Protector Factors for Use of Non-Prescribed Hormones among Transwomen in São Paulo, Brazil, 2020

Abstract Despite the Brazilian universal and free of charge public health system, transwomen (TGW) still face barriers to their right to access healthcare, especially transition-related. One of the most common gender- affirmative need is the use of hormones, which is available for free in the health national system. In spite of that, the use of non-prescribed hormones is a reality - rising the risk of complications. The aim of this analysis is to describe the frequency of non-prescribed hormones and assess risk factors among TGW. TransOdara is a cross-sectional study, conducted in São Paulo, Brazil, from December 2019-October 2020, which included TGW>18 years. Participants were recruited from an ongoing cohort study, originally assembled using RDS. A questionnaire collected socio-demographic and behavioral information. Predictor variables for non-prescribed hormone use were assessed using multivariable logistic regression. Brazilian MOH and PAHO supported the study. 403 TGW participants were recruited. The mean age was 34.4 years (SD 9.6). The majority (70%) declared themselves black/parda, while 103 (27%) participants self-reported white and 12 (3.0%) yellow/Indigenous. Most (95%) reported ever having taken hormones, from which 48.8% (197/384) reported presently taking hormones. Among those, 53% (104/196) reported non-prescribed hormone use. Among participants that ever took hormones, mean age for starting was 18.6 years (SD 6.7). In our multivariate model, higher education - high school (p < 0.05) and incomplete college or higher (p < 0.005) - and older age (p < 0.005) were protective factors for non-prescribed hormone use, adjusted by income and ethnicity. Non-prescribed hormones use is high among TGW, even though free access in Brazil's health system. High formal education and being older are protection factors for using hormones out of professional supervision. There is an urgency to review the current policy strategies, aiming to reduce this health risk behavior. Key messages Use of hormones among TGW is high. Majority reported hormonization out of professional supervision in lifetime. High formal education and being older are protective factors for non-prescribed use.