Bruna Caruso Mazzolani

Introduction Gender-affirming care for transgender children and adolescents has become increasingly contested following recent regulatory changes. Although public and regulatory debates have largely focused on medical interventions, less is known about how healthcare professionals understand and enact care within changing regulatory contexts. This study explored professionals’ perspectives on gender-affirming care, transition, and the implications of Brazil’s Federal Council of Medicine Resolution No. 2,427/2025. Methods A qualitative study was conducted using four online focus groups, held between January and March 2026, with 15 multidisciplinary healthcare professionals involved in the care of transgender children and adolescents in Brazil. Discussions were audio-recorded, transcribed verbatim, and analyzed using qualitative content analysis combining deductive and inductive approaches. Results Professionals described gender-affirming care as a longitudinal, relational, multidisciplinary, and intersectoral process extending beyond medical interventions to include family support, school collaboration, psychosocial care, and advocacy. Participants perceived the resolution as misaligned with this model of care and described divergent interpretations of its transitional provision, resulting in heterogeneous practices regarding treatment eligibility and continuity. They also reported increased legal involvement, psychosocial demands, regulatory uncertainty, and concerns about self-medication and unsupervised hormone use. Conclusions Professionals experienced the resolution not only as a restriction on medical interventions but as a disruption of a longitudinal model of care, with heterogeneous implementation across services and a shift of clinical work toward legal, psychosocial, and harm-reduction demands. Policy Implications Regulatory frameworks should recognize the multidimensional nature of gender-affirming care, provide clear implementation guidance, protect continuity of care, and incorporate the perspectives of healthcare professionals, transgender young people, and their families.

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease associated with increased cardiovascular risk and gut microbiota dysbiosis. Although lifestyle can modulate the microbiome, the impact of multidisciplinary interventions in SLE remains unclear. Thus, the aim of the present study was to investigate the effects of a multidisciplinary lifestyle intervention on gut microbiota diversity and composition in women with SLE and high cardiovascular risk. Materials and methods: This study analyzed a subsample ( n = 31) from the “Living Well with Lupus” (LWWL) study, a 6-month randomized controlled trial. Patients were assigned to a lifestyle intervention + standard care (LWWL) or a standard care control group (CG). Gut microbiota (16S rRNA sequencing), fecal short-chainfatty acids (SCFAs), selected cardiovascular risk factors, dietary intake, and physical activity levels were assessed before and after the intervention. Results: No significant changes were observed in cardiovascular risk factors, food intake, or physical activity levels. Fecal SCFA concentrations and alpha/beta diversity also remained stable. Exploratory taxonomic analyses nevertheless identified distinct relative-abundance patterns across groups and time, including a numerical increase in the Firmicutes -to- Bacteroidota (F/B) ratio in LWWL and different trajectories of several SCFA-associated genera. Among these, Blautia and Parasutterella increased, whereas Butyricimonas , Coprococcus , and Odoribacter decreased from pre- to post-intervention in LWWL, with different trajectories observed in CG across these genera. Conclusions: These findings suggest that taxonomic features of the gut microbiota may show compositional variation following a lifestyle intervention even in the absence of detectable changes in the measured cardiometabolic or behavioral outcomes. However, the functional and clinical significance of these exploratory taxonomic patterns remains uncertain and warrants further investigation.

Objective (1) To synthesise the available evidence on the clinical effectiveness of home-based physical exercise interventions in improving aerobic capacity, functional capacity, muscle strength and quality of life in children and adolescents with chronic diseases, as well as to evaluate their feasibility; and (2) to assess the reporting quality of these interventions using the Consensus on Exercise Reporting Template, with the aim of identifying gaps in methodological transparency that may limit reproducibility and scalability. Design Systematic review and meta-analysis. Data sources Medline (via PubMed), Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), SportDiscus and CINAHL database (via EBSCOhost) were searched until 31 December 2025. Eligibility criteria Eligible studies included intervention designs (randomised controlled trials (RCTs), non-randomised trials and before–after studies) that evaluated home-based physical exercise interventions in children and adolescents with chronic diseases. Studies were required to include a comparator (eg, centre-based interventions, alternative home-based interventions, such as motor imagery, constraint-induced movement therapy or hand-arm bimanual intensive therapy or no intervention) or to report within-group (baseline-to-follow-up) comparisons. Outcomes of interest were aerobic capacity, functional capacity, muscle strength and quality of life. Results A total of 81 studies were included, comprising 2923 children and adolescents. The most frequently represented conditions were cerebral palsy (n=26; 32.1%), cystic fibrosis (n=10; 12.3%) and idiopathic arthritis (n=8; 9.8%). Of the 45 RCTs identified, 19 met the criteria for inclusion in the meta-analysis. Home-based physical exercise interventions were effective in increasing aerobic capacity (pConclusions Our meta-analysis of randomised controlled trials comparing home-based interventions with control conditions suggests that home-based physical exercise is feasible and improves aerobic capacity, but does not confer significant benefits for functional capacity, muscle strength or quality of life in children and adolescents with chronic diseases. Suboptimal reporting quality, risk of bias and inconsistent adherence/safety data necessitate cautious interpretation. PROSPERO registration number CRD42022330567.

Objective: To compare body composition and physical fitness between transgender and cisgender individuals. Design: Systematic review with meta-analysis. Data sources: PubMed, Web of Science, Embase and SportDiscus. Eligibility criteria: Inclusion criteria comprised studies of transgender individuals comparing body composition or physical fitness pre-to-post gender-affirming hormone therapy (GAHT) or versus cisgender controls. Results: 50 studies (n=6099) were included. Transgender women had similar relative fat mass (standardised mean difference (SMD) −0.29, 95% CI −0.63 to 0.05, Grading of Recommendations Assessment, Development and Evaluation (GRADE): very low), relative lean mass (SMD 0.19, 95% CI −0.14 to 0.53, GRADE: low), upper-body strength (SMD 0.92, 95% CI −0.52 to 2.35, GRADE: very low), lower-body strength (SMD −0.10, 95% CI −1.07 to 0.86, GRADE: very low) and maximal oxygen consumption (SMD −0.28, 95% CI −0.81 to 0.25, GRADE: very low) in comparison to cisgender women. Transgender men exhibited higher relative fat mass (SMD 1.09, 95% CI 0.66 to 1.53, GRADE: moderate), lower relative lean mass (SMD −6.42, 95% CI −12.26 to −0.58, GRADE: moderate) and lower upper-body strength (SMD −1.20, 95% CI −1.96 to −0.45, GRADE: moderate) than cisgender men. In transgender women, GAHT was associated with increased fat mass and reduced lean mass and upper-body strength over 1–3 years. Transgender men demonstrated reduced fat mass and increased lean mass and strength following GAHT. Conclusion: While transgender women exhibited higher lean mass than cisgender women, their physical fitness was comparable. Current evidence is mostly low certainty and has heterogenous quality but does not support theories of inherent athletic advantages for transgender women over cisgender. PROSPERO registration number: CRD42024562210.

Background: Patients with systemic lupus erythematosus (SLE) experience impaired wellbeing and elevated cardiovascular risk. Lifestyle interventions targeting exercise and nutrition may improve overall health outcomes, but evidence in this population remains limited. Purpose: This study aimed to investigate the effects of a newly developed healthy lifestyle intervention, the Living Well with Lupus (LWWL) program, on overall wellbeing in patients with SLE and high cardiovascular risk. Research Design: A 6-month, parallel-group, randomized controlled trial was conducted in São Paulo, Brazil, between August 2020 and March 2023. Participants were randomly assigned to either the LWWL intervention group or a standard care control group. The LWWL program was a goal-setting, behavioral intervention including a home-based exercise program and nutritional counseling. Study Sample: Eighty adults with SLE and high cardiovascular risk were included. Twelve participants in the LWWL group dropped out due to personal reasons, and six in the control group did not respond to post-intervention assessments. Data Collection and/or Analysis: Secondary outcomes related to wellbeing were assessed, including quality of life (SF-36), fatigue (FACIT), functional capacity, anxiety and depression symptoms, and sleep quality. Between-group comparisons were performed at post-intervention, and complete-case sensitivity analyses were conducted. Results: Significant between-group differences were observed for the role physical domain of the SF-36 (EMD [95% CI]: −1.0 [−1.6; −0.4]; p = .01; ES [95% CI]: −1.03 [−1.6; −0.4]) and the FACIT fatigue score (EMD [95% CI]: 7.1 [1.6; 12.6]; p = .01; ES [95% CI]: 1.24 [0.5; 2.0]) in favor of the LWWL group. No significant between-group differences were detected for other variables ( p > .05). Sensitivity analyses corroborated these findings and suggested improvements in mood and strength following the program. Conclusions: The LWWL intervention improved fatigue and the role physical domain of quality of life in SLE patients with high cardiovascular risk. This behavioral lifestyle approach represents a potentially clinically relevant strategy to enhance selected aspects of wellbeing in SLE.

Transgender youth and their caregivers are rarely included in regulatory processes concerning gender-affirming care, despite being directly affected. In April 2025, the Brazilian Federal Council of Medicine (CFM) issued Resolution 2.427/2025, which banned the use of puberty blockers in all minors, prohibited hormone therapy before age 18, and introduced stricter age thresholds for surgical interventions. This study aimed to assess stakeholder perspectives regarding these new restrictions. We conducted a cross-sectional survey between May and June 2025 with patients and caregivers from Brazil’s largest outpatient gender identity service. A total of 54 transgender youth (mean age 13.6 ± 2.0 years) and 116 caregivers completed the survey independently. Participants rated their level of agreement with each provision of the resolution using a 6-point Likert scale. Findings demonstrated overwhelming opposition to the new regulations. Among youth, 92.6% strongly disagreed with the ban on puberty blockers, 94.4% opposed restrictions on hormone therapy before 18, and 59.3% disagreed with surgical age limits. Caregivers reported similar opposition, with 93.1% rejecting the ban on puberty blockers, 89.7% rejecting restrictions on hormone therapy, and 61.2% disagreeing with surgical restrictions. Importantly, opposition was consistent across all stages of treatment engagement, including among those who had not initiated or had declined medical interventions, suggesting that disagreement is not solely attributable to personal investment in treatment. These findings highlight a substantial misalignment between regulatory policy and the perspectives of directly affected youth and families. Incorporating patient and caregiver voices, alongside clinical evidence, is essential to ensure that policies remain ethically sound and responsive to stakeholder needs. Public significance statement: This study found that over 90% of transgender youth and their caregivers in Brazil strongly oppose new bans on gender-affirming medical care, revealing a significant disconnect between regulatory policies and the lived experiences of those most affected. These findings underscore the critical importance of incorporating patient and family perspectives into healthcare policy to ensure it is both ethical and effective.

In April 2025, Brazil's Federal Council of Medicine (CFM) issued Resolution 2.427/2025 banning puberty blockers, restricting hormone therapy until age 18, and delaying gender-affirming surgeries until age 21. These measures sharply contrast with previous national protocols aligned with international standards of care. We conducted a qualitative study to explore how transgender adolescents and their caregivers perceive these new restrictions. Nine focus groups were held between May and June 2025 with 31 transgender adolescents (11-18 years) and 21 caregivers receiving care at Brazil's largest gender identity outpatient clinic. Discussions were transcribed verbatim, coded, and analyzed using qualitative content analysis. Participants consistently viewed the resolution as unjust, ideologically motivated, and detached from scientific evidence. Adolescents described puberty blockers and hormone therapy as life-saving, emphasizing their positive physical and psychological effects. They rejected detransition as a valid justification for restrictions, framing it as rare and often driven by external pressures. Caregivers echoed these concerns, describing the resolution as harmful, unscientific, and likely to exacerbate inequalities, mental health challenges, and unsafe self-medication practices. Both groups highlighted that gender-affirming care is preceded by long-term, multidisciplinary follow-up under robust clinical protocols, minimizing risks of regret or adverse outcomes. Findings show that restrictive policies are not perceived as neutral regulation but as an assault on the rights, health, and dignity of transgender youth. By amplifying the lived experiences of adolescents and caregivers, this study points out the urgent need for evidence-based, inclusive, and participatory health policies that do not exclude trans voices.