Written by Joshua Matthews.

A Brazilian woman and her young daughter have undergone gender reassignment surgeries, facilitated by the nation’s public healthcare system, to live as “father and son.” This unusual case has sparked debate about medical ethics, parental influence, and the role of state-funded care in enabling such transformations, particularly for a child as young as 10.

A Family’s Radical Transformation

The 38-year-old mother, now identifying as Raphael, and her 10-year-old daughter, now called Gustavo, completed their transitions through Brazil’s Unified Health System, known as SUS, which offers free medical services to all citizens. Gustavo began this journey at age four, starting with social transitioning—name and pronoun changes—before progressing to surgical intervention. Raphael, by contrast, only adopted a male identity last year, aligning her transition with her child’s. Together, they’ve redefined their family roles, with Gustavo casually noting to G1, “It wasn’t hard to call my mother dad.”

This isn’t a quiet shift. The pair command an Instagram following of 25,000, where they share their lives as trans activists, posting updates and railing against those who use their pre-transition “dead names.” Brazil’s SUS, covering over 200 million people, has offered transgender surgeries like mastectomies and genital reconstruction since 2008, though access often involves long waitlists—up to seven years in some regions. For Raphael and Gustavo, the system fast-tracked a process that’s rare even by global standards: a parent and child transitioning in tandem, with the child starting so young.

Gustavo’s case stands out. At four, most kids are mastering basic skills—tying shoes, counting to 10—not navigating gender identity with surgical endpoints in mind. Brazil’s legal framework allows minors to transition with parental consent, and SUS guidelines permit hormone blockers at puberty’s onset, followed by surgery post-16, though exceptions occur. Raphael’s decision to join her daughter, flipping from mother to “father,” adds another layer—psychologists call this “mirroring,” where a parent echoes a child’s behavior, but here it’s amplified by permanent medical steps.

Public Reaction and Policy Backdrop

Raphael and Gustavo aren’t shy about their story, but not everyone’s cheering. Their vocal pushback against “deadnaming”—using their birth names—has drawn both support and ire online. In Brazil, where 1.6 million people identify as transgender per a 2022 UCLA study, acceptance varies—urban centers like São Paulo lean progressive, while rural areas lag. The duo’s 25,000 followers signal a niche but engaged audience, yet their public complaints highlight a tension: demanding recognition while leaning on a taxpayer-funded system that’s already stretched thin, with 1.5 million patients awaiting surgeries nationwide.

Across the Atlantic, U.S. President Donald Trump waded into this fray on March 4, 2025, during a joint congressional address. Hours after a federal judge blocked his executive order—which aimed to cut federal funds to hospitals offering transgender treatments to those under 19—Trump doubled down. He urged Congress to “permanently ban and criminalize sex changes on children,” arguing it’s a “big lie” that kids are born in the wrong bodies. “You are perfect exactly the way God made you,” he told American youth, tying the issue to his broader anti-“wokeness” crusade—a term he bashed as “trouble” and “bad,” claiming society’s better off without it.

Trump’s words hit a nerve. A Daily Mail poll pegged his jab at trans athletes in women’s sports as the speech’s most popular moment—68% approval. It’s a stark contrast to Brazil’s approach, where SUS expanded trans care amid a global push for inclusion. The U.S. has 1.6 million trans individuals too, but state-level bans on youth transitions—like Texas’s 2023 law—mirror Trump’s stance, clashing with federal funding battles. Raphael and Gustavo’s story, then, lands in a polarized world, amplifying questions about age, consent, and who foots the bill.

The Mechanics of a Dual Transition

How does this even work? For Gustavo, transitioning at four meant social steps first—new name, new pronouns—guided by Raphael’s consent. By 10, surgery entered the mix, likely a mastectomy or chest reconstruction, as genital surgeries typically wait until later teens under SUS rules. Raphael’s path was more abrupt—last year’s shift to male identity led to her own surgery, possibly a hysterectomy or top surgery, though details are scarce. Brazil’s public system covers these under a 2013 ordinance, with 8,000 trans procedures logged since—small potatoes next to its 150 million annual consultations, but a lightning rod nonetheless.

The mental health angle looms large. Both were diagnosed with gender dysphoria, a condition affecting 0.5% of people globally, where one’s gender identity doesn’t match their birth sex. Critics—like those echoing Trump—argue a 10-year-old can’t grasp such choices, pointing to studies showing 80% of pre-pubescent dysphoria cases resolve by adulthood without intervention. Raphael’s dual role as patient and parent raises red flags too—did her own struggles shape Gustavo’s path? Brazil’s medical board insists on psych evaluations, but the mother-child dynamic here feels like uncharted turf.

Cost-wise, SUS spends $1.2 billion yearly on specialty care, including trans surgeries averaging $5,000 each. For Raphael and Gustavo, taxpayers likely shelled out $10,000 total—not a budget-buster, but symbolic in a country where 13 million live on less than $2 a day. Compare that to the U.S., where private insurance or out-of-pocket costs for similar procedures hit $20,000–$100,000. Brazil’s model prioritizes access; the catch is, it’s slow—some wait a decade for non-emergency ops, yet this duo sailed through.

Our Take

Raphael and Gustavo’s saga is a jarring snapshot of where medicine, policy, and personal choice collide. Brazil’s public healthcare deserves credit for tackling gender dysphoria head-on—SUS’s reach is a lifeline for millions, and their story shows its muscle. But a 10-year-old getting surgery, nudged by a mom who then follows suit, tests the limits of consent and ethics. It’s not about denying their reality—dysphoria’s real, and treatment can save lives—but about timing and influence. Kids evolve; locking in such permanent moves so young risks outpacing their own clarity.

Trump’s call to ban youth transitions lands like a sledgehammer here. He’s got a point—data backs waiting out childhood dysphoria in most cases, and protecting kids from hasty calls makes sense. Yet his blanket “wokeness is bad” pitch oversimplifies a messy issue, ignoring those like Gustavo who stick with it. Brazil’s gamble—free care, early access—leans the other way, but Raphael’s role blurs the line between support and projection. Both sides miss nuance: this isn’t black-and-white. For now, the duo’s thriving on Instagram, but the bigger question—who decides, and when—won’t fade as fast as their scars.