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Contribution short abstract

This contribution examines the care itineraries of transmasculine people in Brazil. Using ethnography in "local initiative" clinics, I analyze how the gap in federal funding and institutional inertia transform professional commitment into a depleting labor of survival and institutional fatigue.

Contribution long abstract

In Brazil’s Unified Health System (SUS), trans healthcare is often relegated to specialized centers. While only 10 hospitals are federally funded for surgeries and 12 for hormone therapy, over 100 clinics operate as "local initiatives," lacking institutional standardization or federal support. Drawing on ethnographic fieldwork regarding the care itineraries of trans men and transmasculine individuals, I examine how access has relied on the ethical-political commitment of professionals rather than robust policies. One of my fieldsites is precisely one of these clinics, functioning through "local initiative”. This reliance on individual "caring" creates a profound paradox. While it fosters a sense of belonging for a marginalized population, it generates intense institutional fatigue. In team meetings, exhaustion is omnipresent; phrases like "this clinic is not a place where you work until retirement" signal the limits of endurance. This fatigue is exacerbated by a broader healthcare network that reflexively redirects any demand involving a trans body to these specialized units, regardless of clinical necessity, overwhelming the staff. I contend that "caring" as a personal-political project is insufficient to sustain a healthcare system. The daily reality of these clinics reveals how institutional inertia transforms care into a depleting labor of survival. Truly transformative care requires moving beyond the "sensitization" of professionals toward public policies co-designed by trans populations, managers, and the frontline workers who navigate the ambivalence of exhaustion and resistance in their everyday practice.