Around the World in Gender Medicine, Part 2

Change and Controversy

Source: www.equaldex.com

In October 2025, I reviewed the state of pediatric gender medicine in various parts of the world. Since then, I have learned of significant developments in countries I did not cover as well as some new developments.

Change and Controversy in New Zealand

New Zealand had been competing with Canada for the dubious distinction of being the last country in the Anglosphere to reform pediatric gender medicine. However, the new government has changed course. In November 2024, the Ministry of Health released an evidence brief and position statement which called for more caution in the use of puberty blockers. In 2025, the government introduced regulations that banned new prescriptions of puberty blockers pending the outcome of the proposed clinical trial in the United Kingdom. The Professional Association for Transgender Health Aotearao Incorporated (the New Zealand WPATH affiliate) has brought an application for judicial review and obtained an interim injunction halting the implementation of the regulations pending a full hearing.

Brazil

Brazil has led the world in the expansion of transgender rights. In 2020, the Federal Council of Medicine dropped the age for cross-sex hormone therapy from 18 to 16 and the minimum age for surgery from 21 to 18. (These are the same age limits that currently apply in the United Kingdom and Alberta, Canada.) However, in April 2025 the Federal Council of Medicine adopted a resolution which bans the use of puberty blockers, raises the minimum age for cross-sex hormones from 16 to 18 and the minimum age for surgeries which have a potential sterilizing effect from 18 to 21. The resolution was widely opposed and a lawsuit has been started to challenge it. Opponents of the resolution obtained an injunction preventing the resolution from going into effect pending the hearing of the lawsuit, but this order was set aside on appeal and the resolution will remain in effect unless the court overturns it after a full hearing.

Argentina

Argentina was also once seen as a world leader in transgender rights. In 2012, it became one of the first countries in the world to allow people to change their sex markers on official records without the need for a medical diagnosis or surgery. It also expanded the availability of pediatric gender medicine.

However, this is changing rapidly. Argentinian President Javier Milei is an admirer of U.S. President Donald Trump and he seems to be following a similar path on gender issues. In February 2025, Milei issued a presidential decree banning gender-affirming surgery and hormone therapy for people under the age of 18. The decree has met with strong opposition. It has been successfully challenged in court and some provincial governments have said they will continue to provide treatment.

Chile

Medical transition of minors has been widely available in Chile for over a decade. It received a boost in 2023 when the government of President Gabriel Boric introduced the Grow With Pride program. However, Bernard Lane reports that the Cass Review received extensive coverage in the Chilean media and this prompted a national debate. The UC Christus Health Network has stopped prescribing puberty blockers and hormones to new patients. In 2024, the Chilean legislature voted to block the use of public funds for youth gender medicine. In May 2025, the Chamber of Deputies approved a report from a special investigative commission which called for the immediate suspension of the gender identity support program and restrictions on medical transition for minors. Many of these initiatives were opposed by President Boric,however, the November 2025 presidential election was José Antonio Kast, a right-wing candidate with a history of opposition to transgender and LGBQ causes.

Peru

The gender debate in Peru has received little international attention, but it may have unexpected significance. Pope Leo XIV spent two decades in Peru and became a Peruvian citizen. It is reasonable to assume that his thinking on gender issues has been influenced by developments in Peru. Peru has a reputation as a trans-friendly country. Transgender influencer Dylan Mulvaney traveled there to “feel safe” after the backlash from a disastrous advertising campaign where the use of Mulvaney’s image cost Bud Light a third of its market share.

The actual state of LGBT rights in Peru is more complex. Consensual same-sex relations have been legal in Peru since 1924, but same sex marriage is not yet recognized. Both the Catholic and evangelical churches are socially conservative on gender issues. Changing legal gender is possible but requires a lengthy and costly judicial process.

Medical transition is funded by the national health insurance, but in 2024 there were protests against new regulations that classified transgender identity as a mental illness for insurance purposes. The ministry of health responded by confirming that it does not regard gender and sexual diversity as illnesses. In September 2025, a member of Congress introduced a bill to ban medical transition of minors.

Venezuela

While the Chavez regime was widely admired by Western progressives, its policies on gender and LGBT issues are quite conservative. According to The Advocate, Venezuela does not permit same-sex marriage or legal changes of gender markers. Medical transition is not banned, but access to treatment is limited by lack of resources in the healthcare system.

Medical Tourism in Mexico

Mexico is another country that has been generally supportive of transgender rights. It has become a major centre for medical tourism. Private clinics offer a full range of gender affirming surgeries with lower costs, shorter waiting times and fewer assessment requirements than hospitals in the United States. However, for ordinary Mexicans, access to treatment is limited by the lack of public gender clinics, except in the major cites.

There are no legal age limits on treatment, but treatment of patients under 18 depends on state and local practices. In general, surgery is not available until age 18. Hormonal treatment may be provided to minors 16 and older with parental consent and a medical assessment.

Poland

Poland has generally been conservative in its approach to LGBT rights, but there are signs of change. Legal changes to gender markers require a court proceeding in which the applicant’s parents need to be parties. In 2025, the Polish Supreme Court eliminated the requirement to include parents in the proceedings. There is still an open question of whether a spouse needs to be included.

Medical transition of minors is legal in Poland but rare. Gender affirming care is not covered under Polish health insurance and the whole health care system suffers from waiting lists and an inconsistent reimbursement system. In 2025, an expert group issued treatment guidelines for adolescents with gender dysphoria which criticized the Cass Review and adopted the recommendations of WPATH SOC8 and the Endocrine Society guidelines.

Iceland

While other Nordic countries are moving to a more cautious approach, Iceland remains fully committed to medical gender transition. Iceland follows an “informed consent” model based which allows access to hormonal therapy and mastectomies without any mental health assessment. A psychological evaluation is required before genital surgery. Surgery is available after the age of 18. Mastectomies are publicly funded and performed in Reyjavik. Genital surgery is also publicly funded and performed in a private clinic in the Netherlands.

Puberty blockers are available from the onset of puberty (Tanner Stage 2) and cross-sex hormones are available from the age of 16. Children under age 16 require parental consent for medical treatment. Everyone has the right to change their gender registration after the age of 15. Children under 15 may change their gender registration with the approval of their parents or guardians. If the parents or guardians refuse, the child may submit a request to an “expert committee.”

Activist influence on the debate is strong. A gay rights activist who has been raising concerns about medical transition of minors is facing criminal prosecution.

Japan

Like other countries in Asia, Japan has taken a restrictive approach to gender transition. Japan does not have anti-discrimination legislation and transgender people may experience discrimination at work and in obtaining shelter and healthcare.

The requirements for changing gender markers are stringent. Until 2023, the law required sterilization as a condition for legal gender change but the Supreme Court ruled that this requirement was unconstitutional. A lower court recently ruled that a requirement to alter the appearance of genitals was also unconstitutional. The minimum age for a change of gender markers was recently lowered from 20 to 18.

There are no legal restrictions on medical transition of minors and the treatment guidelines of the Japanese Society of Psychiatry and Neurology allow for hormonal therapy for patients aged 15 and over with parental consent.

India

Transgender rights in India are complicated because of religious and cultural history. Hinduism recognizes a community of male transvestites known as hijra who are often invited to perform dances and songs at births, marriages and other celebrations. Some, but not all hijra are eunuchs. Hijra often experience discrimination Many of them support themselves as sex workers and pay much of their income to a guru. There is no female to male equivalent to the hijra and transmen in India struggle for recognition of their existence.

The Transgender Persons (Protection of Rights) Act, 2019 creates a two stage process for recognition of gender identity. The act defines a transgender person as a “person whose gender does not match with the gender assigned to that person at birth.” It includes people with “intersex” conditions. Surgery or hormonal treatment is not required for recognition as a transgender person. A person may apply to a District Magistrate for a certificate of recognition as a transgender person. Transgender persons are viewed as a third sex category which is neither male nor female. In 2014 India’s Supreme Court ruled that transgender people were entitled to separate toilet facilities but implementation of the decision as been inconsistent.

Medical transition for adults is legal in India. Gender reassignment surgery is available in many private hospitals and India has become a medical tourism destination. However, surgery is out of reach for most transgender people in India. In 2022 the federal government announced that gender surgeries would be covered under a national insurance plan, but implementation has been slow.

The Adolescent Health Academy has issued a Statement on the Care of Transgender Children, Adolescents and Youth that endorses a very cautious version of gender affirming care. Social transition and puberty blockers are permitted with parental consent, but cross-sex hormones and surgery are only available after the age of majority (18 years).

South Africa

While other countries in Africa are highly intolerant to LGBT people (some punish same sex relations with death), South Africa has been more liberal. The constitution prohibits discrimination based on sexual orientation and gender identity and same sex marriage has been legal since 2006. Medical gender transition is legal and available in major cities, but resources are limited. The Professional Association for Transgender Health South Africa is the local WPATH affiliate. The Southern Africa HIV Clinicians Society (SAHCS) has issued guidelines for gender-affirming healthcare which support the affirmative model. Opposition has come from First Do No Harm South Africa which has argued that the SACHS guidelines are not evidence-based and were rated poorly by the Cass Review.

Conclusions

The differing approaches of various countries to gender medicine are the result of multiple factors. Culture clearly plays a significant role. While it is debatable whether gender dysphoria is purely a culture bound syndrome, there is no doubt that how a society understands gender roles will influence its approach to gender non-conformity.

Another is that pediatric gender medicine is largely a first-world concern. Countries that struggle to provide basic health services are not willing to invest substantial resources in elective plastic surgeries.

Throughout the world, policies on gender are subordinate to other political issues. Change in government is driven by concerns over issues like the economy, corruption and crime. Policies on gender will shift depending on the leanings of the incoming government. However, there could be some outliers. It would be ironic if the changes in government in Venezuela triggered by American military action led to an expansion of transgender rights. The Islamic regime in Iran also appears on the verge of collapse. It will be interesting to see if this results in changes to current policies which give gay men the choice between death and a state-funded vaginoplasty.