Fragments of care: The trajectory of health policy in gender transition processes

Abstract

The article analyzes the trajectory of the public health policy for transgender people undergoing gender transition processes in Brazil, from 1997 to 2025. Based on an exploratory document analysis from a Trajectory Studies perspective, it identifies official federal records, regulations, events, and other institutional milestones to reconstruct the main phases of the policy, considering its relationship with the public policy cycle. Five distinct phases are identified: experimental and pathologizing; judicialization and initial institutionalization; expansion and normative disputes; regression and stagnation; and recent attempt at restructuring. The study highlights the persistent fragmentation of the policy, the dominance of the biomedical model, weak institutionalization of public policy cycle mechanisms, and limited social participation. It concludes that consolidating the policy depends on overcoming these weaknesses and strengthening participatory, evaluative, and federative structures to ensure effective and continuous comprehensive care for the transgender population within Brazil’s Unified Health System.