Alexandre Sacramento is a transgender individual who experienced a pivotal moment when he felt the potential of change. At sixteen, the drive to begin gender-affirming treatment became clear, and the plan was to start with a dedicated endocrinologist and pursue surgical options as soon as public health responded. Yet a required eight‑month wait for an initial consultation led him to pause. He recalls a period of intense distress and suicidal thoughts, choosing private care to continue treatment. He has since met others who faced even longer waits, some lasting two years before hormone therapy began.
Sacramento’s experience is not unusual in Portugal. Eleven years after hormonal treatments and gender-affirming surgeries were introduced into the public health system, only two hospitals in the country have the capacity to perform gender reassignment surgeries. The scarcity of community centers complicates the path for many who seek the process, and not everyone feels the need for operating room procedures.
Responding to requests from LGTBI+ associations that have long condemned lengthy waits for surgeries, the government announced the opening of two new hospital units in mid‑May, located in Lisbon and the Algarve. Health Minister António Lacerda Sales stated that these units would provide a more equitable nationwide response and help ease pressure on waiting lists. The new units, planned for after the summer, add to measures approved by the Portuguese Parliament to advance LGTBI+ rights, including the ability to change name and gender in the population register without a prior medical report, a policy in effect since 2018.
content optimism
Even with government assurances, LGTBI+ associations remain cautious. Sara Malcato, a clinical psychologist and coordinator of the ILGA association, notes that there is little concrete information yet about how the new units will operate. She observes that the state did not provide details on how many endocrinologists or surgeons would be available, or whether the centers could handle the expected patient volume. If the same surgeon serves both the new Lisbon unit and existing centers, that could limit capacity and delay, she warns. Malcato emphasizes that clarity on staffing and workflows is crucial for real improvement, especially for those far from major cities.
Raffaello Dante, 36, shares a similar concern about delays for mastectomy consultations. He points out that many surgeons in this field work in private facilities, making it uncertain whether the public system can absorb the current waiting list. After waiting several months, Dante managed a treatment at a Coimbra hospital, a bit over two hours from Lisbon. He notes that the journey itself consumes a full day and a hefty amount of time, which can be a barrier for many patients who live closer to the capital yet still face long waits.
delays due to covid
Since 2011, the Portuguese public health system has performed nearly 200 surgeries for transgender patients. The pace slowed with the onset of the Covid-19 pandemic in 2020, exacerbating waiting lists. The Ministry of Health reports 129 pending interventions at Coimbra hospital alone, with hopes that activity will rebound as normal operations resume. The backlog also stems from urgent interventions related to breast cancer and other conditions, which have taken priority in many facilities. Malcato notes that while Covid contributed to delays, there is also a broader shortage of qualified professionals in this field.
Despite criticism, the government asserts progress in improving surgical services for transgender people. Last year, the transgender counseling unit at Santo António de Porto hospital — which serves as a major center alongside Coimbra — announced the formation of a dedicated team of psychiatrists, endocrinologists, and surgeons. This specialized cadre focuses on transgender care, aiming to streamline procedures and enhance patient support.