A Rapid Assessment of Stakeholder Agreement with Brazil's New Gender-Affirming Care Restrictions

Transgender youth and their caregivers are rarely included in regulatory processes concerning gender-affirming care, despite being directly affected. In April 2025, the Brazilian Federal Council of Medicine (CFM) issued Resolution 2.427/2025, which banned the use of puberty blockers in all minors, prohibited hormone therapy before age 18, and introduced stricter age thresholds for surgical interventions. This study aimed to assess stakeholder perspectives regarding these new restrictions. We conducted a cross-sectional survey between May and June 2025 with patients and caregivers from Brazils largest outpatient gender identity service. A total of 54 transgender youth (mean age 13.6 {+/-} 2.0 years) and 116 caregivers completed the survey independently. Participants rated their level of agreement with each provision of the resolution using a 6-point Likert scale. Findings demonstrated overwhelming opposition to the new regulations. Among youth, 92.6% strongly disagreed with the ban on puberty blockers, 94.4% opposed restrictions on hormone therapy before 18, and 59.3% disagreed with surgical age limits. Caregivers reported similar opposition, with 93.1% rejecting the ban on puberty blockers, 89.7% rejecting restrictions on hormone therapy, and 61.2% disagreeing with surgical restrictions. Importantly, opposition was consistent across all stages of treatment engagement, including among those who had not initiated or had declined medical interventions, suggesting that disagreement is not solely attributable to personal investment in treatment. These findings highlight a substantial misalignment between regulatory policy and the perspectives of directly affected youth and families. Incorporating patient and caregiver voices, alongside clinical evidence, is essential to ensure that policies remain ethically sound and responsive to stakeholder needs. Public significance statementThis study found that over 90% of transgender youth and their caregivers in Brazil strongly oppose new bans on gender-affirming medical care, revealing a significant disconnect between regulatory policies and the lived experiences of those most affected. These findings underscore the critical importance of incorporating patient and family perspectives into healthcare policy to ensure it is both ethical and effective.