Transsexual women and men have a gender identity different from the biological sex determined at birth, understanding that this identity is built from social and cultural experiences and interactions1. Transvestites, on the other hand, a term more widespread in Brazil and other countries in Latin America, are recognized as a female figure who seeks to build a unique image, not undoing some male characteristics and experiencing a constant flow between these two genders2.
In the global context, transgender people, a term used to refer to transsexual women and men, as well as transvestites, represent a small portion of the general population3. However, the discrimination and social exclusion imposed on these people puts them in worse health and living conditions4.
Transgender people are the biggest consumers of alcohol, tobacco and illicit drugs and have high rates of psychological distress, including suicidal ideation and attempt; unique health problems, caused mainly by bodily changes arising from attempts to align the phenotype with gender identity; lower life expectancy and greater difficulties in accessing health services4,5.
In Brazil, despite the reality of other countries, transgender people are at greater vulnerability, being, among the LGBTI population, the main victims of violence, especially of bodily injuries and homicides by firearms6,7. In view of this reality, health care should not be configured only in assisting the health needs and demands of this population, but also in broad and concrete actions to welcome transgender people and assist them in facing transphobia.
The Brazilian health system, created in 1990 and called SUS, is mainly composed of free public health services, with the complementation of some private health services financed by the State8. In addition, this health system is constituted by doctrinal principles (universality, equity and integrality) in which the health care model, expressed in policies, programs, organization of services and provision of care, must focus, primarily, on the recognition of the social determinants of the health-disease process and health inequities9.
Especially based on the principle of equity, health care practices must be carried out in a more fruitful way to serve the most vulnerable people, including transgender people. National health policies directed at the transgender population have been implemented in SUS over the years, such as the National Comprehensive Health Policy LGBTI, created in 2011, and the Transexualizador Process program in SUS, created in 2008 and expanded in 201310.
In Brazilian literature, there is an increase in scientific articles publication approaching LGBTI population health after the creation of the National Comprehensive Health Policy LGBTI11, as well as theses and dissertations on transvestite, transsexuality and health after the expansion of the Transexualizador Process in SUS12. From this perspective, it is possible to identify some integrative reviews on transgender people health in Brazil, specifically on the difficulties that this population faces in order to access health services13,14.
However, there are no systematic reviews that present summarized evidence on the other aspects related to health care for transgender population in Brazil. Considering that Brazil is a country of continental dimension with several and profound inequalities, especially with regard to the realization of the universal right to health, it is questioned: how has health care for the transgender population occurred within the scope of SUS? As a result, the objective of this study is to establish a systematic review protocol to analyze how health care for the transgender population in SUS occurs.