Access to healthcare for Trans, Travestis, and Gender-Diverse people in Latin America: a scoping review

Background: Trans, Travestis, and Gender-Diverse (TTGD) populations in Latin America face substantial barriers to equitable healthcare. Travesti refers to a regionally specific gender identity with distinct cultural and political meanings.

Objective: This scoping review aimed to map and characterize the literature and factors influencing access to health services and goods (such as medicines, diagnostic tests, and other resources for these populations).

Methods: Following Joanna Briggs Institute (JBI) methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, a comprehensive search was conducted in SciELO, PubMed, LILACS, Web of Science, and Scopus. Paired screening and data charting were guided by a multidimensional access framework encompassing enabling and disabling factors, health needs, and individual behaviors. Inclusion criteria comprised primary studies on healthcare access for TTGD people in Latin America.

Results: A total of 115 studies were included, all published between 2007 and 2024, although no publication date restrictions were applied. Disabling factors included undertrained professionals, pathologizing protocols (e.g., requiring diagnoses to access gender-affirming services), institutional transphobia (e.g., disrespect of social names and pronouns), limited funding for gender-affirming care, fragmented services, weak integration with primary care, inconsistent recognition of social names, and geographic or regional access gaps. Health needs were often unmet. Normative needs included gender-affirming procedures, hormone management, and comprehensive care. Felt needs encompassed humanized care, access to medicines and prostheses, chronic disease management, and psychological support. Expressed needs included emergency care and vaccination. Individual health behaviors reflected resilience and adaptation. Economic vulnerability and systemic exclusion (e.g., denial of care in public health facilities and cisnormative protocols) led many to avoid formal care and seek informal, peer-based, or self-managed alternatives. Access-enabling strategies included services involving TTGD professionals and inclusive policies, mostly implemented at municipal or institutional levels, promoting safe spaces, non-trans-pathologizing care, autonomy, and user collaboration.

Conclusion: The findings highlight the importance of inclusive policies addressing cis-heteronormative norms and fostering community participation at all levels of healthcare, particularly in primary care. Key pathways to achieving equitable healthcare include structural reforms, investment in provider training, and the adoption of depathologized, rights-based models centered on TTGD leadership.

Systematic review registration: osf.io/4zvse.

1 Introduction

Trans, Travestis, and Gender-Diverse (TTGD) people face persistent barriers to healthcare access (1–5). Beyond general health needs, TTGD populations often require gender-affirming services such as hormonization and body modification procedures (6). However, access to these services is often limited due to unmet health needs and experiences of discrimination (1–3, 5, 7, 8).

Trans, Travestis, and Gender-Diverse (TTGD) individuals have a gender identity that differs from the gender assigned at birth. This review adopts the term “TTGD people” as essential to a decolonial perspective, highlighting the political and cultural relevance of regional terminology and the plurality of identities, while acknowledging potential interpretive differences for international audiences. “Trans” is an umbrella term encompassing multiple gender identities. Although “Travesti” may carry pejorative connotations in certain contexts, in Latin America, it designates a specific transfeminine identity with distinct cultural and political significance. The term “Gender Diverse” refers to individuals whose gender identities or expressions diverge from binary gender norms (9, 10). In this regional context, “hormonization” denotes the use of hormones to affirm gender diversity as a human right and to contest the biomedical pathologization of Trans bodies (11).

Latin America presents a unique context for understanding healthcare disparities among TTGD populations. Although several countries have recognized health as a universal right and adopted policies to support TTGD healthcare, such as Brazil's National Policy for Comprehensive LGBT Health (12), Argentina's Gender Identity Law (13), and Uruguay's Ley Integral para Personas Trans (14), structural challenges persist, including fragmented health systems, underfunding, regional disparities (15, 16), and high levels of violence against TTGD people. The region accounts for over 70% of reported murders of Trans individuals worldwide (17). TTGD people also frequently face institutional discrimination in healthcare settings, including misgendering, disrespect, and denial of care (2, 18–20).

Previous reviews have examined aspects of TTGD healthcare, but important limitations remain. Many focus solely on Brazil, specific levels of care, or primarily on lesbian, gay, and bisexual populations, with limited attention to trans experiences (2, 5, 21–23). Even in global reviews including Latin America, the region is often subsumed within broader international contexts, limiting depth and specificity (3, 4, 23, 24). Consequently, comprehensive knowledge on how access to healthcare for TTGD people is framed, discussed, and studied across Latin America remains limited.

A scoping review is particularly suited to map these patterns and gaps, identify key concepts and types of evidence, and provide a comprehensive overview of this complex, underexplored area (25).

This study's framework was guided by Andersen's Behavioral Model of Health Services Use due to its multidimensional perspective on healthcare access, encompassing both individual and contextual factors (26), and is recognized as the most important and frequently cited theoretical model in this field of research (27). We adapted selected components, particularly enabling factors, with the dimensions of information, acceptability, and adequacy proposed by Soares (28) and Sanchez and Ciconelli (29), alongside an expanded concept of health needs based on Bradshaw (30), to provide a comprehensive, context-sensitive lens for examining health access among TTGD populations in Latin America. By mapping populations, countries, and factors influencing healthcare access, this review provides an overview of the current state of knowledge, highlights research gaps, and informs context-sensitive approaches to healthcare provision and policy discussions grounded in the realities of TTGD communities in the region. Anticipated limitations include language restrictions, potential publication bias, and heterogeneity across included studies, which may affect the completeness and comparability of the evidence.

2 Methods

We conducted a scoping review using a systematic and structured approach to comprehensively map the existing literature, characterize factors related to, and identify knowledge gaps regarding access to healthcare services and goods for TTGD people in Latin America. The guiding question for the review was “What are the characteristics of the scientific literature and the factors related to access to health services and goods for TTGD people in Latin America?” The Population, Concept, and Context framework guided the review, defining Trans, Travestis, and Gender-Diverse people as the Population, healthcare access as the Concept, and Latin American health services as the Context.

The methodology followed the Joanna Briggs Institute (JBI) Manual for Scoping Reviews guidelines (25) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist (31), ensuring a rigorous and transparent process across all stages of the review. The research protocol was developed and prospectively registered on the Open Science Framework (osf.io/4zvse) before conducting the review, with updates made as necessary (32).

2.1 Search strategy

A comprehensive search was conducted between May 5 and 9, 2024, across the SciELO, PubMed, LILACS, Web of Science, and Scopus databases. Controlled vocabularies (DeCS/MeSH) and relevant keywords, including synonyms, were used to maximize the retrieval of studies focused on Latin America. Searches were carried out in English, Portuguese, and Spanish, with no date restrictions. The process followed the JBI three-step strategy: initial identification of terms, expanded database searches, and screening of included studies' reference lists. Full search strategies are available in Supplementary material.

The strategy was designed to map the literature on access to health goods and services for TTGD people living in Latin America. Boolean operators and tailored strings were adapted to each database. In LILACS and SciELO, DeCS terms and commonly used keywords were combined in strings written in Portuguese, Spanish, and English. In PubMed, MeSH terms and common English keywords were used. For Web of Science and Scopus, English strings included synonyms and entry terms from MeSH. In databases not specifically focused on Latin American research, geographic delimiters such as regional MeSH terms or the explicit names of Latin American countries were included to refine the scope. The search strategy applied no date filters.

2.2 Study selection

Duplicates were removed using EndNote software and manual checks. Prior to screening, a calibration exercise was performed to ensure at least 75% agreement between reviewers. Subsequently, two reviewers independently screened titles, abstracts, and full texts. Any discrepancies were resolved through consensus or by consulting a third reviewer. Inclusion criteria were:

(a) studies addressing access to healthcare goods and services for TTGD or Lesbian, Gay, Bisexual, Trans, Queer, Intersex, Asexual, Pansexual, Non-binary, and other (LGBTQIAPN+) populations, with findings specifically reported for TTGD participants; thus, studies in which TTGD data could not be separated from broader LGBTQIAPN+ data were not included;

(b) primary research, including empirical qualitative, quantitative, and mixed-methods studies, excluding reviews, commentaries, editorials, or opinion pieces;

(c) availability of abstracts to allow screening; and

(d) participants residing in Latin American countries.

Gray literature and policy reports were not included, as they did not meet criterion (b); as the review aimed to analyze peer-reviewed scientific evidence. These criteria ensured a focus on original evidence addressing healthcare access for TTGD people in the region and supported the feasibility of the screening process, in line with JBI guidance (25).

The search yielded 954 records, of which 272 duplicates were removed. A total of 682 titles and abstracts were screened, and 185 full-text articles were assessed for eligibility. Of these, 497 were excluded during title and abstract screening and 95 during full-text review based on the eligibility criteria. Most exclusions occurred because TTGD-related results could not be distinguished from those of the broader LGBTQIAPN+ population (criterion a) or because the records did not constitute primary research (criterion b). A total of 90 studies were included through database searches and an additional 25 through reference screening, resulting in 115 studies. Among the excluded records, eighteen retrieved through the search and published between 1994 and 2006 were also removed during screening for not meeting the eligibility criteria, mostly due to criterion a. This helps explain why all included studies were published from 2007 onward. The full flow of identification, screening, and inclusion is presented in the PRISMA-ScR diagram (Figure 1).

Figure 1

Figure 1. PRISMA-ScR flow diagram illustrating the study selection process.

2.3 Data charting and analysis

Data charting was conducted independently by pairs of reviewers using a standardized Excel^® sheet, with consistency ensured through pilot testing (25). Extracted data included study characteristics, population, methodology, and dimensions based on the conceptual framework integrating Andersen's Behavioral Model (26) with further health access domains (28, 29). Information on the first author's field of graduation was obtained by consulting scientific platforms (ORCID, ResearchGate, and CNPq Lattes Curriculum) and official institutional websites, and authors were contacted when additional information was required.

Data charting was conducted using three tools: a general data form for all studies and specific forms for qualitative and quantitative data. Mixed-methods studies were extracted using both forms, ensuring that all relevant data were captured appropriately.

A general data charting form was developed to capture essential descriptive and contextual information from each included study. This form comprised variables related to study identification (e.g., title, authors, year, journal, and language), methodological features (e.g., study design, type of research, and population), and contextual characteristics (e.g., authors' institutional affiliation, country, and funding source). It also included fields to specify whether the study addressed health goods and services for Trans people exclusively or for both Trans and cis populations, as well as the level of healthcare involved. Finally, the form recorded details on population subgroups, such as transfeminine, transmasculine, and gender-diverse participants, ensuring comprehensive mapping of the study's scope and context.

Data charting templates and examples are provided in Tables 1, 2 (qualitative data). The quantitative extraction form retained the same core categories as the qualitative template, excluding qualitative methodological details. In addition, it included variables specific to quantitative studies (Table 3).

Table 1

Table 1. Data charting template for qualitative studies.

Table 2

Table 2. Extended data charting template for qualitative studies.

Table 3

Table 3. Specific categories of data charting template for quantitative studies.

The conceptual framework also underpinned the analysis. A detailed rationale for the theoretical foundation is provided in Supplementary material. Data were summarized using a basic deductive content analysis, consistent with JBI guidance (25). Extracted findings were independently categorized by each researcher according to the predefined framework rationale, with continuous comparison and without reinterpretation. This approach enabled a structured mapping of the evidence while respecting the methodological diversity and heterogeneity of the included studies.

Frequency counts were used to quantify the occurrence of publications by country, research methods, target populations, and other key elements within the literature. The geographic distribution of included studies was visually represented using Datawrapper (33).

Results are presented in tables and figures detailing study characteristics and dimensions related to healthcare access. Additionally, narrative summaries were provided within predefined sections aligned with the conceptual framework.

3 Results

A total of 954 records were identified across all databases searched, resulting in 115 studies included in the review. Information on records found in each database, duplicate removal, and the screening process is presented in the PRISMA-ScR flow diagram (Figure 1).

3.1 Study characteristics and findings

The 115 primary articles addressing health access for TTGD people in Latin America were published between 2007 and 2024.

There is a clear upward trend in publications beginning around 2013, with some yearly fluctuations and a peak of 18 studies in 2022 (Figure 2). The linear trendline indicates a strong positive correlation (R² = 0.832), projecting continuous growth through 2023. However, there was a notable decline in the number of reports in 2023. Data for 2024 was incomplete since the search was limited to May 2024; therefore, excluded from the trendline analysis. The exponential trendline, calculated up to 2022, shows the strongest fit (R² = 0.937) and highlights that the publication rate followed an exponential growth pattern until that year. After 2022, the trajectory shifted to a linear trendline, which provides a more accurate representation of the overall pattern through 2023.

Figure 2

Figure 2. Number of reports per year. Annual distribution of reports (n) addressing access to health services and/or health products by TTGD populations in Latin America, from 2007 to 2024. Blue dots represent the number of reports per year, connected by a solid blue line until 2023 and a dashed line for 2024, reflecting incomplete data not included in the trendline calculations. The yellow line shows the linear trendline up to 2023 (R² = 0.832), and the green line indicates the exponential trendline up to 2022 (R² = 0.937).

The geographical distribution of included studies (Figure 3) illustrates a strong concentration of publications in Brazil and Argentina, which account for over 80% of all records. This suggests that research on Trans health access in Latin America remains uneven, with limited representation from Central America and smaller South American countries, highlighting a geographic bias that should be considered when interpreting the regional scope of the findings. A total of 64 research institutions were identified, located mainly in Argentina, Brazil, and Colombia, with studies widely dispersed among them. Fundación Huésped led with 6.9% of publications, followed by Universidade Federal da Bahia, Pontificia Universidad Javeriana, and Faculdade de Ciências Médicas da Santa Casa de São Paulo, each with 4.3%.

Figure 3

Figure 3. Geographic distribution of included studies (n = 115) on access to health services and/or health products for TTGD populations in Latin America. Darker shades indicate a higher proportion of studies conducted in each country. No studies were identified in countries shaded in gray. Figure generated using Datawrapper (33).

The objectives, countries, types, and findings of the studies are presented in Table 4. Each article has been assigned a reference number (column “N”), which will be used to refer to the respective study throughout the Section 3.

Table 4

Table 4. Study characteristics and findings.

All reports presented field research, and the majority (71.2%) adopted a purely qualitative approach (Table 4). Across these and mixed-methods studies, the majority did not specify a clear methodological framework, merely describing their design as qualitative (Table 5). Ethnographic, phenomenological, and grounded theory approaches were the most frequently reported among those that specified one.

Table 5

Table 5. Article attributes summary.

Quantitative (23.48%) and mixed-method studies (5.2%) were predominantly cross-sectional and descriptive, focusing on sociodemographic factors, healthcare access, hormone use, body modification, and HIV prevention behaviors (Table 4). Analytical studies explored associations with HIV care, ART adherence, psychosocial factors, and quality of life. Only one cohort study examined PrEP engagement and adherence, and two intervention studies assessed adherence-promoting and clinical follow-up strategies among transgender women.

Table 5 presents the key characteristics of the included studies. Most were published in English or Portuguese, and over 70% focused exclusively on Trans, Travestis, and Gender-Diverse (TTGD) populations (1–4, 7–8, 11–19, 21–24, 26–27, 29–35, 37–49, 51–55, 57–63, 67–71, 74–76, 79–83, 85–91, 93–95, 97–107, 109–110, 112, 114–115). Smaller proportions examined only healthcare professionals (7.8%) (22, 31, 39, 60, 68, 79, 82, 91, 98) or included more than one sample population (20.0%) (5, 6, 9, 10, 20, 25, 28, 36, 50, 56, 64–66, 72, 73, 77, 78, 84, 92, 96, 108, 111, 113), such as Trans people alongside cis individuals living with HIV, Men who have Sex with Men (MSM), Lesbian, Gay, and Bisexual (LGB) individuals, and healthcare workers.

Nearly half of the studies focused exclusively on transfeminine identities (1–4, 8, 11–14, 16–17, 19, 26–27, 29–30, 34–35, 37, 40, 46–49, 52–55, 59, 61–63, 67, 69, 71, 74, 76, 80, 83, 85, 87–90, 93, 99, 102, 106–107, 110, 112, 114–115).

The healthcare worker population included community health workers; mental health professionals (psychologists, psychiatrists, and therapists); nursing staff (nurses, nursing assistants, and technicians); physicians and medical specialists (surgeons, endocrinologists, gynecologists, urologists, and sexologists); allied health and support staff (social workers, hospital receptionists, midwives, nutritionists, oral health technicians, emergency medical technicians, and physical educators); and professionals in healthcare-related roles (lawyers, journalists, health service coordinators) (9, 10, 22, 28, 31, 39, 50, 56, 60, 64, 68, 77, 79, 82, 84, 91, 98, 113). Three studies did not specify professional categories (66, 108, 111). Most studies (56.5%) did not report the level of care (1, 3–5, 7–15, 19–22, 25, 27, 30, 33–34, 37, 40, 46–47, 51, 54–55, 57–59, 62–63, 67, 69, 71–73, 76–78, 80, 83, 85, 87–93, 98–99, 101–104, 107–109, 112–115).

Contributions from Sociology and Cultural Studies, as well as Social Work and Counseling, played a meaningful role in shaping the literature, as Social and Behavioral Sciences narrow fields (146) accounted for nearly half of the first authors' disciplinary backgrounds (46.9%) (1–2, 4–5, 7–8, 10, 21–26, 28, 32–33, 35–37, 39, 41–45, 48–50, 53–55, 58, 61, 63–64, 68, 72–73, 75–77, 79, 84–85, 87, 89, 91–92, 96–98, 108–109, 111). Health disciplines followed closely, representing 43.5% (3, 11–19, 29–31, 34, 46–47, 51–52, 57, 59–60, 62, 67, 69–71, 74, 78, 80–83, 86, 88, 90, 94–95, 99–101, 103–107, 112–115).

3.2 Access to health services and goods

Individual and contextual factors that enable or hinder access to healthcare for TTGD populations in Latin America are synthesized in Figure 4, which presents the Adapted Andersen Behavioral Model, highlighting the principal findings of this scoping review.

Figure 4

Figure 4. Representation of key findings within the adapted Andersen Behavioral Model. Adapted Andersen's Behavioral Model: incorporating the dimensions of information, acceptability, and adequacy (28, 29) and considering broad health needs (30). STI, Sexually Transmitted Infection; PHC, Primary Health Care.

3.2.1 Enabling and disabling factors

3.2.1.1 Availability/accessibility

Availability, similar to accessibility, refers to the presence of health services and goods in the right place and time, considering geographic proximity, transport options, and provider willingness (22, 29). Studies indicated that the availability and accessibility of healthcare for TTGD populations in Latin American public health systems remain fragmented and inadequate. Services across all levels are shaped by systemic cisnormativity, institutional transphobia, regional disparities, underfunding, and prejudice. These challenges are compounded by structural and organizational barriers, which hinder comprehensive, affirming, and timely care. Altogether, these elements operate within a broader social apparatus that reproduces institutional violence, adapting its forms and sustaining its effects across contexts (14, 16, 19, 26, 40, 48, 61, 63, 68, 79, 84, 86, 106, 115).

The availability of healthcare services and goods across the region is characterized by a mix of isolated positive initiatives and persistent systemic obstacles. Many reported non-uniform care due to discrimination or geographic inaccessibility (9, 12, 71, 109). Challenges include scheduling, bureaucracy, unwelcoming or unsupportive reception, physician shortages—particularly in specialized gender-affirming services but also in general care units—and information systems that fail to accommodate social names (49, 58, 66, 68, 104, 105, 114). A study showed a lack of coordination between health systems, universities, and social movements, as well as an absence of outreach promoting service use (61). Institutional denial of gender identity was frequently reported, particularly through the use of legal (rather than social) names and sex assigned at birth (1, 3, 63, 68, 86). “Social names” is a Latin American term referring to a person's chosen name (Brazil, 2016; Argentina, 2012), similar to the notion of “chosen or affirmed names” in global northern contexts.

Public Primary Healthcare (PHC) often lacks structural support and qualified professionals, compromising both the delivery of humanized care—understood here as a welcoming and person-centered approach—and PHC's function as a gateway for TTGD users (3, 4, 11, 18, 26, 31, 38, 48, 51, 55, 95, 103, 115). Users report weak connections to PHC, demanding better integration among providers and users, as well as more welcoming environments (106). Care quality varies by region, with central units having more staff and greater availability of gender-affirming services compared to outlying areas. The limited access to gender-affirming procedures and higher prevalence of stigma in peripheral or rural locations often compel TTGD people to seek private care or clandestine alternatives (24, 48, 103). Despite increased demand for care in Psychosocial Public Care Centers, professional and service capacity to support TTGD individuals remains insufficient across settings (79). Proximity to PHC facilities and ease of transportation further influence service utilization, as TTGD users may avoid distant or non-affirming centers due to anticipated discrimination or inadequate care (115).

Some services are characterized by power imbalances in the relationships between physicians and TTGD users, weakening therapeutic bonds, and discouraging care-seeking. In addition to inadequate professional qualifications, these issues are compounded by institutional neglect (e.g., disregard for users' gender identity, providers remaining silent when users raise sexual or gender diversity–specific issues, and breaches of confidentiality) and a lack of disaggregated data on users' characteristics, as well as the capacity of health services for planning and resource allocation. Care also tends to be predominantly curative rather than preventive (9, 111).

Healthcare was often perceived as prejudiced, violent, and inadequate, marked by misgendering, denial of care, medical coercion, and other forms of institutional violence detailed below (2, 3, 14, 16, 26, 40, 67, 99, 104, 106). Reported barriers included inappropriate hospital ward allocation (1, 3) and prejudice from other service users (99). In Brazil, although TTGD individuals frequently experience injuries resulting from public violence, they rarely seek care in the public health system, perceiving it as inadequate (14). While discrimination in public care is recognized, availability encourages use, especially for gender-affirming procedures and emergencies (49). Reports of severe violations of healthcare rights in Colombia included torture manifested in continuous forced testosterone injections carried out against users' will, as well as degrading psychological and medical practices that pathologize and humiliate TTGD users (40), with older Trans women experiencing abuse more frequently (67).

Delays in accessing services were a significant barrier. In Colombia, emergency care for some Trans women was immediate, but non-emergency services were often delayed, reflecting uneven system responsiveness (35). Similar delays affected other settings, including Brazil's SUS gender-affirming services (6, 7, 15, 28, 51, 99).

Gender-affirming services were characterized by long waiting times in service queues, limited hours that overlooked sex workers' schedules, bureaucratic hurdles such as excessive documentation requirements, overcrowding within Trans-specific services (high demand facing limited availability), poor signage and infrastructure, lack of coordination among specialists, unqualified professionals, unstable supplies of inputs, and high staff turnover (1, 2, 4, 10, 24, 26, 28, 36, 35, 37, 41, 43, 44, 51, 53, 56, 66, 75, 81, 84, 86, 91, 98, 103, 106, 109, 111, 114).

TTGD participants accessed public gender-affirming services primarily for diagnosis, post-operative care, and some body modification procedures, while others opted for private surgeries due to long wait times (45, 97). Conversely, some individuals reported private services as less respectful of gender identity, including chosen names, despite available information (22).

Gaps in national policies persist. The geographic concentration of health services in capital cities further exacerbates inequities for individuals living in rural or remote areas. The main public gender-affirming care services identified were Brazil's Transsexualization Process (PTr) and Argentina's Gender Identity Law (8, 13, 17, 21, 22, 23, 28, 29, 39, 39, 43, 44, 45, 51, 53, 59, 63, 76, 87, 97, 111), both mostly concentrated in capitals, with long waitlists and travel burdens (24, 26, 36, 41, 42, 44, 51, 53, 56, 100, 101, 114). While the Argentine law promoted depathologization and multidisciplinary care, implementation varies (see Section 3.2.1.5) (22, 28, 39, 98, 108, 111). However, despite the law, limited hospital capacity and human resources in the public sector hinder its full implementation (22).

Brazil faces challenges in implementing its National Policy for Comprehensive Health of the LGBT Population (77, 104), and studies highlight significant criticism regarding the standards of PTr implementation (53). PTr hospital services exhibit poor integration with other Brazilian Unified Health System (SUS) services and a regulatory approach to mental health. The focus on procedures and approaches centered on technological devices leads to a division of responsibilities and the trivialization of users' suffering. Moreover, its institutional requirements are grounded in biomedical and cisnormative logics (see Section 3.2.1.5) (21, 23, 29, 42, 63, 64, 97, 100).

The exclusion of hormonization medicines from Brazil's SUS Essential Medicines List restricts access to hospital-based PTr services, limiting availability. Many obtain hormones through private pharmacies, often without prescriptions or using falsified ones, and via informal or unsafe markets, gyms, or other sources (11, 15, 30, 32, 35, 40, 44, 45, 46, 59, 69, 81, 88, 97). Public access is rare, reported as 1.8% (45) and 2.2% (97). Pharmacies frequently serve as both sources and healthcare facilities for injectable hormone administration (11, 32, 35, 46, 88). Their widespread availability, combined with weak PHC support and limited public provision, fosters self-medication and the use of counterfeit or controlled substances such as testosterone, which requires a prescription in Brazil (1, 3, 7, 8, 14, 15, 17, 18, 21, 24, 25, 37, 40, 41, 42, 44, 48, 49, 58, 66, 81, 95, 99, 100, 103, 114). Hormonization regulation remains weak, with no clear protocols for access, distribution, or clinical guidance (8, 94). Hormone availability was associated with better PrEP adherence (83), and recognition of affirmed names functioned as a protective factor against self-medication (59).

Barriers to sexual health services, ranging from pharmacies to specialized healthcare facilities, included discrimination, HIV stigma, cost, inadequate support, and incompatible service hours, particularly for sex workers, while peer support facilitated access and consistent use (5, 6, 76, 90). Despite limitations, STI services, especially for HIV/AIDS, are often the most Trans-competent and structured facilities available, though their centrality reinforces stigma (5, 24, 63, 74, 76). HIV diagnosis availability occurs through public services, NGOs, and private clinics (20). SUS remains the main source of care for many in Brazil, particularly for HIV prevention and treatment (99). ART and HIV tests were generally available during routine visits or hospitalizations (25, 33, 62, 71), but their use is limited by discrimination and provider unpreparedness (62, 71, 83). Self-testing among Trans women was facilitated by privacy and availability, with recommendations for PHC-based distribution and peer support (107). For STIs like syphilis, care involved SUS or private diagnostics in Brazil, but treatment was accessed only through the public system (90). Condoms were mainly accessed through community organizations and healthcare facilities (89).

During the COVID-19 pandemic, the availability of healthcare services in Argentina was significantly disrupted, particularly for individuals not previously linked to specialized services, resulting in reduced access to hormonization as well as general and mental healthcare (108, 109). Informal support networks played a key role in maintaining access despite service interruptions (108). In contrast, in southern Brazil, PrEP, and PEP services remained available, although users experienced increased exposure and heightened risks of serostatus disclosure (96).

The absence of formal institutional support, such as managerial endorsement, clear guidance, and team training for TTGD healthcare, was a consistent issue. Some providers were unfamiliar with appropriate practices, such as guidance on hormone use, and unaware of the local availability of Trans-specific facilities, such as the SUS Transsexualization Process (40, 63, 68, 70, 75, 77, 99). In northern Chile, 77% of healthcare professionals were unaware of Trans-specific care standards, though 96% expressed interest in learning (82).

Multiple studies highlighted that TTGD individuals are often not recognized as legitimate recipients of care (4, 28, 50, 60, 64, 68, 111, 113). Systemic invisibility, the absence of guidelines and research, the prevalence of cis-heteronormativity (services structured around the assumption of cisgender and heterosexual users, excluding the realities and needs of TTGD people), and professional dominance, expressed in hierarchical, physician-centered models that disregard users' autonomy, contributed to the marginalization of transmasculine individuals in lactation care (113). As a result of systemic barriers, many Trans men avoided accessing gynecological care in public PHC and sought private specialized services, relying on the Brazilian SUS only when no alternatives were available, such as during COVID-19 vaccination (104). Invisibility was linked to the absence of specific policies, data collection systems, and protocols that address the diversity of bodies, identities, and experiences of TTGD. For instance, several studies pointed out that transmasculine individuals and non-binary people remain largely invisible in public policies and health services, especially regarding reproductive and sexual healthcare (26, 33, 42, 58, 64, 66, 72, 75, 84, 85, 94, 97, 98, 101, 104, 107, 108, 110, 113).

Inclusive healthcare facilitated access across all care levels (18, 36). Nurses and social workers reported isolated efforts to improve accessibility for TTGD, including providing gender-responsive services, institutional support, safe spaces (characterized by respect for gender identity, confidentiality, and supportive environments), inter-facility collaboration, and staff training (91). However, Trans-specific PHC initiatives were limited to medical consultations, with little multiprofessional integration or connection to higher-level care, and lacked gender-affirming procedures like surgeries (18).

Respect for social names and inclusive provider attitudes were seen as service strengths, alongside calls for professional training and the hiring of TTGD staff to improve care (48). Some promising initiatives emerged, including community-led protocol revisions, collaborative learning between professionals and TTGD users, LGBTQ+ communication workshops, and mandatory rotations at Trans-specialized facilities for medical residents (5, 48, 56, 64, 84), though these remain isolated and inconsistently applied.

3.2.1.2 Payment capacity/Financing

Payment capacity or financing refers to the relationship between healthcare costs and users' ability to afford them (28, 29). The studies indicate that both users' financial means and funding sources (public, social security, or otherwise) are key determinants of access. Limited financial resources and high costs of Trans-specific care are frequently cited as barriers. Consequently, many rely on public health systems due to the unaffordability of private care, despite concerns over organizational issues, quality, and scope of services (1, 6, 7, 14, 21–24, 38, 44, 49, 53, 56, 66, 84, 100, 102). However, service barriers (see Section 3.2.1.1) led some to seek gender-affirming procedures in private or informal settings (6, 7, 15, 28, 51, 99).

Many studies reported that participants had monthly incomes below the minimum wage (25, 35, 59, 62, 69, 88) and lacked private health insurance (13, 92, 102). An exception was observed in Brazil's Federal District, where most participants earned up to four times the minimum wage (46). During the COVID-19 lockdown, financial aid was particularly difficult for accessing healthcare (109).

Limited income was associated with reduced access to hormonization, gender-affirming surgeries, decreased ART adherence, and limited HIV-related care, while higher income and education correlated with consistent hormone use and access to professional guidance (32, 35, 45, 46, 62, 88, 97). Conversely, lower income and engagement in sex work were linked to non-prescribed hormone use and difficulties communicating with providers due to anticipated mistreatment (88, 112).

Economic vulnerability was particularly pronounced among Travestis and Trans women, with many reporting unemployment or underemployment as barriers to consistent care (20, 40, 48, 49, 67, 97). Unemployment increased the likelihood of fearing mistreatment and reduced communication about health needs (112). Homelessness and reliance on sex work were often linked to financial precarity and the need to fund health-related expenses (48, 49).

Healthcare costs, including psychological support, gender-affirming care, and STI prevention tools like PrEP, often exceeded participants' means, leading to unsafe practices (see Section 3.2.3) (5, 7, 9, 15, 20, 23, 24, 40, 51, 58, 97). Affordability shaped participants' perceptions of HIV self-testing (107). In Peru, Trans women were willing to pay only USD 5 for HIV self-tests, well-below the market price of USD 18, indicating that payment capacity was a limiting factor (25).

In countries with national gender-affirming policies, some participants accessed services and medicines free of charge (43). Some users of public gender-affirming services reported out-of-pocket expenses for items not covered, including post-operative ointments, hormones, or travel to other cities (53, 84).

Most studies reported low insurance coverage and limited benefits for Trans-specific needs in both public and private systems, with few exceptions (1, 38, 44, 56, 58, 81, 97, 114). Even participants with insurance often turned to private care to expedite access or compensate for gaps in the public system. Private services were perceived as higher quality, yet financial constraints often made continuous care, and sometimes even occasional care, unattainable (7, 14, 24, 49, 81, 100, 108).

Private health insurance was associated with lower healthcare avoidance (12), with Travestis the lowest coverage rates (97) and the highest uninsured rates among individuals with lower educational levels (102). Some participants used general care from private plans but relied on the public system for gender-affirming procedures (e.g., PTr) (47). Uninsured individuals turned to social insurance, public clinics, or fundraising to access private chest surgeries (44). Even within public national healthcare systems, items like hormones or post-operative supplies required out-of-pocket expenses (53, 108); financial constraints hindered travel for care (53).

The economic barriers were further compounded by systemic inequities, including employment discrimination, educational exclusion, and social marginalization, which restrict TTGD people's earning capacity and autonomy, particularly among older Trans women and those in informal housing or unstable living conditions (1, 20, 37, 40, 67, 89).

3.2.1.3 Information

Information refers to the degree of knowledge asymmetry between users and health professionals, impacting communication and healthcare decision-making (29). The studies reveal widespread limitations in access to accurate and comprehensive health information among TTGD participants across diverse settings.

Educational levels varied but were often below secondary education, likely impacting health literacy (3, 4, 6, 13, 16, 24, 25, 30, 35, 42, 46, 47, 49, 55, 59, 69, 70, 92, 81, 102). Low education levels correlate with limited knowledge of healthcare options, use of liquid silicone, low health literacy, and poorer outcomes (27, 30, 33, 34, 83, 93). Trans women with elementary education or less reported higher illness prevalence (102), while higher education was linked to improved communication with providers (112).

Many relied on peers, social networks, NGOs, and community groups for information on hormonization, gender-affirming procedures, and sexual health (3, 8, 10, 11, 14, 15, 19, 24, 32, 37, 44, 46, 49, 51, 56, 65, 66, 75, 77, 89, 94, 96, 97, 99, 103). Transgender and gender-diverse individuals linked to hormone access clinics showed better knowledge of inclusive care and rights (111). The internet and social media were key for disseminating gender-affirming information and fostering community-informed biomedical knowledge (10, 43, 44, 51, 66, 94, 97, 99). Trans men more frequently used online forums for health information than Travestis (97). A lack of knowledge about how to enroll in health coverage was observed among uninsured individuals (35). Uncertainty about healthcare safety healthcare effectiveness and age-dependent; younger or newly informed individuals exhibited more uncertainty (3, 73, 77), while older participants recognized self-medication risks and emphasized long-term self-care (37). Misinformation and insufficient guidance contributed to unsafe practices, leading to heightened health risks (11, 15, 77).

Information gaps regarding general healthcare, especially STI prevention and treatment, were recurrent. Some users, especially sex workers, demonstrated awareness of STI risks and prevention (65, 85, 89, 90). Many healthcare users had limited or inaccurate knowledge of HIV and syphilis treatment (3, 5, 54, 55, 65, 73, 76, 89, 107). Awareness of HIV prevention was low (71% unaware of PEP) (33), and lower education levels were associated with reduced PrEP knowledge and adherence (34, 83, 93). Notably, a social network-based intervention did not improve PrEP knowledge over time (80).

Knowledge about healthcare rights, relevant policies, and locally available services was inconsistent. While some healthcare users, especially activists or those with formal education, understood their rights (6, 24, 47, 48, 49), others were unaware of their entitlements, national LGBTQ+ health policies, or Trans-specific services (9, 50, 63, 77). Confusion about how to access services further hindered navigation of the healthcare system (63, 75).

Staff in specialized services, particularly HIV/AIDS care, demonstrated greater knowledge of gender and sexual diversity than those in general health services (4, 5, 22, 56). However, some professionals perpetuated harmful practices, such as linking Trans people to STIs and minimizing condition severity, exemplified by remarks from sexual health providers such as “you only had syphilis” (68, 90). Most provider knowledge stemmed from personal initiative or post-graduate training, as formal education rarely mandates coursework on gender and sexual diversity (28, 50, 60, 111).

Biomedical and hetero-cisnormative biases in professional training were frequently cited as major barriers to adequate health-related information (22, 28, 64, 87). Users' access to accurate and relevant health information was limited by inadequate provider qualifications in gender diversity, humanized care, and Trans-specific health needs, representing a critical barrier. Providers, mainly in PHC, were unprepared and lacking knowledge about gender identity, hormonization, gender-affirming procedures, and institutional regulations such as the use of social names (3, 4, 10, 14, 15, 16, 18, 19, 24, 31, 38, 40, 42, 47, 50, 51, 55, 56, 57, 58, 60, 63, 64, 68, 70, 75, 77, 79, 81, 85, 87, 90, 98, 99, 100, 101, 104, 111, 113). They misunderstood or conflated concepts like gender identity, sexual orientation, and sexual behavior (56, 58, 63, 64, 68, 85, 79, 90). The knowledge gap ranged from Trans-specific clinical availability to broader topics, including bodily changes related to hormonization and the reproductive health needs of transmasculine people (18, 104, 113). Disparities in informed consent regarding surgical risks were identified, with 80.6% of transmasculine individuals receiving full information compared to 40.3% of transfeminine participants (45).

3.2.1.4 Acceptability

Acceptability refers to the perceptions held by users and providers regarding personal traits and practices, which shape care-seeking and service provision (28, 29). For TTGD users, acceptability is influenced by perceptions of violent, low-quality, unreliable services, long wait times, and unqualified or untrustworthy providers (9, 20, 24, 26, 42, 58, 76, 94, 100, 105, 114). Fear of stigma, misgendering, and discrimination by both healthcare providers and cisgender users emerged as a major barrier to care (1, 3–5, 7, 8, 10, 14, 16, 17, 20, 23, 24, 26, 27, 28–30, 33, 37, 38, 40–61, 63, 66, 68, 73, 74, 76, 77, 81, 84, 85, 89, 90, 94, 95, 99–101, 104–107, 110, 112–115). Such experiences evoked feelings of exclusion, fear, and vulnerability, leading many to delay or avoid care (3–5, 7, 8, 24, 26, 28, 29, 38, 40, 53, 63, 66, 68, 76, 85, 86, 90, 94, 99, 101, 113, 115). These negative experiences are strongly associated with mental health outcomes, including stress, depression, anxiety, and suicidal ideation (20, 61, 66, 79, 101, 113, 115).

Services were often seen as unresponsive to users' needs, reinforcing expectations of mistreatment (61, 69). Insufficient training and weak coordination with social movements led users to feel insecure, disrespected, and invalidated during care, worsening emotional vulnerability (1, 18, 42, 63, 66, 68, 79). Stigmatizing views, such as associating HIV with Trans identities, providers' emotional distance, discomfort discussing health issues, distrust and doubts about providers or procedures, and avoidance of gender diversity topics, contributed to the erosion of acceptability as a fundamental barrier to equitable care (1, 6, 9, 32, 45, 49, 50, 63, 68, 79, 85, 115).

Even in specialized programs like Brazil's PTr or Argentina's Gender Identity Law, dissatisfaction was common when care failed to meet expectations (21, 43, 63, 100). Insecurity arose even from positive initiatives in PHC, where temporary or voluntary staff participation undermined continuity and trust (84). Pathologizing and medicalized approaches led to feelings of violation and loss of autonomy (23, 29, 54, 63). Users opposed pathologization but feared losing access to services if diagnostic criteria were eliminated (42, 44). TTGD participants reported self-perceptions of oral health marked by shame and anxiety compared to cis people (78). The dissatisfaction and insecurity extended beyond PHC services to specialized contexts.

Satisfaction with body-affirming procedures was reported (2, 17), even when industrial silicone was used (30). Some users considered informal procedures safer when performed by health professionals (49). Transmasculine users expressed insecurity about procedures like neophalloplasty (7) and dissatisfaction with public hospital chest surgeries, citing poor aesthetic outcomes and lower prioritization (43). Hormone use could also bring frustration due to unmet expectations (10), and self-medication fostered a sense of personal accountability for outcomes (15).

Professionals often feel unprepared for gender-affirming care (8, 56, 61, 68, 73, 100, 106), including managing hormonization, navigating bureaucracy, and confronting internal biases rooted in pathologizing views (9, 61, 68, 100). Many professionals lacked recognition and acceptance of Trans identities (50, 101), often influenced by cisnormative biases, such as the belief that Trans men would not wish to breastfeed (60, 113). Religious and moral beliefs, along with a lack of willingness, were identified as barriers when conflicting with users' rights (6, 113). Nurses reported that the way Travestis were treated by healthcare staff was central to their care (31). Greater exposure to gender diversity was consistently linked to reduced stigma and transphobia among providers (68).

Some professionals expressed prejudice and discomfort in discussing LGBT health, even though they intended to provide respectful and welcoming care (60). Others reported feeling pressured to prioritize medical reports required for gender-affirming procedures. Additionally, some noted that the visible presence of Trans users in hospitals raised tensions around the use of social names and discrimination (64). Some workers attributed discrimination mainly to other users or within TTGD communities (68). Stereotypes, such as assuming Trans or Travesti users are inherently defensive, undermined empathy and created additional barriers to acceptability (91). Some workers feared backlash from cis healthcare users when providing equitable care to TTGD users (79). Professionals acknowledged that colleagues' resistance to policies and users' identities hinders access (68). While most providers expressed supportive views, a minority admitted discomfort, reflecting underlying stigma (82).

Regarding the acceptability of STI prevention and treatment, PrEP and HIV self-testing were valued for promoting autonomy and were accepted as self-care strategies. Concerns about condom use, side effects, effectiveness, daily dosing, and fears of emotional distress or violence were identified (5, 25, 54, 73, 85). Stigma, distrust, and insufficient or unclear provider communication related to PrEP, PEP, and HIV care hindered uptake and adherence (37, 54, 76). PrEP acceptability varied due to concerns about cost, efficacy, side effects, and adherence (5, 52). In some cases, knowledge gaps and systemic mistrust led to refusal of care (52, 102). Some healthcare users expressed skepticism toward PrEP, associating it with pharmaceuticalization, Trans necropolitics, and distrust in the medical-industrial complex and the state's commitment to Trans health (65, 73), including concerns about the motives behind international trials and safety (65). Another study reported that PrEP was linked to protection and sexual empowerment (25). Positive experiences were associated with respectful care (9, 35, 110) and trust-building interventions, such as community-based PrEP programs (80).

Guilt and responsibility were common when seeking STI care, and treatments such as benzathine penicillin were described as painful yet necessary (90). Trained professionals were viewed as essential to ensure privacy, trust, and adherence support (5, 25). Still, distrust in confidentiality for HIV testing existed (33, 34). Cell phones were reported as facilitators of HIV prevention and care (25). Although less frequent, positive experiences in affirmative care settings involved well-trained providers who were sensitive to gender diversity, which enhanced users' autonomy (10, 37, 43, 63, 105, 106, 111). Users preferred public clinics with specialized Trans or sex worker services, as well as Afro-Indigenous spaces, due to feelings of safety and inclusion (6, 14, 18, 19, 43, 63, 84). Recognition of social names and pronouns promoted feelings of security and respect among users (4, 37, 99). Experiences of attentive care led some users to feel fortunate (4). The inclusion of Trans healthcare workers or peer promoters enhanced acceptability by ensuring confidentiality, respectful support, and understanding, particularly in sexual health services (37, 54, 73, 107).

Users highlighted that improving acceptability requires humanized care, hospital accreditation within national policies (e.g., PTr), investment in staff wellbeing, and clear protocols with accessible reporting systems. They stressed that depathologization advances are vital to reduce transphobia, affirm identities, guarantee rights, and foster trust and engagement with healthcare (106). Community-based care with active social participation was seen as crucial to shaping care models (56). Equity, justice, and the inclusion of Trans professionals were viewed as essential for building trust and improving care (41, 48).

3.2.1.5 Adequacy

Adequacy, referring to the relationship between how resources are organized to receive users and users' ability to adapt to these factors, as well as their perception of appropriateness (28), remains limited for TTGD populations. Many qualitative studies reveal that access to gender-affirming care is conditioned by medicalization and cisnormative frameworks, notably the requirement of diagnoses such as “gender dysphoria” or “transsexualism,” which reinforce binary pathologizing norms and validate only those fitting the “true transsexual” model (7, 24, 44, 53, 62, 64).

PHC frequently focuses on STI prevention or treatment, neglecting comprehensive approaches and reinforcing stigma that predominantly associates Travestis and Trans women with sex work and STIs (24, 30, 31, 68, 94, 95). As a result, these services often exclude social groups (seen Section 3.2.1.4) (95).

Public health institutions in Latin America often operate within cisnormative biomedical frameworks that regulate users' bodies and identities (8, 23, 28, 29, 40, 41, 63, 64, 67, 87, 89, 108). Medicalization and pathologization persist through mandatory psychiatric diagnoses for gender-affirming care, undermining self-determination and bodily autonomy (7, 10, 17, 22, 23, 29, 42, 44, 49, 53, 54, 57, 67, 70, 86, 90, 97, 111). In Argentina, Brazil, and Colombia, services maintain rigid diagnostic requirements for gender-affirming procedures, with some still relying on outdated or pathologizing terms such as “transsexualism,” which remains required by Brazil's PTr despite its removal from ICD-11 (7, 8, 10, 17, 22, 24, 29, 42–44, 53, 63, 87, 108). Psychiatric and psychological assessments, often mandatory and tied to prolonged psychotherapy or hormonization, are commonly prerequisites for gender-affirming procedures, particularly in PTr services, functioning more as gatekeeping than support (7, 8, 10, 17, 24, 28, 29, 44, 53, 63). Requirements such as PTr's biweekly group therapy in centralized facilities further restrict access (63). These institutional demands reproduce biomedical logics that constrain autonomy and selectively validate identities (64, 66, 108), disproportionately affecting Trans men and limiting the recognition of individual needs (108, 114).

Although Argentina's 2012 Gender Identity Law eliminated diagnostic requirements, professional practices remain inconsistent. Some sought assurances to preserve clinical authority, perceiving the law as constraining professional autonomy (39), and still require mental health consultations or social work approval based on the “gender dysphoria” diagnosis (22). Moreover, respect for social names is not always guaranteed, further undermining the adequacy of care (66).

Age restrictions posed barriers to accessing services and goods, with younger Trans women in Brazil seeking non-prescription hormones due to an 18-year age limit, which undermined safe and adequate gender-affirming care (59). A similar age restriction for HIV self-testing limited access for younger users in Peru (25).

3.2.2 Health needs

Data were analyzed using a conceptual framework that classifies health needs as normative, felt, expressed, or comparative (28, 30). Participants reported that their body modification needs were not recognized by public policies, and argued that hormones should be freely provided (8, 9).

Only seven qualitative studies reported normative needs, defined by technical or professional standards. Gender-affirming procedures were framed as such (2), though access often required additional normative criteria (see Section 3.2.1.5) (64, 67, 111). One study noted professionals' recognition of the need for hormone management and comprehensive, welcoming care (84). STI prevention and treatment were also cited as normative, but many professionals restricted care to sexual health, overlooking broader needs (24, 90).

Resources perceived by users as necessary, called felt needs, were discussed in 28 qualitative studies. These included access to respectful, specialized public care, medicines (e.g., minoxidil and hormones), prostheses, surgeries, guidance on usage, specialist consultations, and ongoing multidisciplinary support (2, 7, 17, 18, 21, 41-43, 55, 66, 81, 84, 94, 99, 101). Psychological support was frequently emphasized (7, 18, 42, 58, 72, 81, 90, 94). Humanized care—using social names, active listening, non-stigmatizing environments, and welcoming reception—was highlighted across studies (41, 61, 72, 84, 90, 94). Free access to hormones, especially via Brazil's SUS, was a recurrent request (8, 41). Participants also indicated the need for comprehensive services, including PHC (cholesterol, weight monitoring, and organ function), diagnostic exams and tests, and sexual/reproductive health services (birth control, gynecology, urology, fertility, abortion care, and STI prevention/treatment) (7, 9, 18, 24, 42, 54, 58, 81, 90, 94, 99).

Specific needs linked to aging were reported, especially among those over 40, reflecting previous experiences with informal procedures and a need for emotional, economic, and social stability (67). There was a strong appreciation for non-pathologizing, inclusive services led by qualified professionals offering individualized care beyond binary, cisnormative models (41, 48, 56). One study reported that 71.2% of participants indicated little or no need for medical treatment (71), while another found worse oral health satisfaction and greater perceived dental needs among Trans people (78). Many felt needs arose from institutional neglect, lack of provider qualification, and unequal access. Participants stressed the urgent need for respectful, equitable, and socially just care, especially for vulnerable groups like favela residents and unhoused individuals (9, 44, 48).

Expressed needs are those linked to active help-seeking. They were explicitly described in four studies. One study found that common demands in PHC included hormonization, chronic condition management (e.g., diabetes, hypertension), and vaccination (105). Other needs included access to hormones and surgeries, support for silicone-related complications, non-cisnormative gynecological care, and reproductive services for transmasculine users (111). Only 23% of Trans women sought emergency care, and 21% accessed psychological services in the past 6 months (35). Another study reported that many participants also sought psychological support, but only 34.8% received professional help during gender-affirming procedures (97).

3.2.3 Individual health behaviors

According to Andersen (26), individual health behaviors refer to how users and providers engage with or avoid healthcare services and goods. This study expands that concept to include broader therapeutic strategies beyond formal care, such as self-medication, adherence, service use, alternative care-seeking, and the behaviors of healthcare professionals in providing care (28).

Facing structural barriers, stigma, and discrimination, TTGD people in Latin America often resort to self-managed health strategies. Some reported having to educate providers about their own care (32). Self-medication was common, especially during hormonization, involving home remedies and unsupervised hormone use (1, 3, 7, 8, 10, 11, 14, 17–19, 21, 23, 24, 26, 37, 38, 40–42, 44, 47, 49, 51, 53, 55, 58, 66, 70, 75, 77, 81, 94, 95, 97, 99, 100, 103, 114, 115). Hormone use rates ranged from 52.5% to 96% lifetime and from 45% to 90.8% current (30, 45, 46, 59, 69, 71, 74). Hormonization often began before age 18 and without medical supervision (11, 35, 74, 88); self-medication rates ranged from 64 to 87% (45, 59, 69, 88). Use of high doses without medical guidance was common, leading to adverse effects in some cases (8, 10, 21, 23, 24, 40, 44, 51, 97, 103). In Lima, only 11.8% accessed hormones via prescription, 5.9% received pharmacist recommendations, and 65.9% relied on friends (11). These practices were mainly driven by the limited supply of gender-affirming hormones in public health systems (see Section 3.2.1.1) (94, 97), a situation worsened during the pandemic as users turned to alternative sources and informal support (96).

Body modification practices were widespread. In Argentina, 92.7% of participants reported undergoing procedures (13); in Brazil, 95% had engaged in body modification; breast augmentations were mainly private (42.1%), and breast construction often occurred in clandestine settings (58.1% of Travestis, 23.8% of Trans women) (45). A Colombian study reported that 46.5% of participants had undergone filler injections in non-clinical settings (15).

Industrial silicone injections, often performed by peers known as “bombadeiras,” were frequently reported, especially among Trans women and Travestis (1, 14, 15, 19, 23, 24, 26, 30, 37, 40, 41, 51, 77, 81, 94, 95, 97, 100, 103). Studies reported industrial silicone use ranging from 12.9% to 55.6% (71, 45, 30); however, only 46.2% sought medical care for complications from the procedure in Brazil (30). Structural and economic vulnerabilities (see Section 3.2.1.2) were linked to industrial silicone injection use (30). Homemade binders also emerged as an alternative body modification strategy (96). Industrial silicone use and self-medication with hormones led to serious health complications, such as liver damage, cancer, abscesses, and even death (23, 24, 30, 40, 81).

Avoidance of health services was widespread and included treatment abandonment, delays in seeking care, and lack of PHC follow-up. These behaviors were driven by negative feelings from prior experiences, leading many to forgo care, even for severe conditions (see Section 3.2.1.4) (1, 3, 4, 14, 16, 18–20, 22, 23, 26, 28, 38, 40, 44, 53–55, 57, 70, 72, 77, 79, 81, 84–86, 90, 94, 95, 97, 99, 101, 104, 106, 108, 111, 114, 115). In Argentina and Brazil, 40.7 and 43.2% of Trans women, respectively, avoided care due to concerns related to their gender identity (12, 32). In the Southeast region of Brazil, only 32% of Trans participants and 14.5% of Travestis used public health services (97), while in a capital in the same region, 37.7% of Trans women had not visited healthcare services in the past year (69). Although 68.5% were enrolled in PHC across Northeast Brazil, only 33% relied on it regularly (71).

Formal services care was often sought only in emergencies or as a last resort (1, 3, 9, 14, 18, 19, 37, 40, 47, 55, 106). When searching for care, gender-affirming clinics (mainly for hormonization or surgeries) and STI clinics were preferred (6, 17, 19, 63, 70, 75, 106). In Cali, 25% used pharmacies and 61% accessed clinics or hospitals (35). In Peru, most participants (80.1%) attended clinics regularly, a pattern linked to older age and unemployment (102).

To navigate healthcare and reduce reliance on formal systems, many, particularly sex workers, sought support through peers, social media, or community networks (49, 56, 97, 111, 114, 115). Some attended appointments alone after negative experiences with companions (28). Others used strategic performances, such as “feminine docility” or “middle-class behaviors,” and leveraged activism to navigate public services (49, 56). In settings enforcing binary, pathologizing norms, users often exaggerated gendered behaviors or concealed personal desires to meet institutional expectations and obtain affirming care (53, 64). Alternative care paths were pursued, including Afro-Indigenous religious practices and home remedies, particularly when public care was inaccessible or invalidating (14, 19, 97).

HIV prevention behaviors varied across contexts. Condom use was uncommon with regular partners (89) and influenced by stigma, trust, and financial or client pressures in sex work (3, 22, 27, 89). Most participants had been tested for HIV (25, 33, 34, 102), yet 5.9–6.8% avoided testing due to fears of stigma, breaches of anonymity, or discrimination (33). Participants living with HIV reported challenges with ART adherence (3, 67), although adherence levels were generally high and improving.

Health workers' behaviors strongly influence access to and quality of care for TTGD populations. Pervasive stigma, discrimination, and disrespect were frequently reported, particularly through refusal to use chosen names and pronouns, even when legally mandated, such as in Brazil's SUS (3, 4, 6, 9, 14, 16, 18–20, 22–24, 26, 28, 31, 36–40, 42, 44, 47–49, 53–57, 60, 70, 72, 81, 85, 86, 90, 95, 98, 99, 101, 103–106, 111, 114, 115). Pathologizing attitudes and entrenched biomedical hierarchies also persist (see Section 3.2.1.5) (2, 10, 22, 23, 28, 39, 40, 44, 53, 58, 63, 64, 86, 87, 103, 111).

Pathologizing practices persist among providers, mostly physicians, even in Argentina, where depathologization is policy (see Section 3.2.1.5) (22, 44, 91, 111). Nurses and social workers often delivered more compassionate care, resisting both medical control over users and their professional subordination to biomedicine (91).

Denial of general care, especially in PHC, is common. Refusals include hormone prescriptions, follow-ups, gynecological services, and other preventive care (7, 18, 30, 51, 53, 56, 58, 86, 91, 98, 103–105, 108). Tensions also arise when providers reject high hormone doses self-administered by users (8).

Discriminatory practices by providers span all healthcare levels, including private community pharmacies and specialized services (see Section 3.2.1.4), and often involve verbal abuse, inadequacies in gender-affirming language and communication such as misgendering, deadnaming, and refusal to acknowledge chosen names, as well as binary assumptions, denial of care, stereotyping, HIV stigma, and religiously motivated transphobia, reflecting systemic hostility (1, 3, 4, 9, 12, 13, 14, 16, 18–20, 23, 24, 26–30, 32, 33, 36, 37, 40, 42, 44, 48, 50, 54–59, 60, 63, 65, 68–70, 72, 75, 76, 79, 82, 85, 86, 90, 91, 94, 95, 97–99, 101, 103–106, 108, 111, 112–115). Discrimination was strongly correlated with avoidance of healthcare services (32).

The lack of humanized care, trust, and continuity in user–provider relationships disproportionately affects TTGD people, especially those engaged in sex work (see Section 3.2.1.5) (1, 4, 5, 31, 50, 57, 79, 98). Discrimination intersects with class, age, and place of residence, with younger users often treated with less respect (9). In PHC, some physicians avoid physical exams with Trans users, relying solely on self-reporting, while specialized service providers show less discomfort (3). Such practices have normalized exclusion and poor-quality care, particularly in PHC (31, 47, 53, 55, 57, 79, 90, 95, 98).

Nevertheless, isolated instances of respectful care exist, including empathetic approaches and inclusive participatory practices, often led by professionals from socially marginalized groups (22, 38, 48, 56, 70, 75, 79, 84, 108). However, these actions frequently coexist with ongoing discrimination within the same services (75, 79, 108).

4 Discussion

4.1 Trends in knowledge production and regional inequities

Knowledge production on TTGD health access in Latin America has followed patterns that reflect structural, linguistic, and political determinants. The concentration of publications after 2007 corresponds not only to expansions in public policies on gender identity but also to the delayed recognition of TTGD health needs within research systems historically oriented toward cis-heteronormative priorities. This temporal pattern suggests that TTGD health became “researchable” only once broader sociopolitical shifts rendered these populations institutionally visible. Additionally, studies show a growing trend, with most publications emerging in the last 6 years. This reflects increasing academic interest, likely linked to the heightened public visibility of LGBTQIAPN+ communities (147) and the implementation of national health policies (12–14).

The uneven representation of TTGD subgroups, with the literature heavily focused on transfeminine experiences while transmasculine and gender-diverse populations receive comparatively little attention, may reflect historical research priorities, greater social visibility of transfeminine people, and methodological challenges in recruiting transmasculine or gender-diverse participants (148).

Research was also found to be unevenly distributed across Latin America, with Brazil's dominance limiting region-specific policy development. The absence of studies from several countries highlights substantial gaps in regional research production and dissemination. While academic dissemination is multilingual, English and Portuguese prevail over Spanish, the region's most spoken language (149). Although English is official only in Guyana and Belize (absent from this review), its dominance marginalizes research in Spanish, Portuguese, and Indigenous languages, reflecting epistemological coloniality, the anglophone bias of Brazil, and the concentration of knowledge in the Global North. Future studies should explore how linguistic and geopolitical hierarchies shape knowledge production and dissemination.

The current evidence base, comprising mostly qualitative studies followed by descriptive quantitative designs, offers important insight into lived experiences but limits the possibility of comparative or system-level analyses. The scarcity of interventional research also indicates that the field has advanced more in documenting inequities than in testing solutions. This pattern is consistent with Lacombe-Duncan (150), who found that although most peer-based interventions reported positive outcomes, few explicitly incorporated gender affirmation, and most focused primarily on HIV, reinforcing the need for peer-led approaches that address holistic health needs and structural barriers to care.

The high predominance of first authors from Nursing and Medicine indicates a concentration of epistemic perspectives and limited engagement from other health fields, such as pharmacy and dentistry, with a near absence of contributions from disciplines like physiotherapy, nutrition, and related areas.

4.2 Structural and political context shaping TTGD health

This review considers how recent political shifts, marked by authoritarian, neoliberal, and anti-gender agendas, undermine health rights and research related to TTGD populations. Far-right governments in Brazil (2019–2022, under Bolsonaro) and Argentina (2023–present, under Milei) have advanced an anti-Trans agenda under the guise of austerity and moral conservatism. These dynamics echo global trends in late capitalism, such as the Trump administration in the USA, whose influence has emboldened anti-rights movements across Latin America. Such contexts promote regional policies not only to restrict access to care but also to constrain the development and funding of inclusive public health research, reinforcing systemic invisibility and and exclusion (151, 152).

The literature spans multiple historical periods, with most studies published in the past decade. This temporal distribution is crucial for understanding the persistence of pathologizing narratives and their entrenchment in national systems. While legal advancements in some countries suggest progress toward depathologization, biopolitical practices and systemic barriers still demand urgent policy revisions, updated clinical protocols, and care centered on autonomy, dignity, and Trans rights (151, 152).

In Brazil, for instance, the outdated classification of PTr services persists despite the ICD-11 (153) removing “transexualism” from the chapter on mental and behavioral disorders and replacing it with “gender incongruence.” This regulatory lag has delayed policy reform and impeded the transition toward a less pathologizing framework in the public health system, while private providers are already aligned with the new classification (154). In contrast, Argentina's Gender Identity Law eliminated the requirement for medical or psychological diagnoses for gender-affirming care (13). Nonetheless, implementation remains inconsistent, and clinical practices often fail to meet the law's objectives. Recent political changes under the Milei administration have raised concerns about potential reversals of gender-related rights, underscoring the importance of continued vigilance (152). Although the law constitutes a regional milestone, Gonzales (155) noted the absence of official data, which hampers evaluation of its effectiveness and reflects broader deficiencies in state monitoring.

This review has revealed that gender-affirming healthcare in Latin America often operates within biopolitical frameworks that reinforce cisnormative and binary norms, regulating TTGD bodies via medicalized diagnoses. These medical categories serve as instruments of institutional control beyond care access (156, 157). Despite structural precarity from transphobia, cisnormativity, and underfunded systems, TTGD communities resist through peer networks, self-care, and advocacy, asserting agency and creating alternative care pathways. While such strategies reflect resilience and autonomy, potential risks associated with unsupervised practices underscore the urgency of integrating peer networks and Trans professionals into formal systems to ensure culturally responsive, affirming, and safer care models.

Persistent structural and organizational challenges in Latin American healthcare systems affect both cisgender and TTGD users, including limited service availability, workforce shortages, fragmented care, long waiting times, underfunding, regional disparities, and poor coordination across levels of care, which exacerbate health inequities and service avoidance (15, 16, 158).

4.3 Health barriers through the lens of the conceptual framework

Theoretical insights from Lugones (159, 160) and Vergueiro (161) help illuminate how these system-level barriers are historically and structurally produced. Lugones' concept of the “coloniality of gender” and Vergueiro's analysis of cisnormativity in Latin American contexts revealed how colonial, Eurocentric constructs of gender continue to shape healthcare systems through the imposition of binary and cisnormative norms. Lugones' concept of the “coloniality of gender” and Vergueiro's critique of cisgenderism as structured by pre-discursivity, binarism, and permanence expose how dominant epistemologies naturalize gender as biologically fixed and delegitimize non-normative identities. The following sections are structured by access dimensions using this lens.

4.3.1 Availability/accessibility and adequacy

The studies revealed a marked underrepresentation of PHC as a research setting. Gonçalves (162) noted limited research on LGBTQIA+ access to PHC, despite its central role in Brazil's public health system, and identified persistent cis-heteronormative norms as barriers to inclusive, gender-affirming care. Such biomedical dynamics dominating the organization of health systems are overrepresented in the production of knowledge, perpetuate structural exclusion, and sustain unmet health needs. Similar issues have been reported in high-income countries. Across the USA, UK, Australia, Canada, New Zealand, France, and Sweden, Trans and non-binary people frequently face discrimination in PHC, including limited provider knowledge, strained interactions, and unwelcoming environments, highlighting the need to reorient PHC toward equity-based, affirming models (163).

The findings point to significant gaps in both gender-affirming and general health services in Latin America. Care is often fragmented and insufficient, shaped by systemic cisnormativity, transphobia, funding limitations, and inadequate provider qualifications, which reinforce institutional exclusion. The geographic concentration of Trans-specific services in capital cities presents a major access barrier. TTGD health services in North America, Europe, and Oceania are largely urban-centered, with access further constrained in rural and suburban areas. While rural living is not inherently harmful, structural barriers and stigma from healthcare services in these regions sustain persistent health inequities (164).

In line with these structural gaps, Boldrin et al. (165) reviewed the advances and ongoing challenges of the Brazilian PTr. The expansion of gender-affirming healthcare access for Trans people has emerged with persistent weaknesses, including unprepared healthcare professionals, social stigma, pathologizing clinical diagnoses, and limited hospital coverage. They underscore that improving access and addressing stigmatizing practices are essential to ensuring inclusive, biopsychosocial care.

Access to medicines, particularly hormonization and technologies like PrEP and PEP, was widely discussed in the literature. The lack of standardization and the unavailability of public provision for hormonal medicines often forces individuals to rely on informal or clandestine sources, primarily due to financial barriers. Advancing the inclusion of hormones in national lists of essential medicines across Latin America is therefore imperative. In Argentina, where hormonal medicines are standardized, decentralizing distribution remains a challenge. Brazil needs to integrate hormone use into the broader pharmaceutical care system, extending beyond the current hospital-based model.

Pharmacies emerged to occupy a significant and complex position in the healthcare continuum for Trans people, often serving as accessible points for hormone access amid broader barriers to other health services. However, the role and qualifications of pharmacists, potential key actors in medicine access, have remained underexplored, while the training and practices of psychologists, nurses, social workers, and physicians have been discussed under “professional knowledge,” “acceptability,” and “individual health behaviors.” Redfern and Jann (166) emphasized the central role of pharmacists in Trans healthcare, highlighting their capacity to provide gender-affirming, unbiased care, including pharmacotherapy management and laboratory monitoring. Pharmacists' roles in counseling, hormone support, and preventive care underscore their potential to offer culturally competent services (167). However, these observations are primarily drawn from North American studies, and evidence from other regions remains limited.

4.3.2 Affordability/financing, information, and acceptability

Financial factors, including income, employment, and insurance, emerged as key determinants shaping healthcare access for TTGD people in the region. These findings resonate with broader patterns of socioeconomic inequality identified as major barriers to healthcare access across Latin America, where vulnerable groups face compounded disadvantages (168). Such evidence underscores the inequities in access and highlights the pressing need for public, qualified, and accessible healthcare services specifically tailored to the TTGD population.

This study revealed a persistent lack of information for both TTGD populations and healthcare professionals, contributing to informal practices and reinforcing barriers to care. Research on healthcare information from providers' perspectives remains limited, leaving critical aspects of access poorly understood. Acceptability is further constrained by stigma, provider unpreparedness, and systemic obstacles, highlighting how structural and interpersonal factors intersect to limit equitable care.

The lack of professional qualifications and institutional biases in biomedical care reinforce these hierarchies and marginalize TTGD people by privileging cisnormative logics. As such, reliance on informal networks is not only a survival strategy but also an epistemic repositioning that resists colonial frameworks and reimagines healthcare beyond binary and pathologizing paradigms.

4.3.3 Health needs

The scarcity of comprehensive and multidimensional data on TTGD health needs reflects a significant epistemic gap, limiting the development of informed, equitable, and context-sensitive healthcare strategies. This deficit is particularly concerning because it translates into persistent misalignment between the services provided and the actual needs of TTGD populations. Users' felt and expressed needs often remain unrecognized or inadequately addressed, highlighting how institutional biases, professional unpreparedness, and cisnormative frameworks perpetuate inequities. Addressing these shortcomings is therefore essential for designing interventions that are both technically sound and socially responsive.

4.3.4 Individual health behaviors

Users demonstrate significant autonomy, resilience, and agency in navigating care and body modification outside formal systems. However, this often occurs in contexts of risk due to the lack of gender-affirming, competent, and respectful services. Stigma, discrimination, and pathologization by healthcare professionals remain significant barriers to equitable TTGD healthcare. The findings revealed predominantly negative professional behaviors, with few positive exceptions, reflecting a failure to provide culturally competent, gender-affirming care. Discrimination in healthcare settings contributes to adverse health outcomes and reinforces cycles of control and surveillance within cisnormative systems. One of the main results of these barriers was the avoidance of formal health services.

Prior reviews identified barriers to Trans people's access to the Brazilian public system, including discrimination, inadequate care, and inadequate professional qualifications (2, 23, 94). Lima et al. (5) confirmed these Brazilian issues, noting transphobic violence, rights violations, and reliance on alternative care strategies. Transphobia erodes healthcare trust, leading to care avoidance, particularly in rural areas (164).

4.4 Regional and global parallels

Progress in the recognition of LGBTQIAPN+ rights across Latin America is uneven. Countries such as Argentina and Brazil have achieved notable legal and social advances, including the recognition of social name rights, same-gender marriage and adoption, the prohibition of conversion therapies, and access to gender-affirming services. According to Corrales, these gains have been facilitated by active social movements, supportive political institutions, and relatively higher income levels. However, economic resources alone are insufficient to explain progress, particularly in contexts with strong conservative religious influence. In contrast, limited political support, weaker social movements, lower economic resources, and conservative religious pressures have hindered progress in other countries (169). This uneven development likely affects both the recognition of rights and local scientific production on LGBTQIAPN+ issues and may explain the absence or scarcity of research from certain Latin American countries, despite comprehensive search efforts.

In Latin America, TTGD populations face compounded inequalities at the intersection of gender identity, race, class, disability, sexuality, and migration status (170–172). Ethnic and sociocultural diversity coexist with persistent inequities rooted in colonial histories and structural exclusion. Individuals with multiple marginalized identities, such as Indigenous or Afro-descendant heritage, migrant backgrounds, or gender-diverse status, experience systemic barriers, including discrimination, poverty, and invisibility in political and statistical systems (170, 171). Intersectional discrimination is not merely additive but arises from the complex interaction of social hierarchies, and addressing these inequities requires acknowledging that TTGD individuals with additional marginalized identities face distinct obstacles limiting access to resources and opportunities (172).

Compared with global literature, Latin American findings show both convergences and region-specific challenges. Consistent with Scheim et al.'s (3) findings on research gaps regarding transmasculine populations in low- and middle-income countries and limited attention to gender-affirming and general health beyond HIV, this review found a predominance of studies on transfeminine experiences. Holland et al. (163) reported that discrimination and insufficient provider knowledge remain key barriers in PHC globally, mirroring patterns in Latin America. Kearns et al. (4) highlighted that Trans and non-binary youth worldwide navigate complex, costly, and emotionally challenging pathways to gender-affirming care, shaped by family tensions and inconsistent professional support, similar to the dynamics observed in our review. The most peer-based interventions focus narrowly on HIV prevention rather than broader wellbeing or gender affirmation, reflecting a trend in Latin America's limited holistic, community-led initiatives (150). These parallels indicate that the barriers identified in this review reflect broader global inequities in TTGD healthcare, rooted in cisnormativity and structural stigma, yet further shaped in Latin America by colonial legacies and local political, cultural, and health system dynamics that both hinder and sometimes foster more inclusive care.

4.5 Health needs and care pathways

Based on the evidence mapped in this scoping review, several priority areas recur in the literature related to structural barriers rooted in cis-heteronormative and biomedical paradigms: Strengthening workforce qualifications to deliver culturally competent, gender-affirming, and humanized care while addressing stigma, discrimination, and knowledge gaps is essential; improving data collection on gender identity, service use, and health outcomes can inform inclusive policies; service organization should reduce regional disparities, decentralize care, and integrate community-led, rights-based approaches, particularly in primary healthcare; expanding access beyond body modifications and enhancing financial protection are critical steps toward structural transformation that recognizes TTGD people as active agents in equitable and sustainable health systems.

4.6 Strengths and limitations

Variations in terminology and database indexing may have influenced the scope of the literature retrieved, potentially limiting the comprehensiveness of the review. The inclusion of studies primarily published in English, Spanish, and Portuguese introduces possible language bias, and the search, conducted in 2024, captured only studies published up to that year. The large volume of studies identified, combined with rigorous selection, charting, and analysis procedures, contributed to a lengthy manuscript preparation process.

The predominance of studies from Brazil underscores regional imbalances and highlights the need for broader representation across Latin America. To maintain a clear focus on primary research, non-academic sources, editorials, and commentaries were excluded, although they often provide important contextual insights into barriers to healthcare access. Additionally, as appropriate for scoping reviews and in line with our objective, no formal quality appraisal was conducted; therefore, findings should be interpreted as indicative rather than conclusive.

Despite these limitations, this review provides a comprehensive overview of existing evidence and highlights key priorities for future research and policy to advance equitable healthcare for TTGD populations.

5 Conclusion

This scoping review provides the first comprehensive overview of existing evidence on healthcare access for Trans populations in Latin America. The findings highlight persistent structural, economic, and institutional barriers that hinder equitable access to care. Key challenges include fragmented PHC systems, cis-heteronormative and pathologizing approaches, financial and geographic obstacles, and a widespread lack of professional training. These conditions often lead individuals to seek care in emergency settings or engage in risky self-managed health practices, with trust in health systems further compromised by stigma and discrimination.

Promising pathways identified in the literature involve affirming care models with queer-identified providers, community participation, and collaborative planning. Across the studies reviewed, three main directions emerge: (1) comprehensive, gender-affirming care across multiple levels of healthcare, focusing on PHC; (2) intersectional and interprofessional qualification programs, often community-driven, to enhance provider competencies and reduce bias; and (3) the collection and monitoring of regional data to better understand the health needs of diverse TTGD populations.

Future research should address remaining gaps, including longitudinal studies tracking health trajectories, comparative analyses across countries and subregions, and focused investigations on transmasculine and gender-diverse populations. Advancing equitable healthcare in Latin America requires structural transformation that challenges colonial, binary, and biomedical paradigms, centers TTGD voices, and positions these communities as active agents in shaping health systems. Such approaches have the potential to generate innovative, sustainable, and rights-oriented improvements in health equity across the region.

Author contributions

LG: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. NR: Conceptualization, Formal analysis, Writing – review & editing. HM: Formal analysis, Writing – review & editing. BG: Formal analysis, Methodology, Writing – review & editing. LS: Conceptualization, Formal analysis, Methodology, Supervision, Writing – review & editing.

Funding

The author(s) declared that financial support was received for this work and/or its publication. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001.

Acknowledgments

We thank Maria E. Zimmerman, André I. O. Prado, Alana C. E. G. Loregian, Marcelo R. Reser, and Alessandra S. Kulkamp (UFSC) for their collaboration in peer review, and Stephen Anderson (JCU) for his guidance in developing the search strategy.

Conflict of interest

The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Generative AI statement

The author(s) declared that generative AI was not used in the creation of this manuscript.

Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpubh.2025.1710952/full#supplementary-material

References

1. Reisner SL, Poteat T, Keatley J, Cabral M, Mothopeng T, Dunham E, et al. Global health burden and needs of transgender populations: a review. Lancet. (2016) 388:412–36. doi: 10.1016/S0140-6736(16)00684-X

Crossref Full Text | Google Scholar

2. Rocon PC, Wandekoken KD, Barros MEB, Neves ET, Rodrigues HBC. Access to health by the Trans population in Brazil: between the lines of the integrative review. Trab Educ Saúde. (2020) 18:e0023469. doi: 10.1590/1981-7746-sol00234

Crossref Full Text | Google Scholar

3. Scheim A, Kacholia V, Logie C, Chakrapani V, Ranade K, Gupta S. Health of transgender men in low-income and middle-income countries: a scoping review. BMJ Glob Health. (2020) 5:e003471. doi: 10.1136/bmjgh-2020-003471

Crossref Full Text | Google Scholar

4. Kearns S, Kroll T, O'Shea D, Neff K. Experiences of transgender and non-binary youth accessing gender-affirming care: a systematic review and meta-ethnography. PLoS ONE. (2021) 16:e0257194. doi: 10.1371/journal.pone.0257194

Crossref Full Text | Google Scholar

5. Lima RRT, Flor TBM, Noro LRA. Systematic review on health care for transvestites and transsexuals in Brazil. Rev Saude Publica. (2023) 57:19. doi: 10.11606/s1518-8787.2023057004693

Crossref Full Text | Google Scholar

6. Costa AB, da Rosa Filho HT, Pase PF, Fontanari AMV, Catelan RF, Mueller A, et al. Healthcare needs of and access barriers for Brazilian transgender and gender diverse people. J Immigr Minor Health. (2018) 20:115–23. doi: 10.1007/s10903-016-0527-7

Crossref Full Text | Google Scholar

7. Winter S, Diamond M, Green J, Karasic D, Reed T, Whittle S, et al. Transgender people: health at the margins of society. Lancet. (2016) 388:390–400. doi: 10.1016/S0140-6736(16)00683-8

Crossref Full Text | Google Scholar

8. Cavalcanti MR. An analysis of the demands of the transsexualization process at the Pernambuco State Center for Combating Homophobia. Rev InSURgência. (2017) 3:196–240. doi: 10.26512/insurgncia.v3i1.19379

Crossref Full Text | Google Scholar

9. Thorne N, Yip AK, Bouman WP, Marshall E, Arcelus J. The terminology of identities between, outside, and beyond the gender binary: a systematic review. Int J Transgend. (2019) 20:138–54. doi: 10.1080/15532739.2019.1640654

Crossref Full Text | Google Scholar

10. Costa AB, Rosa LO, Fontanari AMV. Sampling bias in Brazilian studies on transgender and gender diverse populations: the two-step measure for assessing gender identity in surveys. Cad Saude Publica. (2022) 38:e00180420. doi: 10.1590/0102-311x00180420

Crossref Full Text | Google Scholar

11. Vieira C, Porto RM. “Making the masculine emerge”: notions of “therapy” and pathology in the hormonization of trans men. Cad Pagu. (2019) 55:e195516. doi: 10.1590/18094449201900550016

Crossref Full Text | Google Scholar

12. Ministry of Health. National Policy for Comprehensive Health Care for Lesbians, Gays, Bisexuals, Travestis and Transsexuals. Brasília: Ministry of Health (2011).

Google Scholar

13. Ley de Identidad de Género No 26.743. Argentina: Boletín Oficial (2012).

Google Scholar

14. Ley No 19.684, Ley Integral para Personas Trans. Montevideo, Uruguay: IMPA (2018).

Google Scholar

15. McIntyre D, Mooney G, editors. The Economics of Health Equity. New York, NY: Cambridge University Press (2007). doi: 10.1017/CBO9780511544460

Crossref Full Text | Google Scholar

16. Levcovitz E, Costa-Couto MH. Health Systems in Latin America XXI century. In:Nogueira RP, Santana JP, Padilla M, Rodrigues VA, , editors. International Observatory of Human Capabilities, Development and Public Policies: Studies and Analyses. Brasília, DF, Brazil: International Observatory of Human Capabilities, Development and Public Policies (2018). p. 99–118.

Google Scholar

17. Trans Murder Monitoring. TransMurder Monitoring (TMM) update - Trans Day of Remembrance (2022). Available online at: https://transmurdermonitoring.tgeu.org/en (Accessed December 10, 2022).

Google Scholar

18. Socías ME, Marshall BD, Arístegui I, Romero M, Cahn P, Kerr T, et al. Factors associated with healthcare avoidance among transgender women in Argentina. Int J Equity Health. (2014) 13:81. doi: 10.1186/s12939-014-0081-7

Crossref Full Text | Google Scholar

19. Barrientos J. Situación social y legal de gays, lesbianas y personas transgénero y la discriminación contra estas poblaciones en América Latina. Sex. Salud Soc. (2016) 22:331–54. doi: 10.1590/1984-6487.sess.2016.22.15.a

Crossref Full Text | Google Scholar

20. Domínguez CM, Ramírez SV, Arrivillaga M. Access to health services for transgender women in the city of Cali, Colombia. MedUNAB. (2018) 20:296–309. doi: 10.29375/01237047.2404

Crossref Full Text | Google Scholar

21. Lucena MM, Ferreira GG, Floss M, Melo DAC. Serviços de atendimento integral à saúde de transexuais e Travestis no Sistema Único de Saúde: uma revisão integrativa. Rev Bras Med Fam Comunidade. (2022) 17:2964. doi: 10.5712/rbmfc17(44)2964

Crossref Full Text | Google Scholar

22. Pereira LBC, Chazan ACS. O acesso das pessoas transexuais e Travestis à atenção primária à saúde: uma revisão integrativa. Rev Bras Med Fam Comunidade. (2019) 14:1795. doi: 10.5712/rbmfc14(41)1795

Crossref Full Text | Google Scholar

23. Silva LSR, Cruz LMFS, Cunha Junior LVS, Silva Filho HM, Pereira DMR, Araújo EC. Obstáculos no acesso a serviços públicos de saúde por Travestis e pessoas transexuais: revisão integrativa. Rev Rene. (2023) 24:e81811. doi: 10.15253/2175-6783.20232481811

Crossref Full Text | Google Scholar

24. Hernandez PAA, Duarte Alarcon C, Valderrama LJ. Atención de los profesionales de la salud a personas Trans en América Latina y el Caribe. Interdisciplinaria. (2023) 40:63–80. doi: 10.16888/interd.2023.40.1.4

Crossref Full Text | Google Scholar

25. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Scoping Reviews. In:Aromataris E, Lockwood C, , editors. JBI Manual for Evidence Synthesis. Adelaide, SA: Joanna Briggs Institute (JBI) (2024). doi: 10.46658/JBIMES-24-09

Crossref Full Text | Google Scholar

26. Andersen RM. National health surveys and the behavioral model of health services use. Med Care. (2008) 46:647–53. doi: 10.1097/MLR.0b013e31817a835d

Crossref Full Text | Google Scholar

27. Schulz S, Hecker F, Sauerbrey U, Wolf F. Illness behaviour and influencing aspects of general practitioners in Germany and their use of the health care system: a qualitative study. BMJ Open. (2022) 12:e051404. doi: 10.1136/bmjopen-2021-051404

Crossref Full Text | Google Scholar

28. Soares L. Access to Dispensing Services and Medicines [thesis]. Florianópolis: UFSC. (2013).

Google Scholar

29. Sanchez RM, Ciconelli RM. Concepts of access to health care. Rev Panam Salud Publica. (2012) 31:260–8. doi: 10.1590/S1020-49892012000300012

Crossref Full Text | Google Scholar

30. Bradshaw J. A taxonomy of social need. In:McLachlan G, , editor. Problems and Progress in Medical Care 7th series NPHT. London, UK; New York, NY: Open University Press (1972). p. 71–82.

Google Scholar

31. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. (2018) 169:467–73. doi: 10.7326/M18-0850

Crossref Full Text | Google Scholar

32. Gonçalves LMS. Access to Healthcare for Transgender Persons in Latin America: A Scoping Review. OSF (2024). Available online at: https://osf.io/4zvse/ (Accessed June 7, 2025)

Google Scholar

33. Datawrapper (2025). Available online at: https://app.datawrapper.de (Accessed July 2, 2025)

Google Scholar

34. Engelman M. Discriminación y estigmatización como barreras de accesibilidad a la salud (2007).

Google Scholar

35. Márcia A, Zaidhaft S, Murta D. Transexualidade: corpo, subjetividade e saúde coletiva. Psicol Soc. (2008) 20:70–9. doi: 10.1590/S0102-71822008000100008

Crossref Full Text | Google Scholar

36. Muller MI, Knauth DR. Desigualdades no SUS: o caso do atendimento às travestis é “babado”! Cad EBAPEBR. (2008) 6:1–14. doi: 10.1590/S1679-39512008000200002

Crossref Full Text | Google Scholar

37. Bones Rocha K, Rubim Barbosa LH, Zambom Barboza C, Ücker Calvetti P, Torres de Carvalho F, Cerqueira Santos E, et al. Attitudes and perceptions of the Brazilian public health system by transgender individuals Forum. Qual Soc Res. (2009) 10:1–21. doi: 10.17169/fqs-10.2.1302

Crossref Full Text | Google Scholar

38. Galea JT. Acceptability of preexposure prophylaxis as an HIV prevention strategy: barriers and facilitators to pre-exposure prophylaxis uptake among at-risk Peruvian populations. Int J STD AIDS. (2011) 22:256–62. doi: 10.1258/ijsa.2009.009255

Crossref Full Text | Google Scholar

39. Boyce S, Barrington C, Bolaños H, Galindo Arandi C, Paz-Bailey G. Facilitating access to sexual health services for men who have sex with men and male-to-female transgender persons in Guatemala City. Cult Health Sex. (2012) 14:313–27. doi: 10.1080/13691058.2011.639393

Crossref Full Text | Google Scholar

40. Sampaio LLPC, Coelho MTAD. Transexualidade: aspectos psicológicos e novas demandas ao setor saúde. Interface. (2012) 16:751–66. doi: 10.1590/S1414-32832012000300005

Crossref Full Text | Google Scholar

41. Santos ART. A experiência da hormonioterapia das transexuais em Maceió/AL. Latitude. (2013) 7:129–47. doi: 10.28998/lte.2013.n.1.1068

Crossref Full Text | Google Scholar

42. Bittencourt D, Fonseca V, Segundo M. Acesso da população LGBT moradora de favelas aos serviços públicos de saúde: entraves, silêncios e perspectivas. Conexões Psi (Rio J). (2014) 2:60–85.

Google Scholar

43. Báez RAL. Transexualidad y servicios de salud utilizados para transitar por los sexos-géneros (Transsexualism and health care services used to transit by the sexes-genders) (2014) (Spanish).

Google Scholar

44. Sánchez S, Casquero J, Chávez S, Liendo G. Características y efectos del uso de hormonas femeninas en transexuales masculinos en Lima, Perú. An Fac Med. (2014) 75:313–7. doi: 10.15381/anales.v75i4.10844

Crossref Full Text | Google Scholar

45. Socías ME, Marshall BD, Arístegui I, Zalazar V, Romero M, Sued O, et al. Towards full citizenship: correlates of engagement with the gender identity law among transwomen in Argentina. PLoS ONE. (2014) 9:e105402. doi: 10.1371/journal.pone.0105402

Crossref Full Text | Google Scholar

46. Souza MH, Signorelli MC, Coviello DM, Pereira PPG. Itinerários terapêuticos de travestis da região central do Rio Grande do Sul, Brasil. Ciênc Saúde Colet. (2014) 19:2277–86. doi: 10.1590/1413-81232014197.10852013

Crossref Full Text | Google Scholar

47. Aguayo-Romero RA, Reisen C, Zea MC, Bianchi F, Poppen PJ. Gender affirmation and body modification among transgender persons in Bogotá, Colombia. Int J Transgend. (2015) 16:103–15. doi: 10.1080/15532739.2015.1075930

Crossref Full Text | Google Scholar

48. de Souza MHT Malvasi P, Signorelli MC, Pereira PPG. Violência e sofrimento social no itinerário de travestis de Santa Maria, Rio Grande do Sul, Brasil. Cad Saúde Pública. (2015) 31:767–76. doi: 10.1590/0102-311X00077514

Crossref Full Text | Google Scholar

49. Petry AR. Mulheres transexuais e o Processo Transexualizador: experiências de sujeição, padecimento e prazer na adequação do corpo. Rev Gaúcha Enferm. (2015) 36:70–5. doi: 10.1590/1983-1447.2015.02.50158

Crossref Full Text | Google Scholar

50. Rogers J, Tesser ZC Jr, Moretti-Pires RO, Kovaleski DF. Pessoas trans na atenção primária: análise preliminar da implantação no município de Florianópolis. Saúde Transform Soc. (2015) 6:85–95. Available online at: https://incubadora.periodicos.ufsc.br/index.php/saudeetransformacao/article/view/4276/4647

Google Scholar

51. Souza MHT, Pereira PPG. Cuidado com saúde: as travestis de Santa Maria, Rio Grande do Sul. Texto Contexto Enferm. (2015) 24:517–24. doi: 10.1590/0104-07072015001920013

Crossref Full Text | Google Scholar

52. Barrington C, Knudston K, Bailey OAP, Aguilar JM, Loya-Montiel MI, Morales-Miranda S. HIV diagnosis, linkage to care, and retention among men who have sex with men and transgender women in Guatemala City. J Health Care Poor Underserved. (2016) 27:1745–60. doi: 10.1353/hpu.2016.0160

Crossref Full Text | Google Scholar

53. Lima F, Cruz KT. Os processos de hormonização e a produção do cuidado em saúde na transexualidade masculina. Sex Salud Soc. (2016) 23:380–402. doi: 10.1590/1984-6487.sess.2016.23.07.a

Crossref Full Text | Google Scholar

54. Neer AF. Obstáculos y facilitadores para garantizar el derecho a la salud integral trans en el Gran Buenos Aires y La Plata. Rev Argent Salud Publica. (2016) 7:26–30. Available online at: https://www.rasp.msal.gov.ar/index.php/rasp/article/view/156

Google Scholar

55. Rocon PC, Rodrigues A, Zamboni J, Pedrini MD. Dificuldades vividas por pessoas trans no acesso ao Sistema Único de Saúde. Ciênc Saúde Colet. (2016) 21:2517–26. doi: 10.1590/1413-81232015218.14362015

Crossref Full Text | Google Scholar

56. Tagliamento G, Paiva V. Trans-specific health care: challenges in the context of new policies for transgender people. J Homosex. (2016) 63:1556–72. doi: 10.1080/00918369.2016.1223359

Crossref Full Text | Google Scholar

57. Bustamante MJ, Konda KA, Joseph Davey D, León SR, Calvo GM, Salvatierra J, et al. HIV self-testing in Peru: questionable availability, high acceptability but potential low linkage to care among men who have sex with men and transgender women. Int J STD AIDS. (2017) 28:133–7. doi: 10.1177/0956462416630674

Crossref Full Text | Google Scholar

58. Ferreira BO, Nascimento EF, Pedrosa JIS, Monte LMI. Vivências de travestis no acesso ao SUS. Physis. (2017) 27:1023–38. doi: 10.1590/s0103-73312017000400009

Crossref Full Text | Google Scholar

59. Budhwani H, Hearld KR, Hasbun J, Charow R, Rosario S, Tillotson L, et al. Transgender female sex workers' HIV knowledge, experienced stigma, and condom use in the Dominican Republic. PLoS ONE. (2017) 12:e0186457. doi: 10.1371/journal.pone.0186457

Crossref Full Text | Google Scholar

60. Ortega JT, Morcillo S, Gálvez M. (Im)pacientes trans en hospitales públicos de Buenos Aires: la experiencia de la espera y la accesibilidad en contextos de estigmatización. Vivência Rev Antropol. (2017) 50:39–61. doi: 10.21680/2238-6009.2017v1n49ID12807

Crossref Full Text | Google Scholar

61. Pinto JJ, Santos RS, Vargens OMC, Araújo LM. A medicalização e patologização na perspectiva das mulheres transexuais: acessibilidade ou exclusão social. Rev Enferm UERJ. (2017) 25:e29009. doi: 10.12957/reuerj.2017.29009

Crossref Full Text | Google Scholar

62. Pinto TP, Teixeira FDB, Barros CRDS, Martins RB, Saggese GSR, Barros DD, et al. Use of industrial liquid silicone to transform the body: prevalence and factors associated with its use among transvestites and transsexual women in São Paulo, Brazil. Cad Saude Publica. (2017) 33:e00113316. doi: 10.1590/0102-311x00113316

Crossref Full Text | Google Scholar

63. Sehnem GD, Lima R, Lipinski JM, Vasquez MED, Schmidt A. Assistência em saúde às travestis na atenção primária: do acesso ao atendimento. Rev Enferm UFPE Online. (2017) 11:3644–52.

Google Scholar

64. Costa AB, Fontanari AMV, Catelan RF, Schwarz K, Stucky JL, da Rosa Filho HT, et al. HIV-related healthcare needs and access barriers for Brazilian transgender and gender diverse people. AIDS Behav. (2018) 22:2534–42. doi: 10.1007/s10461-017-2021-1

Crossref Full Text | Google Scholar

65. Jalil EM, Grinsztejn B, Velasque L, Ramos Makkeda A, Luz PM, Moreira RI, et al. Awareness, willingness, and PrEP eligibility among transgender women in Rio de Janeiro, Brazil. J Acquir Immune Defic Syndr. (2018) 79:445–52. doi: 10.1097/QAI.0000000000001839

Crossref Full Text | Google Scholar

66. de Oliveira Ferreira B, Ivo dos Santos Pedrosa J, Ferreira do Nascimento E. Diversidade de gênero e acesso ao Sistema Único de Saúde. Rev Bras Promoç Saúde (Impr). (2018) 31:1–10. doi: 10.5020/18061230.2018.6726

Crossref Full Text | Google Scholar

67. Zalazar V, Aristegui I, Cardozo N, Sued O, Rodríguez AE, Frola C, et al. Factores contextuales, sociales e individuales como barreras y facilitadores para el acceso a la salud de mujeres trans: desde la perspectiva de la comunidad. Act SIDA Infectol. (2018) 26:1–14. doi: 10.52226/revista.v26i98.22

Crossref Full Text | Google Scholar

68. Donoso C, Nuñez S, Parra-Villarroel J. Significado que otorgan las personas trans a sus experiencias en la atención en el sistema de salud chileno. Rev Chil Salud Pública. (2018) 22:126–34. doi: 10.5354/0719-5281.2018.53235

Crossref Full Text | Google Scholar

69. Neer AF. Los/as profesionales de la salud frente a la Ley de Identidad de Género argentina: tensiones entre el saber experto y el cuidado integral. Physis. (2018) 28:e280318. doi: 10.1590/s0103-73312018280318

Crossref Full Text | Google Scholar

70. Ritterbusch AE, Correa Salazar C, Correa A. Stigma-related access barriers and violence against trans women in the Colombian healthcare system. Glob Public Health. (2018) 13:1831–45. doi: 10.1080/17441692.2018.1455887

Crossref Full Text | Google Scholar

71. Rocon PC, Sodré F, Zamboni J, Rodrigues A, Roseiro MCFB. O que esperam pessoas trans do Sistema Único de Saúde? Interface. (2018) 22:43–53. doi: 10.1590/1807-57622016.0712

Crossref Full Text | Google Scholar

72. Sousa D, Iriart J. “Viver dignamente”: necessidades e demandas de saúde de homens trans em Salvador, Bahia, Brasil. Cad Saúde Pública. (2018) 34:e00036318. doi: 10.1590/0102-311x00036318

Crossref Full Text | Google Scholar

73. Braz C. “Acá yo soy un pibe normal” – narrativas sobre la espera y el acceso a derechos entre varones trans en Argentina. Sex Salud Soc. (2019) 31:119–38. doi: 10.1590/1984-6487.sess.2019.31.07.a

Crossref Full Text | Google Scholar

74. Braz C. Vidas que esperam? Itinerários do acesso a serviços de saúde para homens trans no Brasil e na Argentina. Cad Saúde Pública. (2019) 35:e00110518. doi: 10.1590/0102-311x00110518

Crossref Full Text | Google Scholar

75. Carrara S, Hernandez JG, Uziel AP, Conceição GMS, Panjo H, Baldanzi ACO, et al. Body construction and health itineraries: a survey among travestis and trans people in Rio de Janeiro, Brazil. Cad Saúde Pública. (2019) 35:e00110618. doi: 10.1590/0102-311x00110618

Crossref Full Text | Google Scholar

76. Krüger A, Sperandei S, Bermudez XPCD, Merchán-Hamann E. Characteristics of hormone use by travestis and transgender women of the Brazilian Federal District. Rev Bras Epidemiol. (2019) 22:e190004. doi: 10.1590/1980-549720190004.supl.1

Crossref Full Text | Google Scholar

77. Lovison R, Ascari TM, Zocche DAA, Durand MK, Ascari RA. Travestis e transexuais: despindo as percepções acerca do acesso e assistência em saúde. Enferm Foco. (2019) 10:167–72. doi: 10.21675/2357-707X.2019.v10.n5.2370

Crossref Full Text | Google Scholar

78. Mendes LG, Jorge AO, Pilecco FB. Proteção social e produção do cuidado a travestis e a mulheres trans em situação de rua no município de Belo Horizonte (MG). Saúde Debate. (2019) 43(spe8):107–19. doi: 10.1590/0103-11042019s808

Crossref Full Text | Google Scholar

79. Monteiro S, Brigeiro M. Experiências de acesso de mulheres trans/travestis aos serviços de saúde: avanços, limites e tensões. Cad Saúde Pública. (2019) 35:e00111318. doi: 10.1590/0102-311x00111318

Crossref Full Text | Google Scholar

80. Nogueira FJS, Aragão TAP. Política Nacional de Saúde Integral LGBT: o que ocorre na prática sob o prisma de usuários(as) e profissionais de saúde. Saude Pesqui. (2019) 12:463–70. doi: 10.17765/2176-9206.2019v12n3p463-470

Crossref Full Text | Google Scholar

81. Hanauer OFD. Caminhos percorridos por transexuais: em busca pela transição de gênero (2019). doi: 10.1590/0103-11042019s807

Crossref Full Text | Google Scholar

82. Soares F, MacCarthy S, Magno L, da Silva LAV, Amorim L, Nunn A, et al. Factors associated with PrEP refusal among transgender women in Northeastern Brazil. AIDS Behav. (2019) 23:2710–8. doi: 10.1007/s10461-019-02501-z

Crossref Full Text | Google Scholar

83. Rocon PC, Sodré F, Rodrigues A, Barros MEB, Wandekoken KD. Desafios enfrentados por pessoas trans para acessar o processo transexualizador do Sistema Único de Saúde. Interface. (2019) 23:e180633. doi: 10.1590/interface.180633

Crossref Full Text | Google Scholar

84. Sevelius J, Murray LR, Martinez Fernandes N, Veras MA, Grinsztejn B, Lippman SA. Optimising HIV programming for transgender women in Brazil. Cult Health Sex. (2019) 21:543–58. doi: 10.1080/13691058.2018.1496277

Crossref Full Text | Google Scholar

85. Wilson EC, Jalil EM, Castro C, Martinez Fernandez N, Kamel L, Grinsztejn B. Barriers and facilitators to PrEP for trans women in Brazil. Glob Public Health. (2019) 14:300–8. doi: 10.1080/17441692.2018.1505933

Crossref Full Text | Google Scholar

86. Valenzuela-Valenzuela A, Cartes-Velásquez R. Salud comunitaria: la experiencia de salud trans en el Servicio de Salud Talcahuano, Chile. Psicoperspectivas. (2020) 19:1–12. doi: 10.12804/revistas.urosario.edu.co/revsalud/a.10383

Crossref Full Text | Google Scholar

87. Cortes HM. O (des)acesso de pessoas trans ao serviço de saúde no Recôncavo Baiano. Cad Gênero Divers. (2020) 6:159–80. doi: 10.9771/cgd.v6i4.36104

Crossref Full Text | Google Scholar

88. Calderón-Jaramillo M, Mendoza Á, Acevedo N, Forero-Martínez LJ, Sánchez SM, Rivillas-García JC. How to adapt sexual and reproductive health services to the needs and circumstances of trans people: a qualitative study in Colombia. Int J Equity Health. (2020) 19:148. doi: 10.1186/s12939-020-01250-z

Crossref Full Text | Google Scholar

89. Maschião LF, Wilson E, McFarland W, Turner C, Pestana T, Veras MA. Nonprescribed sex hormone use among trans women: the complex interplay of public policies, social context, and discrimination. Transgend Health. (2020) 5:143–50. doi: 10.1089/trgh.2020.0012

Crossref Full Text | Google Scholar

90. Guimarães NP, Sotero RL, Cola JP, Antonio S, Galavote HS. Avaliação da implementação da Política Nacional de Saúde Integral à população LGBT em um município da região Sudeste do Brasil. RECIIS. (2020) 14:372–85. doi: 10.29397/reciis.v14i2.1712

Crossref Full Text | Google Scholar

91. Moraes AND Silva GSN. Travestis e o cuidado humanizado em saúde. Rev Abordagem Gestál. (2020) 26:175–87. doi: 10.18065/2020v26n2.5

Crossref Full Text | Google Scholar

92. Rocha ABM, Barros C, Generoso IP, Bastos FI, Veras MA. HIV continuum of care among trans women and travestis living in São Paulo, Brazil. Rev Saude Publica. (2020) 54:118. doi: 10.11606/s1518-8787.2020054002374

Crossref Full Text | Google Scholar

93. Oliveira I, Romanini M. (Re)escrevendo roteiros (in)visíveis: a trajetória de mulheres transgênero nas políticas públicas de saúde. Saúde Soc. (2020) 29:e170961. doi: 10.1590/s0104-12902020170961

Crossref Full Text | Google Scholar

94. Rocon PC, Barros MEB, Rodrigues HBC. Aprendizagens com signos trans: uma transetopoiese disruptiva. Educar em Rev. (2020) 36:1–21. doi: 10.1590/0104-4060.74656

Crossref Full Text | Google Scholar

95. Longino A, Montano MA, Sanchez H, Bayer A, Sanchez J, Tossas-Milligan K, et al. Increasing PrEP uptake and adherence among MSM and TW sex workers in Lima, Perú: what and whom do different patients trust? AIDS Care. (2020) 32:255–60. doi: 10.1080/09540121.2019.1634787

Crossref Full Text | Google Scholar

96. Braz C, Almeida AS. Waiting, patience and resistance: anthropological reflections on transexualities, life course and itineraries of access to health services. Rev Antropol. (2020) 63:1–17. doi: 10.11606/2179-0892.ra.2020.170813

Crossref Full Text | Google Scholar

97. Beltrán JAL. Educación, trabajo y salud: realidades de mujeres transgénero residentes en Bogotá, Colombia. Saude Soc. (2020) 29:e190639. doi: 10.1590/s0104-12902020190639

Crossref Full Text | Google Scholar

98. Baccarim RCG. Acesso de Pessoas Trans à Saúde: uma análise das práticas de profissionais (2020). doi: 10.7213/psicolargum.38.102.AO01

Crossref Full Text | Google Scholar

99. Costa MCB, McFarland W, Wilson EC, Xie H, Arayasirikul S, Moura FD, et al. Prevalence and correlates of nonprescription hormone use among trans women in São Paulo, Brazil. LGBT Health. (2021) 8:162–6. doi: 10.1089/lgbt.2020.0059

Crossref Full Text | Google Scholar

100. Florêncio LLF, de Souza KR, Oliveira ECDS, Cabral JDR, Silva FPD, Silva RAD, et al. Therapeutic itinerary of transsexual people in light of human rights. Nurs Ethics. (2021) 28:704–13. doi: 10.1177/0969733020968864

Crossref Full Text | Google Scholar

101. Leite BO, de Medeiros DS, Magno L, Bastos FI, Coutinho C, de Brito AM, et al. Association between gender-based discrimination and medical visits and HIV testing in a large sample of transgender women in northeast Brazil. Int J Equity Health. (2021) 20:199. doi: 10.1186/s12939-021-01541-z

Crossref Full Text | Google Scholar

102. Shihadeh NA, Pessoa EM, Silva FF. A (in)visibilidade do acolhimento no âmbito da saúde: em pauta as experiências de integrantes da comunidade LGBTQIA+. Barbarói. (2021) 58:172–94. doi: 10.17058/barbaroi.v0i58.14765

Crossref Full Text | Google Scholar

103. Zucchi EM, Couto MT, Castellanos M, Dumont-Pena É, Ferraz D, Félix Pinheiro T, et al. Acceptability of daily pre-exposure prophylaxis among adolescent men who have sex with men, travestis and transgender women in Brazil: a qualitative study. PLoS ONE. (2021) 16:e0253842. doi: 10.1371/journal.pone.0249293

Crossref Full Text | Google Scholar

104. Sabino TE, Avelino-Silva VI, Cavalcantte C, Goulart SP, Luiz OC, Fonseca LAM, et al. Adherence to antiretroviral treatment and quality of life among transgender women living with HIV/AIDS in São Paulo, Brazil. AIDS Care. (2021) 33:31–8. doi: 10.1080/09540121.2019.1710449

Crossref Full Text | Google Scholar

105. Cohen CR, De Tilio R. Atendimentos em saúde na perspectiva de transexuais. Psicol Rev. (2021) 27:165–84. doi: 10.5752/P.1678-9563.2021v27n1p165-184

Crossref Full Text | Google Scholar

106. Zalazar V, Aristegui I, Socías ME, Cardozo N, Sued O, Shannon K, et al. Ethics and the treatment as prevention strategy among transgender women living with HIV in Argentina. Cult Health Sex. (2021) 23:674–89. doi: 10.1080/13691058.2020.1720821

Crossref Full Text | Google Scholar

107. Nogueira FJS, Leitão ESF, Silva ECS. Interseccionalidades na experiência de pessoas trans nos serviços de saúde. Rev Psicol Saúde. (2021) 13:35–50. doi: 10.20435/pssa.v13i3.1243

Crossref Full Text | Google Scholar

108. Prates SG, Jesuíno RD, Paranhos LR, Herval ÁM, Gontijo LPT. Oral health self-perception for transgender people: a controlled cross-sectional study. Biosci J. (2021) 37:e37003. doi: 10.14393/BJ-v37n0a2021-55794

Crossref Full Text | Google Scholar

109. Silva Filho JB, Nascimento ACP, Castro GHC. Pacientes trans e cuidado multiprofissional em centros de atendimento psicossocial. Rev Polis Psique. (2021) 11:56–80. doi: 10.22456/2238-152X.105552

Crossref Full Text | Google Scholar

110. Clark J, Reisner S, Perez-Brumer A, Huerta L, Sanchez H, Moriarty K, et al. TransPrEP: results from the pilot study of a social network-based intervention to support PrEP adherence among transgender women in Lima, Peru. AIDS Behav. (2021) 25:1873–83. doi: 10.1007/s10461-020-03117-4

Crossref Full Text | Google Scholar

111. Silva RA, Tajra FS, Luz PCM, Sales JCS. Itinerários terapêuticos da população trans em um município do nordeste brasileiro. Sex Salud Soc. (2021) 37:e21207. doi: 10.1590/1984-6487.sess.2021.37.e21207a

Crossref Full Text | Google Scholar

112. Pizarro AZ, Villarroel JA, Jenkis FL, Bugueño CM, Nilo SQ, Friedrich JV, et al. Percepción de la atención de salud de personas transgénero en profesionales médicos y médicas del norte de Chile. Rev Chil Obstet Ginecol. (2021) 86:61–7. doi: 10.4067/S0717-75262021000100061

Crossref Full Text | Google Scholar

113. Jalil EM, Torres TS, Luz PM, Monteiro L, Moreira RI, de Castro CRV, et al. Low PrEP adherence despite high retention among transgender women in Brazil: the PrEParadas study. J Int AIDS Soc. (2022) 25:e25896. doi: 10.1002/jia2.25896

Crossref Full Text | Google Scholar

114. Lazcano CL, Toneli MJF. Producción de sentidos sobre asistencia transespecífica en salud, derechos y ciudadanía trans. Psicol Ciênc Prof. (2022) 42:e230748. doi: 10.1590/1982-3703003230748

Crossref Full Text | Google Scholar

115. Miwa HYC, Neves ALM, Therense M. Negociações cotidianas de travestis e mulheres trans trabalhadoras sexuais. Psicol Pesq. (2022) 16:1–24. doi: 10.34019/1982-1247.2022.v16.32719

Crossref Full Text | Google Scholar

116. Mota M, Santana ADS, Silva LR, Melo LP. “Clara, esta sou eu!” Nome, acesso à saúde e sofrimento social entre pessoas transgênero. Interface. (2022) 26:e210017. doi: 10.1590/interface.210017

Crossref Full Text | Google Scholar

117. Rocon PC, De Barros MEB, Rodrigues A. A formação dos(as) trabalhadores(as) da saúde na construção de um acesso à saúde integral, equânime e universal à população trans. Pro-Posições. (2022) 33:e20220018. doi: 10.1590/1980-6248-2019-0083

Crossref Full Text | Google Scholar

118. Silva RA, Silva LAV, Soares F, Dourado I. Uso de hormônios não prescritos na modificação corporal de travestis e mulheres transexuais de Salvador/Bahia, Brasil. Ciênc Saúde Colet. (2022) 27:503–14. doi: 10.1590/1413-81232022272.44342020

Crossref Full Text | Google Scholar

119. Moncayo Quevedo JE, Pérez-Arizabaleta MDM, Reyes Sevillano WH. Condom use and non-use among transgender women in Colombia: a qualitative analysis based on the IMB model. Rev Saude Publica. (2022) 56:84. doi: 10.11606/s1518-8787.2022056004145

Crossref Full Text | Google Scholar

120. Rossi TA, Brasil SA, Magno L, Veras MA, Pinheiro TF, Pereira M, et al. Conhecimentos, percepções e itinerários terapêuticos de travestis e mulheres trans no cuidado a infecções sexualmente transmissíveis em Salvador, Brasil. Sex Salud Soc. (2022) 38:e22304. doi: 10.1590/1984-6487.sess.2022.38.e22304.a

Crossref Full Text | Google Scholar

121. Neer AF, Newton C. Desafíos para el acceso a la salud de la población travesti y trans en el noroeste del conurbano bonaerense: un análisis de las prácticas y sentidos profesionales del trabajo social y la enfermería (José C. Paz, 2015–2019). Astrolabio Nueva Época. (2022) 18:111–20. Available online at: https://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1668-75152022000100111&lng=es&nrm=iso

Google Scholar

122. Radusky PD, Aristegui I, Mandell LN, Dell'Isola E, Zalazar V, Cardozo N, et al. Examining factors associated with gender identity among individuals disengaged from HIV care in Argentina. Int J Behav Med. (2022) 29:69–77. doi: 10.1007/s12529-021-09998-6

Crossref Full Text | Google Scholar

123. Konda KA, Torres TS, Mariño G, Ramos A, Moreira RI, Leite IC, et al. Factors associated with long-term HIV pre-exposure prophylaxis engagement and adherence among transgender women in Brazil, Mexico and Peru: results from the ImPrEP study. J Int AIDS Soc. (2022) 25(Suppl 5):e25974. doi: 10.1002/jia2.25974

Crossref Full Text | Google Scholar

124. Oliveira PHL, Galvão JR, Rocha KS, Santos AM. Itinerário terapêutico de pessoas transgênero: assistência despersonalizada e produtora de iniquidades. Physis. (2022) 32:e320209. doi: 10.1590/s0103-73312022320209

Crossref Full Text | Google Scholar

125. Gomes DF, Teixeira ER, Sauthier M, Paes GO. Restrição de políticas públicas de saúde: um desafio dos transexuais na atenção básica. Esc Anna Nery Rev Enferm. (2022) 26:e20210425. doi: 10.1590/2177-9465-ean-2021-0425en

Crossref Full Text | Google Scholar

126. Pereira CR, Cruz MM, Cota VL. Sexualidade, sociabilidade, trabalho e prevenção do HIV entre populações vulneráveis na pandemia da Covid-19. Saúde Debate. (2022) 46(spe7):62–74. doi: 10.1590/0103-11042022E704

Crossref Full Text | Google Scholar

127. Hernández JG, Silva Junior AL, Carrara S, Baldanzi ACO, Uziel AP. Saúde de Travestis e pessoas Trans no Rio de Janeiro e Região Metropolitana: estratégias e condições de acesso. Sex Salud Soc. (2022) 38:e22301. doi: 10.1590/1984-6487.sess.2022.38.e22301.a

Crossref Full Text | Google Scholar

128. Arce-Leonel DE, Hoyos-Hernández PA. Labor-related life stories about health care for transgender women in Colombia. Pensamiento Psicol. (2022) 20:1–12. doi: 10.11144/Javerianacali.PPSI20.samt

Crossref Full Text | Google Scholar

129. Oliveira GS, Salimena AMO, Penna LHG, Paraíso AF, Ramos CM, Alves MS, et al. The experience of trans or transvestite women in accessing public health services. Rev Bras Enferm. (2022) 75:e20210713. doi: 10.1590/0034-7167-2021-0713

Crossref Full Text | Google Scholar

130. Cortes HM, de Melo M, De Lacerda LCS, Santiago LP, Santos RO, Pinho PH. Therapeutic itinerary of trans men from Northeastern Brazil. Transgend Health. (2022) 7:357–63. doi: 10.1089/trgh.2021.0042

Crossref Full Text | Google Scholar

131. Borgert V, Stefanello S, Signorelli MC, Dos Santos DVD. “We just want to be treated with professionalism”: experiences of trans people about health care in Curitiba-PR, Brazil. Physis. (2023) 33:1–20. doi: 10.1590/s0103-7331202333036

Crossref Full Text | Google Scholar

132. Carosella EA, Huerta L, Galea JT, Lecca L, Ramos K, Hernández NG, et al. A cross-sectional analysis of self-reported needs and health service utilization among transgender women in Lima, Perú. LGBT Health. (2023) 10:535–43. doi: 10.1089/lgbt.2022.0054

Crossref Full Text | Google Scholar

133. Paiva CR, Farah BF, Duarte MJO. A rede de cuidados à saúde para a população transexual. Physis. (2023) 33:e33001. doi: 10.1590/s0103-7331202333001

Crossref Full Text | Google Scholar

134. Dias JPB, Pietrafesa GAB, Silva SA. Acesso e utilização da atenção ginecológica na atenção primária à saúde: percepção do homem transexual. Saude Pesqui. (2023) 16:11272. doi: 10.17765/2176-9206.2023v16n4.e11272

Crossref Full Text | Google Scholar

135. Gomes ACMS, Sousa FJG, Janini JP, Vargas LA, Gomes MS, Lemos A. Atendimento na atenção primária à saúde: olhares de pessoas trans. Rev Pesqui (Univ Fed Estado Rio J). (2023) 15:12260. doi: 10.9789/2175-5361.rpcfo.v15.12260

Crossref Full Text | Google Scholar

136. Jesus MKMR, Moré IAA, Querino RA, Oliveira VH. Experiências de mulheres transexuais no sistema de saúde: visibilidade em direção à equidade. Interface. (2023) 27:e230114. doi: 10.1590/interface.230151

Crossref Full Text | Google Scholar

137. De Luca A, Zalazar V, Salusso D, Frontini E, Fabian S, Cardozo NF, et al. “If I'm at home, I do it at home”: qualitative study on HIV self-testing among transgender women in Argentina. Int J STD AIDS. (2023) 34:25–30. doi: 10.1177/09564624221132624

Crossref Full Text | Google Scholar

138. Pinto F, Saletti-Cuesta L. “La covid no ha podido con nosotrxs”: impacto de la pandemia en el acceso efectivo de personas trans a tratamientos hormonales integrales en Córdoba, Argentina. Saúde Soc. (2023) 32:e210215. doi: 10.1590/s0104-12902023210215es

Crossref Full Text | Google Scholar

139. Radusky PD, Cardozo N, Duarte M, Fabian S, Frontini E, Sued O, et al. Mental health, substance use, experiences of violence, and access to health care among transgender and non-binary people during the COVID-19 lockdown in Argentina. Int J Transgend Health. (2023) 24:320–33. doi: 10.1080/26895269.2021.1943593

Crossref Full Text | Google Scholar

140. Barrington C, Goldenberg T, Donastorg Y, Gomez H, Perez M, Kerrigan D. Stigma and HIV treatment outcomes among transgender women sex workers in the Dominican Republic. AIDS Behav. (2023) 27:2774–84. doi: 10.1007/s10461-023-04001-7

Crossref Full Text | Google Scholar

141. Vissicchio F, Radusky PD, Zalazar V, Cardozo N, Santa Cruz L, Pecheny M, et al. Obstáculos identificados por las personas trans en la accesibilidad a los consultorios inclusivos en la provincia de Buenos Aires. Rev Argent Salud Publica. (2023) 15:e87. Available online at: https://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1853-810X2023000100087&lng=es&nrm=iso

Google Scholar

142. Amarante ICJ, Lippman SA, Sevelius JM, Saggese GSR, da Silva AAM, Veras M. Anticipated stigma and social barriers to communication between transgender women newly diagnosed with HIV and health care providers: a mediation analysis. LGBT Health. (2024) 11:229–38. doi: 10.1089/lgbt.2023.0041

Crossref Full Text | Google Scholar

143. Galvão DLS, Araújo WJS, Brandão Neto W, Barros MBSC, Monteiro EMM. Desafios para o suporte à amamentação em homens transgêneros sob à luz da interseccionalidade. Ciênc Saúde Coletiva. (2024) 29:1–12. doi: 10.1590/1413-81232024294.19262023en

Crossref Full Text | Google Scholar

144. Zapata Mayor JC, Hoyos Hernández PA. Health care: life stories by trans women in Colombia. Int J Equity Health. (2024) 23:85. doi: 10.1186/s12939-023-01859-w

Crossref Full Text | Google Scholar

145. Medeiros MA, Gomes SM, Spinelli Junior VF. Fatores de estresse e resiliência no acesso e utilização de serviços de saúde por travestis e mulheres transexuais no nordeste brasileiro. Saúde Soc. (2024) 33:e220904. doi: 10.1590/s0104-12902024220904pt

Crossref Full Text | Google Scholar

146. UNESCO Institute for Statistics. International Standard Classification of Education: Fields of education and training 2013 (ISCED-F 2013) – Detailed field descriptions. Montreal, QC: UNESCO (2015). Available online at: https://uis.unesco.org/sites/default/files/documents/international-standard-classification-of-education-fields-of-education-and-training-2013-detailed-field-descriptions-2015-en.pdf (Accessed July 9, 2025)

Google Scholar

147. Mitchell LA, Jacobs C, McEwen A. (In)visibility of LGBTQIA+ people and relationships in healthcare: a scoping review. Patient Educ Couns. (2023) 114:107828. doi: 10.1016/j.pec.2023.107828

Crossref Full Text | Google Scholar

148. Anzani A, Siboni L, Prunas A, Lindley L, Galupo MP. From abstinence to deviance: sexual stereotypes associated with transgender and nonbinary individuals. Sex Res Soc Policy. (2024) 21:27–43. doi: 10.1007/s13178-023-00842-y

Crossref Full Text | Google Scholar

149. Céspedes L. Latin American journals and hegemonic languages for academic publishing in scopus and web of science. Trab Linguist Apl. (2021) 60:141–54. doi: 10.1590/010318138901311520201214

Crossref Full Text | Google Scholar

150. Lacombe-Duncan A, Hughson L, Kay ES, Duncan S, Willbrandt C. Peer-based interventions to support transgender and gender diverse people's health and healthcare access: a scoping review. Int J Transgend Health. (2023) 25:321–51. doi: 10.1080/26895269.2023.2232353

Crossref Full Text | Google Scholar

151. Cortes AM, Jaramillo J. Legal opportunity structure and legal battles over sex education and LGBTQ students in Brazil and Colombia. Rev direito GV. (2024) 20:e2432. doi: 10.1590/2317-6172202432

Crossref Full Text | Google Scholar

152. March S, Carrasco JM, Flores-Balado Á, Muñoz-Haba A, Pereira-Iglesias A, Zaragoza GA. Potential global effects of the rise of the far right on public health. Am J Public Health. (2025) 115:873–82. doi: 10.2105/AJPH.2025.308016

Crossref Full Text | Google Scholar

153. World Health Organization (WHO). International Classification of Diseases (ICD-10). 10th ed. Geneva, Switzerland: WHO (2011).

Google Scholar

154. World Health Organization (WHO). International Classification of Diseases (ICD-11). 11th ed. Geneva, Switzerland: WHO (2019).

Google Scholar

155. González VA. El derecho a la salud integral de las personas trans en Argentina. Saude Soc. (2025) 34:e230349es. doi: 10.1590/s0104-12902025230349es

Crossref Full Text | Google Scholar

156. Foucault M. The History of Sexuality: Volume 1 – An Introduction. New York, NY: Pantheon Books (1978).

Google Scholar

157. Butler J. Notes Toward a Performative Theory of Assembly. Cambridge, UK: Harvard University Press (2015). doi: 10.4159/9780674495548

Crossref Full Text | Google Scholar

158. Gulliford M, Figueroa-Munoz J, Morgan M, Hughes D, Gibson B, Beech R, et al. What does 'access to health care' mean? J Health Serv Res Policy. (2002) 7:186–8. doi: 10.1258/135581902760082517

Crossref Full Text | Google Scholar

159. Lugones M. Toward a decolonial feminism. Hypatia. (2010) 25:742–59. doi: 10.1111/j.1527-2001.2010.01137.x

Crossref Full Text | Google Scholar

160. Lugones M. Colonialidade e gênero. Tabula Rasa. (2008) 9:73–101. doi: 10.25058/20112742.340

Crossref Full Text | Google Scholar

161. Vergueiro V. Thinking cisgenderity as decolonial critique. In:Messeder S, et al., , editors. Enlaçando Sexualidades. Salvador, Brazil: EDUFBA (2016). p. 249–70. doi: 10.7476/9788523218669.0014

Crossref Full Text | Google Scholar

162. Gonçalves EDFM, Oliveira EAD, Cardoso GCP, Silva LTB. Saúde de LGBTQIA+ na atenção básica de saúde: uma revisão de escopo. Saúde Debate. (2023) 47(spe1):e9111. doi: 10.1590/2358-28982023e19111p

Crossref Full Text | Google Scholar

163. Holland D, White LCJ, Pantelic M, Llewellyn C. The experiences of transgender and nonbinary adults in primary care: a systematic review. Eur J Gen Pract. (2024) 30:2296571. doi: 10.1080/13814788.2023.2296571

Crossref Full Text | Google Scholar

164. Renner J, Blaszcyk W, Täuber L, Dekker A, Briken P, Nieder TO. Barriers to accessing health care in rural regions by transgender, non-binary, and gender diverse people: a case-based scoping review. Front Endocrinol. (2021) 12:717821. doi: 10.3389/fendo.2021.717821

Crossref Full Text | Google Scholar

165. Boldrin VDC, Coelho RDR, Alves LC, Teixeira ES, Bernardo SRS, Costa AG. Avanços e desafios no processo transexualizador no Sistema Único de Saúde brasileiro. Cien Saude Colet. (2025) 30:e10912023. doi: 10.1590/1413-81232025301.10912023

Crossref Full Text | Google Scholar

166. Redfern JS, Jann MW. The evolving role of pharmacists in transgender health care. Transgend Health. (2019) 4:118–30. doi: 10.1089/trgh.2018.0038

Crossref Full Text | Google Scholar

167. Chaudhary S, Ray R, Glass B. Pharmacists' role in transgender healthcare: a scoping review. Res Social Adm Pharm. (2021) 17:1553–61. doi: 10.1016/j.sapharm.2020.12.015

Crossref Full Text | Google Scholar

168. Oliveira TDS, Pereira AMM. Expressões das desigualdades no acesso aos serviços de saúde na América Latina: uma revisão de escopo. Ciênc Saúde Coletiva. (2024) 29:e04932024. doi: 10.1590/1413-81232024297.04932024

Crossref Full Text | Google Scholar

169. Corrales J. Understanding the uneven spread of LGBT rights in Latin America and the Caribbean, 1999–2013. J Res Gender Stud. (2017) 7:52–82. Available online at: https://addletonacademicpublishers.com/contents-jrgs/990-volume-7-1-2017/2968-understanding-the-uneven-spread-of-lgbt-rights-in-latin-america-and-the-caribbean-1999-2013

Google Scholar

170. Cabieses B, Velázquez B, Blukacz A, Farante S, Bojórquez I, Mezones-Holguín E. Intersections between gender approaches, migration and health in Latin America and the Caribbean: a discussion based on a scoping review. Lancet Reg Health Am. (2023) 40:100538. doi: 10.1016/j.lana.2023.100538

Crossref Full Text | Google Scholar

171. Wesp LM, Malcoe LH, Elliott A, Poteat T. Intersectionality research for transgender health justice: a theory-driven conceptual framework for structural analysis of transgender health inequities. Transgend Health. (2019) 4:287–96. doi: 10.1089/trgh.2019.0039

Crossref Full Text | Google Scholar

172. Zajdel RA, Rodriquez EJ, Mejía R, Pérez-Stable EJ. Perspectives on the intersection of race and ethnicity, immigration status, and sexual and gender minoritised status among clinical and scientific workforces in Latin America. Lancet Reg Health Am. (2025) 41:100975. doi: 10.1016/j.lana.2024.100975

Crossref Full Text | Google Scholar