Organization in 2019. This pathologization makes access to health care difficult by requiring psychiatric evaluations to receive medical support.

Dom Erick also warned about the negative impacts on the mental health of transmasculine people. According to the report “Transsexual Men: Social Invisibility and Mental Health” (2018), 94.5% of trans men surveyed reported feeling depression, while 66.4% experienced suicidal ideation. The lack of data and statistics on transmasculine lives contributes to their invisibility and the omission of policies that address these problems.

“In Brazil, Bolivia, Ecuador and Peru, we experience critical under-reporting of data and statistics on transmasculine lives. The invisibility and negligence of the State keeps our community on the sidelines. The stressful and violent experiences suffered in public, social and family spaces negatively impact the mental health of our population, generating social phobias, feelings of isolation, depression, anxiety and suicidal behaviors that can lead to self-extermination,” he noted.

Sexual and reproductive rights: a legal and social vacuum

Javier Morón, from Hombres Trans Diversos Bolivia, exposed the systematic violation of the sexual and reproductive rights of trans men. From obstetric violence to the use of incorrect pronouns, experiences of discrimination in gynecological and obstetric contexts are common. In addition, legal gaps in the civil registry make it difficult to register children, forcing trans men to appear as “mothers” in legal documents, a practice that ignores and delegitimizes their gender identity.

“Many find themselves with a desensitized health system, lacking knowledge and above all guided by religious ideologies, denying us access to adequate pre- and post-natal controls. This refusal not only compromises the physical health of father and baby, but also perpetuates an environment prone to obstetric violence during childbirth. Pregnancy and childbirth must stop being associated with the condition of cisgender women and begin to recognize that other identities like ours have the capacity to gestate or need to undergo legal termination of pregnancy,” he emphasized.

Self-medication and shortages: health risks

Gabriel de Prada, of Fraternidad Transmasculina Ecuador, described the dangers associated with self-medication in the absence of accessible resources for hormonal transition. The lack of availability of testosterone in pharmacies and the disparity in prices force many trans men to resort to anabolic drugs of dubious origin, with serious health risks.

Despite these challenges, De Prada pointed to positive examples, such as the inclusive policies implemented in Brazil. In October 2024, the Unified Health System eliminated the need to link consultations and examinations to “biological sex”, allowing more comprehensive and respectful access to gynecological and urological services.

An urgent call to action

The interventions in this thematic hearing before the IACHR concluded with Otávio Zanardi of Race and Equality, who respectfully called on the Commission to:

1) Urge States to produce comprehensive information and disaggregated data on transmasculine people.

2) To monitor and observe whether the States are complying with the recommendations of the report produced by SRESCER regarding trans and gender-diverse people and their economic, social, cultural, and environmental rights, mainly the recommendations on the right to health are met. . Likewise, update the report published in 2015 on Violence against LGBTI people, in order to reassess the violence faced by transmasculine people.

3) Make a public statement on the challenges transmasculine people face in accessing healthcare, to raise awareness among various stakeholders, including governments and civil society organizations.

4) We also recommend making an on-site visit to Peru, a country that has faced legal challenges, such as the classification of trans identities as a mental illness and other anti-trans regulations.

5) In observation of what is established in Resolution 04/2023 in the Prioritization Policy for petitions and cases before the Commission, we call for priority attention to gender transversality and intersectionality, especially related to the health of transmasculine people.