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SUICIDE AND THE TRANSEXUAL AND TRANSVESTITE POPULATION:
WHAT MAKES THESE PEOPLE NOT WANT TO LIVE ANYMORE?
Gabriel Miranda1
Rafael dos Anjos2
Ricardo Silva3
Shirlei Lizak Zolfan4
Abstract: Suicide is a complex phenomenon affecting over 800,000 people annually, according to
WHO data (2019). The transgender and travesti community, despite advancements in the struggle for
rights and recognition, continues to suffer intensely from stigma and discrimination, as pointed out by
ABGLT (2014). Authors such as Brosin and Tokarski (2017) highlight that the persistence of prejudice
is deeply rooted in the normalization of heterosexuality, which exerts constant pressure on individu-
als who diverge from this standard. For the transgender and travesti population, the process of name
and gender rectication can be particularly challenging, as noted by Ribeiro (2001). This moment is
often marked by stress, violence, and the possibility of rejection—factors that can lead to serious psy-
chological problems, including suicide. However, there is a signicant gap in the academic literature
regarding the interrelation between suicide and the transgender and travesti population, especially
in the context of São Paulo. Given this absence of in-depth studies, there is a need to investigate the
psychosocial factors that directly impact the mental health of this population, understand the reasons
that lead them to consider suicide, and highlight the fundamental role of psychologists and public
health systems in this context.
1 Degree in Psychology from FAM University Center
2 Degree in Psychology from FAM University Center
3 Degree in Psychology from FAM University Center
4 Psychology professor at FAM University Center
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Keywords: suicide, transgender, travesti, psychology, public policies, mental health, WHO.
INTRODUCTION
Despite advances (ABGLT, 2014), the transsexual and transvestite population face stigma
and discrimination related to gender expression, violence, criminalization, etc., according to the
WHO (2019) more than 800 thousand people commit suicide annually. Prejudice persists due to
heteronormative standardization (Brosin and Tokarski, 2017).
Vergueiro (2015) addresses the hegemony of heterosexuality as a power base in society, while
Plummer (2020) and Oliveira and Carneiro (2019) discuss the discrimination and exclusion faced by
transgender people and transvestites. Suicide is complex and multifaceted, inuenced by individual
and social factors throughout history (Porto; Delziovo; Queiroz, 2019). Pereira (2013) reports a study
carried out at Columbia University, in the United States of America, according to which homosexual
adolescents aged between 13 and 17 years are ve times more likely to attempt suicide compared
to heterosexual young people in this age group. Transphobia is identied as a contemporary social
problem that requires intervention. Taking all these data into account, we understand that there are no
large in-depth studies that relate the issue of suicide with the transsexual and transvestite population,
highlighting the vulnerability of this population, and with this we understand the need to delve into
this theme from the perspective of these people in the state of São Paulo.
DISCUSSION AND RESULTS
TRANSSEXUALITY: DEFINITION AND CHALLENGES
Gender identity, dened as the internal and individual experience of being a man, woman,
or other, plays a central role in building the mental health of individuals. When this identity is not
aligned with biological sex, a scenario of disconnection arises that can generate profound psychological
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impacts, especially in societies where gender diversity still faces resistance and discrimination. For
the transsexual population, this incongruence between biological sex and gender identity is the central
point of their existence, and the search for recognition, acceptance and body adequacy is an essential
part of the process of gender afrmation.
Transsexuality is characterized by the incongruence between the biological sex and the gender
identity of the individual, where transsexual people often seek to adapt their physical characteristics
through medical interventions, such as the use of hormones and sex reassignment surgeries, in addition
to legal changes of name and gender. These interventions aim to align their gender identity with their
body expression, ensuring that they live a life that is more consistent with their sense of identity
(GOMES et al., 2018; MONTENEGRO; REZENDE, 2018). The recognition and treatment of this
population involves respect for their gender identity and requires specialized multidisciplinary care
that takes into account both physical and mental health, as established by Resolution No. 2,265/2019
of the Federal Council of Medicine (CONSELHO FEDERAL DE MEDICINA, 2019).
The term “transsexual” was coined by endocrinologist Harry Benjamin in 1953 to describe
people who, despite not having genital anomalies, wished to modify their biological sex to align
their appearance with their gender identity (Azeem et al., 2019; Yarns et al., 2016). Over the years,
society has shown progress in understanding transsexuality, but transgender people continue to face
signicant barriers when it comes to accessing basic rights, such as the use of a social name, the
alteration of legal documents, and access to health services, education, and formal employment.
This exclusion is intensied by violence and transphobia — the aversion or discrimination
against transgender people. In Brazil, the transsexual and transvestite population is often the victim of
physical and verbal aggression, death threats and social exclusion. These structural forms of violence
limit the right of these people to enjoy their identity and, in many cases, push them to the margins,
such as prostitution, creating an environment of extreme social and psychological vulnerability
(JESUS, 2013).
Living with the imminent risk of suffering violence for simply being who you are directly
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contributes to the increase in suicide rates among transsexuals. People in this community often seek
mental health services due to problems such as dissatisfaction with their genitalia, the need to be
treated according to the gender with which they identify, as well as facing dissatisfaction with their
biological sex and non-acceptance by their family (SOUZA, 2015). The consequences of this rejection
and marginalization include depression, suicidal behaviors, eating disorders, self-mutilation, and a
host of other psychological problems (MARCIA; ZAIDHAFT; MURTA, 2008).
Transsexuality, therefore, involves not only the bodily dimension, but also psychological and
social dimension. Lack of acceptance, prejudice and violence are factors that intensify the vulnerability
of these people, highlighting the urgency of promoting public policies and multidisciplinary care that
guarantee the physical and mental health of the transsexual and transvestite population.
TRANSSEXUALITY: HISTORICAL CONTEXT
The history of transsexuality is marked by a long process of invisibility, stigmatization and
struggle for recognition. The term “transsexuality” emerged in the twentieth century to describe
people who do not identify with the gender they were assigned at birth and seek to reafrm their
gender identity with their physical expression. However, there is historical evidence of individuals
who have transcended gender norms in diverse cultures. During the twentieth century, transsexuality
was treated as a psychiatric disorder, and it was only in 2018 that the World Health Organization
(WHO) removed it from the category of “mental disorders” and recognized it as a condition related to
sexual health, reecting advances in the struggles of transsexual movements. These struggles gained
momentum in the 1960s and 1970s, with the active participation of transvestites and transsexuals,
especially gures such as Marsha P. Johnson and Sylvia Rivera. The 1990s brought advances in the
legal recognition of transsexuality, with some countries allowing name and gender changes in ofcial
documents.
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TRANSSEXUALITY IN BRAZIL
In Brazil, the trajectory of the trans population is marked by marginalization and stigmatization,
often associated with the historical link between transvestites and prostitution, a consequence of
exclusion from the formal labor market. In the 1970s and 1980s, transvestites were targets of police
repression and violence. It was only in the 2000s that public policies began to emerge, such as the
creation of the Comprehensive Health Outpatient Clinic for Transvestites and Transsexuals, which
guaranteed access to hormones and surgeries through the SUS. The struggle of transgender people
in Brazil extends on several fronts, from the ght against violence and discrimination to the search
for inclusion and access to fundamental rights. Despite the advances, the recognition of transsexual
identities continues to be a process surrounded by challenges, with high rates of violence and social
exclusion, reinforcing the need for urgent public policies.
HEALTH MENTAL AND PSYCHOSOCIAL IMPACTS: RISKS AND INTERVENTIONS
The transsexual population faces negative mental health outcomes at rates much higher than
the general population, with emphasis on depression, suicidal ideation, substance use, and suicide
attempts. In Brazil, the life expectancy of trans people is only 35 years, with suicide being the second
leading cause of death among this population. Marginalization, discrimination and violence are factors
that intensify this reality. Studies show that visibility and the use of bathrooms according to gender are
protective factors for this population, and that the construction of support networks, including family,
friends, and health professionals, is essential for the promotion of mental health. However, the lack of
training of health professionals to deal with the specicities of the trans population still perpetuates
marginalization. Therefore, it is crucial that psychosocial interventions and therapies respect and value
gender identity, providing a safe and inclusive space for the transsexual and transvestite population.
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PUBLIC POLICIES
In Brazil, policies aimed at the trans population are still insufcient to guarantee protection
and equality. The Transexualizing Process of the Unied Health System (SUS), although an important
achievement, does not completely solve the problems of access to comprehensive health. According to
Teixeira et al. (2018), the omissions in the implementation of policies that address the specic needs of
this population, such as inclusive education, employability, and public safety, are evident. The lack of
professional training programs and the persistence of prejudice in the labor market make the insertion
of this population in the work environment extremely difcult.
In addition, Souza and Lima (2020) highlight that the absence of an intersectoral approach in
public policies leads to the marginalization and vulnerability of the trans population, increasing the
risks of suicide. The protection of human rights and the promotion of mental health should be priorities
on government agendas, because without these protections, many trans people remain vulnerable to
situations of violence and discrimination, factors that increase suicide ideation rates.
Finally, Barbosa and Koyama (2006) emphasize that public policies need to include
psychological and social support mechanisms that consider the uniqueness of the experiences of the
trans population, aiming at promoting mental health and well-being.
TRANSCIDADANIA PROGRAM – SÃO PAULO/SP
The Transcitizenship Program is an initiative of the government of the state of São Paulo,
created in 2015, with the objective of promoting citizenship and social inclusion of the trans population.
The program aims to offer support to transvestite and transsexual people in situations of social
vulnerability, especially those who face difculties in accessing education, health and work.
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LAW AND STRUCTURE OF THE PROGRAMME
The Transcitizenship Program was instituted by Law No. 16,933, sanctioned in 2018. This
legislation establishes the creation of actions aimed at the inclusion of the trans population, recognizing
the need for specic public policies that meet their demands.
MAIN OBJECTIVES:
• Offer professional training and inclusion in the labor market;
• Provide psychological support and social assistance;
• Ensure access to health services, respecting gender identity;
• Promote full citizenship and combat discrimination.
The creation of the Transcitizenship Program is a response to the high rates of vulnerability,
discrimination, and violence that the trans population faces, including exclusion from the labor market
and social marginalization. The need for a specic public policy arose from the recognition of the
difculties faced by transvestites and transsexuals in Brazil, a country that historically has high rates
of violence against this population.
The program has been an attempt to guarantee rights and dignity to trans people. Since
its implementation, Transcidadania has worked to improve living conditions and promote social
inclusion, with training programs and employment opportunities. In addition, it seeks to create a
support network, offering a safe and respectful space for the trans population.
CHALLENGES
Despite the advances, the Transcitizenship Program still faces challenges, such as the need
for adequate resources, the continuity of public policies, and cultural resistance to the acceptance of
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the trans population in society. The struggle for rights and recognition continues to be a crucial part
of the activism and human rights advocacy agenda in Brazil.
This information provides an overview of the Transcidadania Program and its impact on the
promotion of citizenship and inclusion of the trans population in São Paulo.
THE REALITY OF THE TRANSSEXUAL AND TRANSVESTITE POPULATION: CON-
TEXTS GLOBAL
The transsexual and transvestite population faces alarming challenges in several countries,
with high rates of discrimination, social exclusion, violence and suicide. In the United States, a survey
on discrimination against transgender people revealed that 63% of respondents faced mistreatment,
abandonment, job loss, denial of care in health services, and even physical and sexual violence
(Edwards et al., 2019). These factors have a direct impact on the mental health of this population.
The National Center for Transgender Equality (2015) found that 40% of transgender people in the
U.S. reported suicide attempts, a number signicantly higher than the national average, attributed to
discrimination and lack of social support.
Despite this worrying scenario, initiatives such as Trans Lifeline, which offers emotional
support and specic resources for the trans community, highlight the importance of dedicated support
networks. In addition, the implementation of inclusive public policies has shown positive impacts in
reducing suicide rates and improving the mental health of this population.
In Brazil, the reality is also alarming. According to the National Association of Transvestites
and Transsexuals (ANTRA), in 2020 there was a 49% increase in the number of murders of transgender
people compared to the previous year, in addition to records of attempted murders, suicides, and human
rights violations (Benevides & Nogueira, 2020). Discrimination, marginalization and the historical
association of transvestites with prostitution further aggravate the vulnerability of this population.
Studies show that suicide rates among trans people in Brazil surpass those of other
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marginalized groups. The lack of effective public policies, added to social exclusion, contributes
signicantly to this reality. However, programs such as the Comprehensive Health Outpatient Clinic
for Transvestites and Transsexuals, created by the Unied Health System (SUS), have played a crucial
role in promoting access to comprehensive health, representing an important advance in tackling this
issue.
In Europe, the situation varies between countries. In Sweden, for example, a study by
Transgender Europe (2016) showed that the inclusion of specic mental health policies for the trans
population resulted in a signicant reduction in suicidal ideation. Nordic countries, in particular, have
excelled in promoting safe environments and education about gender diversity in schools, effective
strategies to reduce stigma and promote inclusion.
These parallels between the USA, Brazil, and Europe show that, despite contextual
differences, the common denominator for reducing suicide rates and improving quality of life among
the transsexual and transvestite population is the implementation of inclusive public policies and
psychosocial support. Suicide prevention depends on a multidisciplinary approach and ongoing efforts
to create nurturing environments where all people, regardless of their gender identity, can live with
dignity and adequate mental health.
FINAL CONSIDERATIONS
Prevention and care for the transsexual and transvestite population require a multidisciplinary
and multiprofessional approach that unites several areas of knowledge. Professionals in psychology,
social work, education and public health must collaborate in an integrated way to meet the complex
needs of this population, which include not only health issues, but also social and psychological
aspects. The construction of a welcoming environment is fundamental; This can be achieved through
the creation of safe spaces in schools, clinics, and workplaces, where gender identity and sexual
orientation are not barriers to access to health rights and care.
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In addition, the formation of teams of gender-sensitive professionals is crucial. This implies
training health and education professionals to adequately deal with the specicities of the transsexual
and transvestite population, recognizing the impact of prejudice and discrimination on psychological
well-being. Souza and Silva (2020) highlight that an approach that includes the active participation of
the transsexual and transvestite population in the construction of policies and practices can be more
effective, ensuring that their voices are heard and their needs met.
Professional training and social inclusion programs are essential to strengthen the self-esteem
and mental well-being of the transsexual and transvestite population. The promotion of initiatives that
encourage insertion in the labor market, as well as the provision of adequate mental health services,
contributes to suicide prevention and improves the quality of life of these individuals. According to
the Federal Council of Psychology (CFP, 2019), the formation of support networks and the promotion
of awareness campaigns are strategies that can reduce stigma and promote a culture of respect and
acceptance.
Although some initiatives, such as the Transcitizenship Program, have been developed to
help the trans population, many challenges remain. The creation of decent employment opportunities,
inclusive education policies, and actions against discrimination in the workplace are essential to
reduce dependence on prostitution. The implementation of public policies that guarantee rights and
safety for the trans population is crucial to change the narrative that marginalizes them.
The variables involving suicide in the transsexual and transvestite population transcend
biological, sexual or surgical issues. Socio-emotional aspects, such as non-acceptance of one’s
own body, difculties in discovering sexual identity, family acceptance problems, self-mutilation,
social transphobia and low situational self-esteem, play signicant roles in the vulnerability of this
population. Rejection and ignorance of one’s own transsexuality also contribute to the high risk of
suicide among trans people and transvestites.
In this context, it is essential to promote new studies that demystify transsexuality and create
strategies to reduce the stigma and prejudice faced by this population, guaranteeing their human
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rights. The promotion of actions at individual and social levels aimed at reducing prejudice and stigma
is fundamental, as well as the implementation of afrmative care that respects and validates trans
identity.
It is important to highlight that the health of trans people should not be limited to procedures
related to gender afrmation, but should include a broad approach to mental health. Public policies
aimed at the trans population are essential not only to reduce prejudice, but also to offer mental
health support. Care for the process of gender afrmation is a crucial part, but not the only focus
on comprehensive care for the trans population (Ferrari, Deyse; Branco, Eduardo; Toledo, Luís
Guilherme; Molina, Ludgleydson Fernandes, 2021).
Thus, it is suggested that national and international research be carried out that focuses on
the creation of inclusive public policies, aiming to provide a better quality of life for trans people, in
addition to promoting a more just and equitable society for all.
REFERENCES
ALBUQUERQUE, Roberto Nascimento de; MÁXIMO, Matheus. Aspectos socioemocionais envol-
vidos na transexualidade: um estudo de caso. 2021. Disponível em: https://www.rbsh.org.br/revis-
ta_sbrash/article/view/638
ORGANIZAÇÃO MUNDIAL DA SAÚDE (OMS). Prevenção do suicídio: um manual para pros-
sionais da saúde em atenção primária. Genebra: Organização Mundial de Saúde, Departamento de
Saúde Mental, 2000. Disponível em: https://www.who.int/mental_health/prevention/suicide/en/suici-
deprev_ph c_port.pdf.
FERRARI, Deyse; BRANCO, Eduardo; TOLEDO, Luís Guilherme; MOLINA, Ludgleydson Fernan-
des. Impacto do estresse de minoria em sintomas depressivos, ideação suicida e tentativa de suicídio
em pessoas trans. Ciência & Saúde Coletiva, v. 26, n. 9, p. 3853-3864, 2021. Disponível em: https://
www.scielo.br/j/csc/a/9jjxfFmdYWBjWQD5Xc5kZVf/?lang=pt.
BORGES, L. M.; SILVA, T. R.; OLIVEIRA, R. A. Impacto da discriminação na saúde mental de
289
ISSN: 2763-5724 / Vol. 04 - n 05 - ano 2024
pessoas transexuais. Revista Brasileira de Psicologia e Saúde, v. 3, n. 2, p. 123-130, 2020.
GOMES, Hiago Veras; JESUS, Lorena Alves de; SILVA, Carline Pacheco Gomes da; FREIRE, San-
dra Elisa de Assis; ARAÚJO, Ludgleydson Fernandes de. Suicídio e população trans: uma revisão de
escopo. Ciencias Psicológicas, v. 15, n. 2, p. e-2501, 2021. Disponível em: https://revistas.ucu.edu.uy/
index.php/cienciaspsicologicas/article/view/2501/2526.
OLIVEIRA, L. C.; NOGUEIRA, C. Suicídio e pessoas trans: Reexões sobre a prevenção e o papel
do psicólogo. Revista Brasileira de Psicologia, 31(1), 120134, 2016.
DURKHEIM, Émile. O suicídio: um estudo sociológico. 2. ed. São Paulo: Martins Fontes, 2000.
TEIXEIRA, M. A.; SOUZA, J. M.; SILVA, T. A. Políticas de saúde e o acesso à saúde integral da
população trans. Revista Brasileira de Saúde Pública, 34(3), 423-435, 2018.
WHO. International Classication of Diseases 11th Revision (ICD11). 2018. Disponível em: https://
www.who.int/news/item/18-06-2018-whoreleases-new-international-classication-of-diseases-(i-
cd-11)
SOUZA, Leandro Colling. Transexualidade e sociedade: uma análise das trajetórias históricas, médi-
cas e sociais das pessoas trans. Rio de Janeiro: Editora Vozes, 2010.
SILVA, J. A. Impactos da saúde mental na população trans. Brazilian Journal of Health Research, v.
5, n. 2, p. 123-134, jun. 2022. Disponível em: https://ojs.brazilianjournals.com.br/ojs/index.php/BJHR/
article/view/52274/390 74
OLIVEIRA, R. A.; SILVA, T. R. Incidência de Ideação Suicida (IS) e principais fatores associa-
dos entre a população trans – revisão de literatura. Brazilian Journal of Health Research, v. 4, n. 1,
p. 56-70, jan. 2022. Disponível em: https://ojs.brazilianjournals.com.br/ojs/index.php/BJHR/article/
view/52274/39074
