Igor Longobardi

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.

Introdução: A atividade física (AF) de deslocamento em meio urbano pode apresentar benefícios para a saúde, sustentabilidade e no direito à cidade, porém, ainda carecem de estudos que investiguem as iniquidades associadas. Considerando as desigualdades entre as macrorregiões brasileiras, faz-se necessário compreender como fatores sociodemográficos influenciam a prática de AF de deslocamento ao longo do tempo. Objetivos: Avaliar a tendência temporal da AF de deslocamento nas macrorregiões do Brasil e sua potencial associação com as variáveis sexo, faixa etária, escolaridade e raça/cor. Métodos: Foram utilizados dados do inquérito telefônico Vigitel, compreendendo 623.193 adultos (≥18 anos) residentes das capitais brasileiras e do Distrito Federal, entre 2009 e 2023. Foram classificados como ativos os indivíduos que atingiram ≥ 150 minutos/semana de AF de deslocamento. Para avaliar as variáveis de interesse, foram aplicados modelos de regressão logística com formas funcionais não-lineares, com nós posicionados nos anos de 2015, 2020 e 2021. Resultados: A proporção de indivíduos ativos no deslocamento diminuiu de 17,9% (IC 95%: 17,2; 18,7) em 2009 para 12,5% (IC 95%: 11,5; 13,6) em 2023. Todas as macrorregiões apresentaram tendência de redução, com a menor prevalência no Centro-Oeste e a maior no Sudeste. Mulheres, pessoas idosas, brancas e com idade maior (12 ou mais anos) e menor (0-4 anos) escolaridade apresentaram menores níveis de AF de deslocamento durante toda a série. Conclusão: Diante da tendência de declínio de AF de deslocamento, a qual está diferentemente relacionada a fatores sociodemográficos, reforça-se a necessidade de políticas que ampliem o seu acesso como escolha, considerando os seus determinantes de forma mais abrangente.

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.

Although creatine supplementation is well established for enhancing athletic performance, data on its long-term safety are still limited, particularly among female athletes. This study investigated the effects of in-season creatine supplementation on biochemical safety markers in young female football players. This real-world, longitudinal single-arm study assessed the safety of creatine supplementation during a competitive season in 71 female athletes from youth and professional football teams. Participants received 20 g/day of creatine monohydrate for 7 days, followed by 5 g/day for the remainder of the season. Dietary intake and a comprehensive panel of hematological, renal, and hepatic biomarkers were evaluated at baseline, mid- (week 16), and end-season (week 32). Linear mixed-model with repeated measures analysis revealed that 8 out of 18 biochemical markers showed statistically significant though clinically minor fluctuations throughout the season. All analytes, except creatine phosphokinase (CPK), remained within reference ranges. No adverse effects were observed on renal (e.g. glomerular filtration rate, creatinine, urea, albuminuria) or hepatic (ALT, AST) function. CPK levels variation likely reflected training load rather than supplementation effects. In this single-arm in-season cohort, long term creatine supplementation was not associated with clinically meaningful derangements in biochemical safety markers in female football players. These findings support the long-term safety profile of creatine in this population and encourage further research into its sex-specific effects in athletic settings.

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.