Transgender Healthcare Portugal
Overview of General Healthcare1
General healthcare in Portugal operates between three (3) coexisting systems:
- The Serviço Nacional de Saúde (SNS): the state funded public system;
- A series of social health subsystem insurance schemes exists for certain professions;
- There is private health insurance.
Universal coverage is provided by SNS for the population at large which is technically free at the point of use, although new measures in the form of user fees were introduced both to ensure sustainability and to discourage frivolous use of the system.
One quarter of Portugal’s population are part of social health subsystems, while private insurance schemes and mutual funds cover 17% of the population.
Development of SNS policy and management is undertaken by the Ministry of Health (Ministério da Saúde). Portugal employs a public independent organisation, the Health Regulatory Entity (Entidade Reguladora de Saúde – ERS), to regulate all the healthcare providers, whether public, private or social.
Created in 1979, the SNS is how the State of Portugal assures the right, established under the Portuguese Constitution, to health protection. The SNS is national, universal and nominally free. National because it covers all of mainland Portugal. Universal because all citizens and residents of Portugal have access. Free because it is publicly funded – although, as mentioned, some fees are charged, though as a moderator of unnecessary access (such as a patient with a minor injury should go to their primary local care unit for treatment rather than a hospital’s emergency room).
The primary health care of local communities is provided by groupings of health centres (agrupamentos de centros de saúde -ACES). SNS requires that each municipality will have at least one health centre.
Secondary health care is covered mainly by hospitals grouped into a hospital centre based on a city or region. These re independent and are classified into various definitions:
- Group One is general hospitals
- Group Two is district hospitals
- Group Three is central hospitals
- Group Four covers specialised (i.e. oncologic or psychiatric) facilities
Local health units (unidades locais de saúde – ULS) group together a region’s or city’s hospitals and health centres into a single administrative unit.
Portugal’s autonomous regions of the Azores and Madeira have their own regional health services (serviços regionais de saúde – SRS) administrated by their respective regional government.
The health subsystems, operated in parallel to the state system provides either public or private health care to certain professions or organisations and subscription is mandatory for these groups.
Transgender Rights in Portugal2
The President of Portugal ratified The Law of Gender Identity (Lei da Identidade de Gênero) in March 2011. This ratification allowed transgender people of at least 18 years of age and having undergone gender reassignment surgery to change their legal gender on their birth certificates. The procedure for changing the gender marker takes only 8 days.
Since then, further ordinances have made the lawbooks in Portugal:
- 2013: gender identity was recognised as a basis for a hate crime.
- 2015: gender identity was added as a grounds for discrimination in employment rights and was also added to several other non-discrimination clauses of the Portuguese Labour Code.
A Parliamentary Bill in 2016 proposed to allow changing of legal gender based on self-determination including the availability of gender reassignment surgery as an amendment to the SNS.
According to the website www.equaldex.com, Portugal has not yet banned conversion therapy.3
On 14 April 2018, the Portugal parliament approved, by 109 votes in the 230-seat assembly, a law allowing citizens over the age of 16 to legally to change their name and gender in official documents without the requirement of a medical report, effectively allowing self-determination. However, people aged 16-18 need parental consent to do this.
Katrin Hugendubel, a representative of the LGBT rights advocacy group ILGA-Europe said: “People will be able to change their legal gender through a procedure based on self-determination. This means that the law finally recognises and respects that trans people know best who they are and how they identify.”
All that remains is for President Marcelo Rebelo to sign the act into law.
A 2012 study—Experiences of Health Care by Transsexual People in Portugal: The perspectives of health professionals and health care users (As experiências dos cuidados de saúde de pessoas transexuais em Portugal: Perspetivas de profisionais de saúde e utentes) by Nuno Pinto and Carla Moleiro—noted that the embryonic stage at which studies on gender identity existed meant available information on the follow-up on treatment of patients by clinicians was, at the time, only just beginning to see light. Moreover, the lack of good practice recommendations was obvious. Clinical details on the prevalence of transgender people in Portugal was based only on informal reports from health professionals and data from respective services. These reports, curiously, indicated greater use of the services by transgender men than transgender women, against the trend found in other countries.
The study aimed to promote research on the clinical care available to transgender people proposing two objectives to achieve this. One was to review literature and international guidelines, while the other was to explore the experiences within the Portuguese health system of medical professionals and of transgender end users of the health services.
As in many countries, people with gender identity issues would take their first step in any desired treatment under the public healthcare system towards their family doctor. Thereafter, at the time of the study there remained issues with gatekeeping psychologists and medical professionals without the information at hand better to offer appropriate treatment to transgender patients and to overcome clinical transphobia.
This website lists many endocrinologists from across Portugal. None, however, list treatment of transgender patients among their specialities where shown.
The website for this hospital has a list of endocrinologists based there. Of the one where their specialisations is shown, treatment for transgender patients is not included.
Dr Ferreira does not list hormone replacement therapy (HRT) for transgender patients as one of his specialties.
The group of professionals listed on this medical centre’s endocrinology page do not list HRT for transgender patients as one of their principal areas of interest.
This webpage representing a group of private hospitals on the Algarve does not specifically list HRT for transgender patients among its most common endocrinologistic treatments.
This website lists endocrinologists in the North of Portugal. No information on specialities or areas of interest is given.
This clinic has an endocrinologist of whom no data about specialities are given.
This hospital has a small team of endocrinologists.
The IdealMed clinic specialises in endocrinology with its small team of Dr Luísa Barros and Dr. Carolina Moreno.
Dr. Barros has specialised in endocrinology since 1997 and has been with IdealMed since 2012. HRT specific for transgender patients is not listed amongst her specialities.
Dr. Moreno has been a specialist in encocrinology and nutrition at the Central Hospital and University of Coimbra. She joined IdealMed in 2016. Dr. Moreno does not list any specialities.
Portugal appears to lack any private medical facility where gender reassignment surgery takes place. However, under the public SNS system, the (URGUS) Reconstructive Unit of the Hospital and University Centre in Coimbra as well as Porto’s Hospital de São João as of 2016 have performed these procedures.
The route of transition whether including GRS or not in Portugal, as in Spain, therefore, seems most commonly to pass through the nation’s public health system.
More international Transgender Healthcare Links and Information: