Self-determination and self-affirmative paths of trans* and gender diverse people in Portugal: Diverse identities and healthcare

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Abstract Background Trans* and gender diverse (TGD) people are very heterogeneous. While legal contexts and healthcare practices have been growingly endorsing self-determination and consent for gender affirmative care in some countries, gender affirmation trajectories need to be understood as unique and fluid processes, constructed and negotiated by each individual in a given social and cultural context. This study aimed to characterize diverse profiles of TGD people in Portugal, regarding individual choices and trajectories in social, legal, and medical gender affirmative processes. Methods A questionnaire, first developed in France and used in Brazil, Italy, Norway, and Chile, was adapted to the Portuguese context. The conducted survey is comprised of 120 questions, organized into six sections: 1) sociodemographic variables; 2) gender affirmation processes and medical and psychological care; 3) general health and sexual health; 4) mental health; 5) sexuality and sexual concerns; 6) experiences of discrimination and gender identity. Data were collected from a convenience sample of 115 adults who identified as TGD. Content analysis was performed on the written responses, and later categorized. Results Approximately 21% of people identified as men, 17% as trans men, 7% as women, 12% as trans women, 26% as non-binary persons, and 17% as agender or other identifications. Differences were calculated among profiles of TGD participants and their choices for affirmative care, social, and legal transition, revealing an association between the way people self-identify and the request for legal recognition of gender identity, as well as the choices of procedures (or aspirations) for medical affirmation (i.e., hormonal treatments, top surgery, bottom surgery). Conclusions The provision of health care practices consistent with the principles of self-determination requires training of health care professionals and adjustment of public policies, to allow for unique trajectories and profiles.