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OBJECTIVE: The transgender population in Brazil faces marginalization and difficulties in accessing education and health, leading many individuals to self-medicate. This study aimed to evaluate the impact of the implementation of Specialized Centers in the Transsexualizing Process (SCTP) on the use of cross-sex hormone therapy (CSHT) without medical prescription, as well as the level of education and mental health profile of these individuals. METHODS: This is a cross-sectional study with data from physical and electronic medical records between September 2017 and February 2023 regarding the use of CSHT before and after the implementation of two SCTP in the state of Bahia, Brazil, in addition to data on education level, previous diagnosis of anxiety and depression of patients. RESULTS: A total of 219 participants, 127 transgender men (TM) and 92 transgender women and travestis (TrTW), were assessed. A significant reduction in the prevalence of self-medication was observed in both TrTW (92.98% before and 51.43% after, p<0.001), and TM (47.17% before and 25.67% after, p = 0.010) with the implementation of SCTP. Transgender individuals who used CSHT before accessing the service were found to have a lower prevalence of depression. Self-medication was not significantly associated with education or anxiety in our sample. CONCLUSION: The results indicate the need for the expansion of SCTP, as they were associated with lower rates of self-medication in the transgender population.

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OBJECTIVES: to estimate the prevalence of depressive levels and their associated factors among transvestite and transsexual individuals. METHODS: this cross-sectional study involved 58 participants assisted by non-governmental organizations. The Beck Depression Inventory was utilized to assess levels of depression, complemented by a sociodemographic questionnaire and a questionnaire on experiences of violence. Data were analyzed using descriptive statistics and Poisson regression with robust variance. RESULTS: a prevalence of 27.6% (95% CI = 11.50-39.10) for moderate to severe levels of depression was observed. This prevalence was associated with being unmarried (PR = 1.19; 95% CI = 1.10-1.28) and experiencing violence in healthcare services (PR = 2.30; 95% CI = 1.10-4.81). CONCLUSIONS: the absence of a partner and experiences of violence in healthcare settings negatively impacted mental health, leading to an increased prevalence of depressive symptoms among transvestite and transsexual individuals. Advocating for transgender rights and providing ongoing education in health care for professionals are critical strategies in promoting the mental health of this population.

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Promoting sexual and reproductive health in the context of transmasculinity constitutes a new issue for health service organisation. This integrative review sought to understand the current evidence on pregnancy in transsexual men in the context of sexual and reproductive health care. From a search of the BVS, PubMed, Science Direct, Scopus, Capes, SciELO and PEPSIC databases, from 2010 to 2020, a sample of 11 articles was selected, treated by content analysis and grouped into four analytical categories: health services - positive experiences; cis heteronormative health services; implications of pregnancy for transsexual bodies; and repercussions of gender-affirming therapy and pregnancy. A cis heteronormative logic was found to predominate in health care, leading to negative experiences during antenatal care and childbirth among transsexual men. Their unique health needs during the pregnancy-puerperium cycle should include mental health care. It is suggested that strategies be adopted to build capacity in health professionals with a view to respectful, inclusive perinatal care for this population group, as well as further studies on the subject.

A promoção da saúde sexual e reprodutiva no contexto da transmasculinidade representa uma nova temática para a organização dos serviços de saúde. A presente revisão integrativa tem por objetivo compreender as evidências atuais sobre a gestação em homens transexuais no contexto da atenção à saúde sexual e reprodutiva. A partir da busca nas bases de dados BVS, PubMed, Science Direct, Scopus, Capes, SciELO e PEPSIC, foi selecionada uma amostra de 11 artigos publicados entre 2010 e 2020, submetidos à análise de conteúdo e agrupados em quatro categorias de análise: serviços de saúde cis heteronormativos; serviços de saúde - experiências positivas; implicações da gestação nos corpos transexuais; repercussões da terapia de afirmação de gênero e gravidez. Verificou-se predomínio da lógica cis heteronormativa na atenção à saúde, que implica experiências negativas durante o pré-natal e o parto entre os homens transexuais. Estes apresentam necessidades singulares em saúde durante o ciclo gravídico puerperal, devendo ser incluído o cuidado à saúde mental. Sugere-se adoção de estratégias de qualificação profissional com vistas aos cuidados perinatais inclusivos e respeitosos para esse grupo populacional, além de novos estudos sobre o tema.

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OBJECTIVE: to analyze the repercussions of transphobia on trans men's and transmasculine people's health. METHOD: a qualitative study carried out with 38 participants, 35 trans men and three trans men, who attended specialized transgender health services in Bahia, Brazil. In-depth interviews were carried out between June 2019 and February 2020. The Discourse of Collective Subject technique was used and interpretation based on the theoretical concept of transphobia. RESULTS: transphobia has intra and interpersonal repercussions on the life and health of trans men and transmasculine people who attend health services. There were experiences of violence in the private space, fraying of family ties; discrimination in the school space; limitation in professional/work opportunities; barriers to self-care and access to health services; elaboration of trans identity protection strategies; consequences of transphobia on psycho-emotional health. CONCLUSION: transphobia is a social disease that affects different life and health dimensions. It causes damage to the socialization of trans men and transmasculine people, in addition to health service spaces as well as in family environments, schools, universities and at work, which result in non-adherence to self-care, distancing from health services and psycho-emotional distress.

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Cisnormativity in the health field has involved the pathologization of identities that do not align with gender binaries. The aim of this study was to analyze the scope and influence of cisnormative discourses on the care and health of trans youth. Semi-structured interviews were carried out between March 2021 and May 2022, and results were analyzed from a social constructivist approach. Five young trans people between 20 and 29 years old participated in the study (2 trans women and 3 trans men). Results showed that aspects of cisnormative gender discourse were evident in their narratives; however, at the same time they generated alternative narratives, where psycho-emotional and bodily care led them to position themselves outside of common tropes such as dysphoria and "the wrong body". We conclude that this study contributes to dismantling the medical view of trans people by showing how they adopt self-care practices by mobilizing their own resources. Furthermore, it reflects the importance of building dialogues with trans people that will allow more and better care strategies to be generated.

La cisnormatividad en el ámbito de la salud ha implicado la patologización de identidades que no se identifican con los criterios de la lógica binaria del género. El objetivo de este estudio fue analizar el alcance y la influencia que los discursos cisnormativos tienen en el cuidado y la salud de las y los jóvenes trans. Entre marzo de 2021 y mayo de 2022, se llevaron a cabo entrevistas semiestructuradas que se analizaron a la luz de la perspectiva socioconstruccionista. Participaron cinco jóvenes trans (dos mujeres trans y tres varones trans), de entre los 20 y 29 años. Los resultados mostraron la incorporación en sus relatos de aspectos del discurso cisnormativo del género; no obstante, a la par generan narrativas alternativas, en las que el cuidado psicoemocional y del cuerpo les lleva a posicionarse lejos de tropos narrativos como la disforia y "el cuerpo equivocado". Concluimos que este trabajo contribuye a desmantelar la visión médica de las personas trans, mostrando cómo a través de sus recursos, adoptan prácticas de autocuidado. Asimismo, refleja la importancia de construir diálogos con las personas trans que permitan generar más y mejores estrategias de atención.

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Objective: To analyze the impact on the psychological and social aspects caused by the COVID-19 pandemic in individuals diagnosed with Gender Dysphoria (GD). Methods: Google Forms inventory was sent via WhatsApp, including qualitative and quantitative questions evaluating three life dimensions denominated as Sociodemographic, Economic, and COVID-19 pandemic. It was applied in two periods: At the beginning of the pandemic (June-2020) (P1) and one year later (June-2021) (P2). The inventory also included questions about economic dimensions before the pandemic for individual comparison purposes (P0). 48 individuals (28 transsexual women, 20 transsexual men) participated in both periods. Results: 77.1% (n = 37) lived in Rio Grande do Sul, 50.0% (n = 24) refereed incomplete high school; Monthly Income increased significantly between the periods (P0) and (P1). Emergence aid approval was significantly higher in (P2), 56.3% (n = 27), compared to (P1), 39.6% (n = 19). A statistically significant difference was detected in the feeling of depression in the (P2) among the cases that requested Emergency Aid. Conclusion: The studied population presented deterioration regarding their condition of social vulnerability in relation to formal employment, access to health services, and mental health.

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ABSTRACT Objective: to analyze the scientific evidence about the experiences of pregnant transsexual men. Method: a descriptive, integrative literature review study without a defined time cut, carried out in January 2021 in the following Databases: Medline, CINAHL, LILACS, CUIDEN, SCOPUS, WoS, EMBASE, PSYCINFO and BDENF, in Portuguese, English and Spanish; using the DECs and MeSH descriptors: "Transgender People", "Pregnancy", "Reproduction", "Fertilization", "Insemination", "Prenatal Care", "Postpartum Period", "Lactation", "Mispontaneous Abortion" , "Habitual abortion", "Reproductive health" and "Health Care" and their respective synonyms. The elaboration of the guiding question was conducted by the PICo Strategy: (Population): transgender men; I (Interest): experiences during the puerperal pregnancy cycle; Co (Context): reproductive health and health services. The final sample was submitted to the Thematic Analysis Technique. Results: a total of 1,011 studies were identified, 10 of which composed this review after the selection process and peer review. The analysis resulted in two thematic categories: "Pregnancy-puerperal cycle: challenges and experiences" and "Pregnant bodies: perceptions and social relationships". Conclusion: the experiences of pregnant transsexual men are marked by concerns related to pregnancy, childbirth, birth and the puerperium, causing unexpected psychological and/or emotional impacts, evidencing cisheteronormativity and transphobia as structuring aspects which add an additional part to fear of childbirth and violations of rights.

RESUMEN Objetivo: analizar la evidencia científica sobre las experiencias de los hombres transexuales embarazados. Método: estudio descriptivo, tipo revisión bibliográfica integradora, sin corte temporal, realizado en enero de 2021 en las siguientes bases de datos: Medline, CINAHL, LILACS, CUIDEN, SCOPUS, WoS, EMBASE, PSYCINFO y BDENF, en los idiomas portugués, inglés y español; utilizando los descriptores DeCS y MeSH: "Personas Transgénero", "Embarazo", "Reproducción", "Fertilización", "Inseminación", "Atención Prenatal", "Período Posparto", "Lactancia", "Aborto Espontáneo", "Aborto Habitual", "Salud Reproductiva" y "Atención a la Salud" y sus respectivos sinónimos. La elaboración de la pregunta guía fue realizada por la estrategia PICo: hombres transgénero (P - Población); experiencias durante el ciclo gravídico-puerperal (I - Interés); salud reproductiva y servicios de salud (Co - Contexto). La muestra final se sometió a la técnica de análisis temático. Resultados: se identificaron 1.011 estudios. Después del proceso de selección y la revisión por pares, 10 compusieron esta revisión. El análisis se ha centrado en dos categorías temáticas: "Ciclo gravídico-puerperal: desafíos y experiencias" y "Cuerpos embarazados: percepciones y relaciones sociales". Conclusión: l as experiencias de hombres transexuales embarazados están marcadas por inquietudes relacionadas a la gestación, el parto, el nacimiento y el puerperio, ocasionando impactos psicológicos y/o emocionales inesperados, evidenciando la cisheteronormatividad y la transfobia como aspectos estructurales que incorporan una parcela adicional al miedo del parto y violaciones de derechos.

RESUMO Objetivo: analisar as evidências científicas sobre experiências de homens transexuais grávidos. Método: estudo descritivo, tipo revisão integrativa de literatura, sem recorte de tempo, realizada em janeiro de 2021 nas seguintes Bases de Dados: Medline, CINAHL, LILACS, CUIDEN, SCOPUS, WoS, EMBASE, PSYCINFO e BDENF, nos idiomas português, inglês e espanhol; usando os descritores DECs e MeSH: "Pessoas Transgênero", "Gravidez", "Reprodução", "Fertilização", "Inseminação", "Cuidado Pré-Natal", "Período Pós-Parto", "Lactação", "Aborto Espontâneo", "Aborto habitual", "Saúde reprodutiva" e "Assistência à Saúde" e respectivos sinônimos. A elaboração da questão norteadora foi conduzida pela Estratégia PICo: (População): homens transexuais; I (Interesse): experiências durante o ciclo gravídico puerperal; Co (Contexto): saúde reprodutiva e serviços de saúde. A amostra final foi submetida à Técnica de Análise Temática. Resultados: foram identificados 1.011 estudos. Após o processo de seleção e avaliação por pares, 10 compuseram esta revisão. A análise resultou em duas categorias temáticas: "Ciclo gravídico-puerperal: desafios e experiências" e "Corpos grávidos: percepções e relações sociais". Conclusão: as experiências de homens transexuais grávidos são marcadas por inquietações relacionadas à gestação, ao parto, ao nascimento e ao puerpério, ocasionando impactos psicológicos e/ou emocionais inesperados, evidenciando a cisheteronormatividade e a transfobia como aspectos estruturantes que acrescentam uma parcela adicional ao medo do parto e violações de direitos.

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Este artículo reflexiona sobre el cuerpo trans* como territorio de poder que hace resistencia al poder hegemónico, cuyo orden busca "normalizar" los cuerpos de acuerdo con lo estipulado socialmente bajo el "deber ser" del género. Para ello se realiza un abordaje teórico sobre el cuerpo, desde posturas como las de Foucault y Butler que lo conciben como entidad que en sí misma es poder. Con base en los referentes teóricos presentados, se expresan los argumentos que permiten entender los cuerpos trans* como territorios de subversión frente al orden establecido sobre estos. Se concluye que las personas trans, si bien se resisten a la heterosexualidad obligatoria, posiblemente no sea de forma estructural y radical, sino desde dentro del orden social, generando ciertas fisuras en sus prácticas y performances que presentan ante el sistema, develando una presencia que excede sus linealidades

This article reflects on the trans* body as a territory of power, which resists the hegemonic power, whose order seeks to "normalize" the bodies according to what is socially stipulated under the "duty to be" of gender. For this, a theoretical approach is made to the body, from positions such as those of Foucault and Butler that conceive it as an entity that in itself is (is) power. Based on the theoretical references presented, the arguments that allow us to understand trans* bodies as territories of subversion against the order established on them are expressed. It is concluded that trans people, although they resist compulsory heterosexuality, may not be structurally and radically, but from within the social order, generating certain fissures in their practices and performances that they present to the system, revealing a presence that exceeds their linearities

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RESUMO. Baseado nas teorias de Foucault e de Butler sobre poder, norma e sujeito, este artigo pretende problematizar o recurso dos sujeitos à identidade na atualidade e os seus desdobramentos para a clínica psicanalítica. Defenderemos que, por um lado, a identidade representa uma sujeição às normas e tem um efeito encarcerador e mascarador de desejos, mas, por outro, pode ser importante enquanto proteção contra o desamparo. Diferenciaremos, a partir de Butler, precariedade (condição universal, compartilhada) de precarização (condição produzida pela distribuição social diferencial da condição de precariedade) e apresentaremos a hipótese de que, quanto maior o grau de precarização de um sujeito, mais importantes o apego e o reconhecimento identitários. Abordaremos especificamente o tema das identidades trans, por sua radicalidade no que diz respeito à condição precária e à busca de reconhecimento. Por fim, recorreremos ao conceito de feminilidade do final da obra de Freud enquanto dispositivo de escuta clínica que permita a transformação de cristalizações identitárias no sentido do novo, do singular e das múltiplas identificações.

RESUMEN. Basado en las teorías de Foucault y Butler sobre el poder, la norma y el sujeto, este artículo pretende problematizar el apego de los sujetos a la identidad en la actualidad y sus consecuencias para la clínica psicoanalítica. Argumentaremos que, por un lado, la identidad representa una sujeción a las normas y tiene un efecto de encarcelamiento y enmascaramiento del deseo, pero por otro lado puede ser importante como protección contra el desamparo. Diferenciaremos, a partir de Butler, la precariedad (condición universal, compartida) de la precarización (condición producida por la distribución social diferencial de la condición de precariedad) y presentaremos la hipótesis de que cuanto mayor es el grado de precariedad de un sujeto, más importantes son el apego y el reconocimiento identitarios. Abordaremos específicamente el tema de las identidades trans debido a su radicalidad con respecto a la condición precaria y la búsqueda de reconocimiento. Finalmente, recurriremos al concepto de feminidad del trabajo final de Freud como dispositivo de escucha clínica que permite la transformación de cristalizaciones identitarias en el sentido del nuevo, del singular y de las identificaciones múltiples.

ABSTRACT. Based on Foucault's and Butler's theories about power, norm and subject, this article intended to problematize the subjects' attachment to identity in the current time and its consequences for the psychoanalytic clinics. We argued that, on the one hand, identity represents a subjection to norms and has an incarcerating and masking effect of desires, but on the other hand, it can be important as a protection against helplessness. We distinguished, with Butler, precariousness (a universal, shared condition) from precarity (a condition produced by the differential social allocation of the precarious condition) and hypothesized that the higher the degree of precariousness of a subject, the more important the identity attachment and recognition. We specifically addressed the theme of trans identities, because of its radicality regarding the precarious condition and the search for recognition. Finally, we used the concept of femininity at the end of Freud's work as a clinical listening device that allows the transformation of identity crystallizations towards the new, the singular and the multiple identifications.

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Resumo O objetivo neste artigo é aproximar a discussão sobre as questões de gênero que constituem o campo de saber da psicologia e as críticas dos saberes transfeministas às práticas e discursos normativos e patologizantes sobre as vivências de pessoas trans. Utiliza-se para tal análise as noções de cisgeneridade, como forma de nomear um lugar a partir do qual as identidades trans são enunciadas, e da cisnormatividade como dispositivo que regula e determina sentidos de coerência para os processos de constituição de gênero. Esses conceitos funcionam como operadores analíticos e políticos que fazem contraponto à naturalização da cisgeneridade como pressuposto fundante das verdades do gênero e dos modos de subjetivação. Problematiza-se, portanto, como a psicologia participa dos arranjos cisnormativos relacionados aos modos de reconhecimento das pessoas trans e às possibilidades de enunciação sobre suas vivências.

Resumen El objetivo de este artículo es aproximar la discusión sobre las cuestiones de género que constituyen el campo del saber de la psicología, así como las críticas de los saberes transfeministas, a las prácticas y discursos normativos y patologizantes sobre las vivencias de las personas trans. Para el análisis se utilizan las nociones de cisgeneridad como forma de nombrar un lugar a partir del cual las identidades trans son enunciadas, y de cisnormatividad como dispositivo que regula y pauta un sentido de coherencia a los procesos de constitución de género. Estos conceptos funcionan como operadores analíticos y políticos que generan un contrapunto a la naturalización de la cisgeneridad como presupuesto instituyente de las verdades del género y los modos de subjetivación. Se problematiza, por tanto, cómo la psicología participa de los acuerdos cisnormativos relacionados con los modos de reconocimiento de las personas trans, así como de las posibilidades de enunciación de sus vivencias.

Abstract This article aims to articulate the discussion about the gender issues that constitute psychology's knowledge field and the critiques of the trans-feminist knowledge to normative and pathological practices and discourses about the experiences of trans people. The notion of cisgenerity is used for such analysis as a way of naming a place from which trans identities are enunciated. Moreover, the notion of cis-normativity is used as an apparatus that regulates and determines meanings of coherence to the processes of gender constitution. These concepts function as analytical and political operators that make a counterpoint to the naturalization of cisgenerity as a founding presupposition of the truths of gender and the modes of subjectivation. Therefore, it is problematized how psychology participates in the cis-normative arrangements related to the modes of recognition of trans people and to the possibilities of enunciation about their experiences.

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