Introduction Globally, few trans women have access to transition-related care (TRC). Lack of TRC can lead to HIV risk as trans women may use sex to meet their needs for gender affirmation. Transwomen may also use non-prescribed hormones (NPH). Little is known about NPH use among transwomen in Brazil. We assessed the prevalence of NPH use and associated factors among transwomen (self-identified as trans, transsexuals and travestis) in 7 municipalities of São Paulo state in Brazil.
Methods Muriel Project was a cross-sectional consecutive snowball sampling study of 673 trans people, with face-to-face interviews carried out from November 2014 to October 2015. This analysis focuses on transwomen (n=616). Socio-demographics, stigma, health care access, transition procedures and self-reported HIV infection were assessed. Descriptive statistics and Poisson regression were performed to determine what factors were associated with use of NPH.
Results Nearly all transwomen (90.7%, n=559) reported ever taking hormones. The mean age for starting hormones was 17. Most (79.2%; n=444) participants reported using NPH, which was positively associated with sex work (p<0.005) and filler use (p<0.005). Chosen name use in public health services (p<0.05), gender confirmation surgery (p<0.05) and higher income (p<0.05) were all protective factors for NPH use.
Conclusion Transwomen in Brazil likely have significant barriers to TRC, as evidenced by the high rate of NPH use in our sample, which may be underestimated given our sample was recruited from health care services. Stigma and few trans-specific health services may explain high use of NPH. Transwomen may have also used NPH and fillers to reach their transition goals faster. Transwomen engaged in sex work may rely on a feminised appearance for income, requiring the use of NPH in the absence of access to TRC. Ensuring social rights, such as requiring health providers and others use trans women’s chosen name, and providing adequate TRC services may reduce barriers to care, resulting in better health outcomes and less HIV risk for transwomen.