State-run clinic for transsexuals opens in Sao Paulo

“Since I was a child of seven years old I felt I was different, I did not like women and liked watching the boys on TV”, says Claudia, a transvestite who lives in the centre of Sao Paulo. “I started taking hormones when I was 18, I had already left home. Nowadays I am completely satisfied with my sexuality. I do not have conflicts anymore”.

Like thousands of transvestites in Brazil – there are no official estimates –Claudia is fine with herself, but not that fine with the way society sees her. “Prejudice is still huge against our class. There is no space, there is no work, people look at us in disgust, that’s the reality”.
Prejudice is great in a country considered to be sexually liberal. Brazil is one of the countries with highest rates of homophobic assassinations. In 2008, 190 homosexuals were murdered, and 32% of them were transvestites, according to the Gay Group of Bahia.

But prejudice is not limited to the streets. For many years the GLBT movement has denounced the maltreatment of transsexuals and transvestites in hospitals and health clinics. The movement denounced what it calls the “elbow syndrome”, in which health workers immediately elbow each other as soon as a transvestite or transsexual enters a clinic.

“Some doctors refuse to receive them when they see it’s a transvestite, psychologists do not want to treat them because don’t know how to deal with the issue”, say Maria Filomena, coordinator of a recently inaugurated state-run health clinic for transsexuals and transvestites in the south of Sao Paulo.

The clinic is the first in Brazil to specialize in this population.

Apart from having staff especially trained, it has proctologists, gynaecologists, urologists and infectologists who can deal with specific health issues. Inaugurated in early June, the clinic had already registered 24 patients in its first week. For Maria Filomena, often the prejudice comes from lack of experience. For instance, if a female transsexual goes to a public hospital she will be called by her masculine name instead of the name she chose to use. In her clinic, she says, all exams will be in the name the patients prefer to use in public.

Filomena explains that doctors will focus in harm reduction and counselling. The most common diseases relate to side effects of the use of contraceptive pills by man who want to effeminate their bodies.

According to Doctor Jessica Fernandes Ramos, poor transvestites administer the pills by themselves, taking from 2 to 4 a day without medical prescription: “since the pills are not designed for men, there is no clinic testing of side effects. What we see is that some patients develop venal thrombosis, diabetes, arterial hypertension – while they are still quite young.”

Another common problem results from the insertion of industrial silicon, the type used around baths, showers or sinks. Even though it’s completely inadequate, transvestites in Brazil who can not afford proper surgery use this material to shape their bodies. “There are some professionals called “bombadeiras” who apply silicon in illegal residences, they are paid to shape the bums, breasts, thighs and to shape the transvestites’ lips”, says doctor Silvia Pereira Goulart.

That is the reason that brought Claudia to the clinic today. She had industrial silicon introduced to her body ten years ago and since then it has spread to her legs and feet, causing repeated infections and a lot of pain. “I had a problem in the lymphatic vases of the legs and feet. It was an internal injury, an ulcer that opened up in 2009. Some of the skin suffered necrosis so I had an operation to remove it”. 

She is now being treated every week at the clinic and has a new surgery for her injury scheduled. For the first time, she says, she has been treated with respect in a public health facility. “They treat me as an equals, as if I someone acceptable in society”

Often the health services do not know how to proceed in the case of harm done by illegal procedures taken by the transvestites and transsexuals. There are only a handful of specialized clinics in the world and literature is very scarce. 

This is one of the main challenges of the new clinic: to identify possible procedures and train professionals to deal with them adequately. “We are starting to develop protocols on how to act and to develop the structure that is needed to provide health and emotional support for this people”, says Maria Filomena. “The idea is to start treatment of transvestites and transsexuals in here but to share this technology with clinic all over Sao Paulo state”.