Open letter to Brazilian media outlets and sector professionals, associations, unions, and freelance journalists

On April 12, 2024, Folha de S. Paulo, one of the most accessed newspapers in Brazil, published a note about the Cass Review by Dr. Hillary Cass with the support of researchers from York University at the request of the National Health Service (NHS). The document results from four years of systematic reviews of clinical evidence and analysis of global medical guidelines on “gender-affirming care” for children and adolescents.

Among the main conclusions are: lack of evidence on the benefits of medical treatment in children and adolescents, lack of knowledge about the risks, particularly concerning long-term consequences, and the use of circular references that helped to create an appearance of consensus about the existence of benefits from subjecting people to puberty blockers, cross-sex hormones, and surgeries.

“The guideline appraisal raises serious questions about the reliability of current guidelines. Most guidelines have not followed the international standards for [rigorous and independent] guideline development. Few guidelines are informed by a systematic review of empirical evidence [the gold standard for assessing the evidence supporting a health intervention] and there is a lack of transparency about how recommendations were developed,” the Cass review says.

The conclusions add to a series of evidence responsible for demonstrating that “gender-affirming care” is a type of Frankenstein medicine, that is, experimental, with essential and permanent side effects. In turn, England joins the European countries that have abandoned the widespread practice of medical transition for under-18s, following in the footsteps of Finland, Denmark, Norway and Sweden.

Given the Brazilian context, where the Brazilian Psychological Society prohibits any approach other than “affirmative care”, authorizing children from the age of nine to carry out “transsexualizing” medical procedures – which follow such experimental guidelines –, a good work of journalism after the Cass review is urgent. It requires media outlets to look into their publications, reviews, and erroneous conclusions previously issued to the public, to enable responsible coverage of the topic.

However, Folha de S. Paulo seems to have written the note so it could “go unnoticed”, in addition to adding dozens of links that direct to other articles from the outlet itself that endorse the benefits of “gender-affirming care”, in which sources are activists, political figures or proven biased scientific publications. The note also does not mention that a very vocal portion of the LGBTQ+ movement in Brazil, through funded civil society organizations, wants to prohibit public debate on the topic. This movement takes place when, after years of silence, scientific evidence that contradicts the hegemonic narrative about the supposedly positive and harmless character of “gender-affirming care” begins to become public. The practice of censorship adopted by Brazilian organizations and the LGBTQ+ movement with ample media space also reflects standard behavior in this sector around the world.

The superficiality of the note is not surprising after years of a biased editorial stance in favor of “gender-affirming care”, adopted despite the lack of scientific evidence – a stance shared by the overwhelming majority of the Brazilian press, from large oligopolies to independent agencies, reaching all the political-ideological spectrum of the national media. In addition to scientific evidence that diverges from ideology, several international news relevant to the national debate have been omitted from society, including the cases of whistleblowers at gender clinics, dating back to 2004; the legal cases of people who “detransition”, their stories as victims of medical misconduct, and Destrans Awareness Day.

The press is also refraining from reporting the scandals involving the World Professional Association for Transgender Health (WPATH), a critical formulator of global guidelines to assist people seeking “gender-affirming care”, including the WPATH Files, leaked communications from health professionals from WPATH where they demonstrate concern about “gender-affirming care” being linked to a series of physical and mental complications, high rates of regret and even death, including in adults, precisely the opposite of what is publicly defended by the association.

WPATH FIles comes after reports revealed a worrying history of defense and public adoption of paraphilias practices by individuals involved with the organization, and WPATH itself recognized “eunuch” (a castrated male subject) as a type of gender identity. Notably, the WPATH guidelines are used by several health professionals worldwide, as demonstrated by the Cass review.

For self-declared independent, investigative, and/or left-wing outlets, this editorial decision is symptomatic of the lack of critical autonomy, susceptibility, and subjection to the hegemonic media narrative and the demands of interest groups, in addition to the lack of systemic vision on the economic agenda behind the rainbow. According to consulting and business intelligence agencies, the market for aesthetic plastic surgeries and genital reassignment carried out intending to simulate the appearance of the opposite sex will drive the growth of a market valued in 2019 at US$ 267 million, with estimates to surpass US$1.5 billion by 2026. In “transgender medicine”, the demand for hormonal therapies was estimated at US$21.8 billion in 2019 and is expected to grow at almost 8% per year. All these figures represent only the American market.

This stance of media bias, not only silent but also responsible for characterizing any criticism of “gender-affirming care” as arising from prejudice or far-right agendas, contributed to building the current context of extreme misinformation and hostility on the topic. By characterizing critics of “gender-affirming care” as “anti-trans reactionaries”, unnecessarily polarizing the debate and making it a question of “left versus right”, and “prejudiced versus good people”, editors and journalists also collaborated to deepen the severe scenario of political and electoral polarization among Brazilians.

As a result, society’s crisis of trust in traditional media outlets, known as the engine for the advancement of the far right, is worsening, putting the health of democratic public debate and, more importantly, the lives of children, adolescents, families, and the rights of girls, women, and homosexual people at risk. The level of toxicity of the debate, a result of this editorial choice, has contributed to the censorship of concerned citizens and to the self-censorship of the victims of this agenda, gagged by the fear of media exposure.