Gender identity: Deconstructions and reconstructions for approaches in health / Identidade de gênero: Desconstruções e reconstruções para abordagens na saúde

Abstract

Objective: to elucidate publications and indicate reflections that describe and discuss the "state of the art", involving trans people and important agendas of the transsexualization process in health. Method: narrative review, with literature published in books and scientific evidence, as well as information on bills, resolutions and decrees, with reflections on the main historical perspectives, epistemological and contemporary aspects involving transgender people. Development: gender identity contemplates the essentialist, constructivist and post-structuralist perspective. In the post-structuralist perspective, gender would be a mechanism through which the notions of masculine and feminine are built, to be a woman is to become a woman insofar as the body is forced to correspond to a historical model of woman, materializing itself even within certain conditions, limits and possibilities delimited by culture. Over the decades, some rights have been achieved with the emergence of new forms of recognition of different gender identities. In the United States, in the National Transgender Discrimination Survey, one of the “Gender Not Listed Here” questions is already being considered. In Germany, the option "diverse" as a gender category, in certificates and other documents, is already part of the routine, including highlighting that binary designations would be discriminatory and violate guarantees of individual freedom. In Austria, for example, there is the option to register as a non-binary person since 2018, through the European Convention on Human Rights. In Japan, the gender considered X refers to a non-binary identity, known as an alternative to man and to woman. In Australia, the option of gender, in the passport, has already made possible some alternatives since 2003. In Brazil, some advances in ensuring respect for the gender identity of trans people can be highlighted. In 2018, a decision of the Federal Supreme Court authorized the change of the civil registry name and biological sex, without the need for surgery or a psychiatric report, dispensing with the opening of legal proceedings, and the procedure can be carried out directly at the notary's office. Science-based health is also a relevant issue and over the past 10 years, health research involving gender identity has increased significantly. This is inevitably reflected in care protocols, materials provided by the SUS, consensus and clinical guidelines. There are important data on the cardiometabolic vulnerability of the trans population, dermatoses, bone susceptibility, among other demands, due to hormone. In addition, health professionals, in most cases, are not trained with this type of content and the situation follows a vicious cycle. Final considerations: it is interesting to note how access to healthcare technologies, such as transgenitalization surgery or hormone, influence transgender identities, research about the construction of political identities, movements, highlighting the influence of social indicators of class and generation in the conflicts related to the identities of the transsexual woman and the non-binary trans. The text brings fundamental reflections and allows health professionals to acquire and update their knowledge on this topic in a short period of time.