“We are simply being crossed out.” As Pride Month begins, changing the gender marker in legal documents and medical transition are being banned in Russia
Анна Павлова
“We are simply being crossed out.” As Pride Month begins, changing the gender marker in legal documents and medical transition are being banned in Russia
1 June 2023, 18:04

Photo: Reuters

On May 30, a bill was introduced in Russia’s State Duma, which puts a full ban on any “medical treatment” related to gender transition, as well as a ban on “state registration of sex change without surgery,” i.e. changing the gender marker in legal documents. The bill was widely discussed by members of the government for over a month. Now, 400 members of the Russian parliament from all political fractions are listed as its authors. They think that the law will protect Russian society “from destructive informational and psychological influence” and strengthen traditional values. Mediazona talked about the potential influence of the legislation on the transgender community in Russia with LGBT activists and lawyers.

The State Duma deputies propose changes to two federal laws, “On civil status acts” and “On health protection.” They want to add a new section 45.1 to the latter, which they called “The ban of sex change in humans.”

If the bill is adopted, doctors will be prohibited to preform “medical treatment aimed at human sex change, including the formation of primary and (or) secondary sex characteristics.” Surgeries which are aimed at treatment of “congenital abnormalities of sex formation” will be permitted after special medical commissions which will be created by the government approves them.

In addition, transgender people will be prohibited to change the gender marker in their legal documents without “surgical treatment.”

According to the bill, legal change of the gender marker will become impossible in Russia?

Anna E. The current wording of the bill is quite raw. They contradict, among other things, the constitutional rights of a person in the realm of healthcare, because they exclude the current psychiatric diagnosis F64.0 that implies that transgender people should receive medical help. According to the bill, just because of their status, people will be rejected this medical help.

Goldman. Their logic is as follows. First: ban any changes in documents without surgery. Second: ban medical treatment. This equals to the impossibility to change documents.

Was this clear from the start or did you think only the changes in paperwork will be banned?

Tsvetkova. This rhetoric gradually grew stronger during the discussions. Human rights activists who followed all sorts of deputy and pro-government Telegram channels witnessed this process, but still, of course, it was hard to believe.

Goldman. Initially, we thought that the intention was only to ban changes in documents without surgery. That would mean retreating to the previous system of legal transition, when in fact the court determines the right of a person to change documents, looking back at the medical aspects of the transition (hormone therapy, surgery).

This, of course, will greatly affect most transgender people who are planning hormone therapy—and even more so those who already started it. Surgery can be easier, as it is mostly a single-time event, and you can preform them abroad. But hormone therapy is for life.

Hormone therapy isn't mentioned in the bill. Will it be banned as well?

Anna E. Under this bill, it is banned: gender-affirmative hormone replacement therapy is, in fact, a medical intervention aimed at changing secondary sexual characteristics. Suppose, a person who didn't change their documents comes to an endocrinologist. The doctor cannot prescribe anything to him according to this law. After all, it is very clearly written there: both primary and secondary sexual characteristics.

Goldman. The term “medical treatment” is very vague. It is not yet clear what lawmakers mean by it. If it gets banned, it will make the work of endocrinologists and gynecologists difficult, because cisgender people, both women and men, sometimes also require hormone therapy. Even hormonal contraception is being questioned, because as long as these drugs are sold over the counter (unlike testosterone, for example), will prescriptions be introduced? How will doctors track the true purpose of taking contraceptives: against pregnancy or as feminizing hormone therapy?

How will the law affect transgender people in Russia?

Anna E. This will make the chance of transgender people integrating into society extremely low. They will not be able to get a normal job, they will not be able to obtain financial autonomy, they will not be able to live independently, they will not be able to receive assistance. This means that they will be dependent on the state, on organisations.

The result will be a catastrophic deterioration in the quality of their life, the constant presence of extremely significant risks in it. Many transgender people live with and depend on transphobic relatives. They are constantly in an environment that provokes conflict, is emotionally and mentally dangerous. And they cannot get out.

The number of sentences for transgender people will increase because they will be forced to do illegal or semi-legal work—like sex work and so on.

The number of suicides will increase as well, and very significantly. Of course, this is a terrible situation, it affects basic human rights.

Tsvetkova. This law will lead to systemic discrimination, which already exists and will be additionally enshrined at the state level. And this can lead to the complication of already existing barriers to obtaining the proper medical care for transgender and non-binary people—it could even become impossible.

This is an additional reinforcement of institutional transphobia and, let's say, encouragement of social transphobia. Both this bill and the so-called law on “LGBT propaganda” adopted in 2022 will lead to an increase in the number of hate crimes, which are already on the rise.

If people are not able to access gender-affirmative help, then their gender dysphoria and related conditions such as depression, anxiety disorder, suicidal behavior, self-injurious behavior will worsen.

But one must take into account the enormous potential of the activist community. I am already seeing an unprecedented level of resistance, mutual aid, mutual support, and solidarity within the community. I assume that some ways of providing medical care will be invented, no matter what. Therefore, I absolutely believe that no matter what they try to do with us, we will have something to oppose them.

Why is this bill introduced now, after other repressive laws aimed against the LGBTQ+ community?

Anna E. For a long time, the Russian government simply did not have an understanding of the phenomenon of gender transition. When the LGBTQ+ topic became popular and repressions began, it was only a matter of time before they figured out that transgender people are the most vulnerable in terms of ties with the state: they are directly dependent on commissions, on changing documents. The commission is licensed by the state, the change of documents is carried out by the state, and the state determines the standards of medical care.

They learned that they have statistics—the state has lists of people who changed documents. Among members of the LGBT community, the state has the most information on transgender people.

Tsvetkova. There are several theories here. So, this bill is now very much in line with the Western trend of anti-trans laws, which are actively adopted in a number of countries, for example, in many US states. In the States, the political background for this is that it's a way for certain politicians to get approval from a certain category of the electorate, conservatives and far right. This is not exactly how the situation in Russia looks like, because it is unlikely that the goal is political approval: those who already support the government do not need additional incentives.

Some media say that this law is adopted in order to please Putin specifically, who is very excited about the whole gender topic. Most of the jokes of this, if I may say so, person are dedicated specifically to the topic of transgender and non-binary people.

I can also assume that this is a kind of final swing at LGBTQ+ people.

Goldman. I'm sure it's a distraction—you know what from. For a portion of Russian society, trans people are something like mysterious animals, they have have never heard of us and are taught to hate us. The LGBT agenda fits perfectly with demographic justification, but if you dig deeper, it becomes clear that such a discriminatory law will only harm both individuals and the entire state. Namely, the outflow of people from the country, rise in suicides, unhappy and unloved children born by force, a decrease in jobs and healthcare options. Even though we are a minority compared to cis people, we are also a part of society. And we're just being crossed out like garbage. Does this sound familiar?

Have any difficulties already occurred for people who are in the process of changing the gender marker or in transition?

Anna E. It's too early to talk about it yet. We can say for sure that first of all, doctors begin to re-insure themselves. The bill hadn't even been drafted yet, but after [minister of justice Konstantin] Chuichenko's words, the doctors who provided support began to abandon their brand of trans-friendly specialists. So far, there are only a few of them, but there are only a few doctors who are willing and able to help transgender people in Russia. So it is a very meaningful change.

Tsvetkova. As long as the bill isn't adopted, everything works in accordance with the current legislation. It always was and still is difficult for transgender people in Russia. Lack of doctors and medical staff in general, for example. Although in recent years a lot has been done to ensure that more competent specialists appear and help is generally of better quality.

Goldman. There is a panic. People are urgently going through the sexual reorientation commissions, changing documents. For some, the bill has become another impetus for emigration from Russia. We are all gnawed by the uncertainty of the future, which does not look bright. We are hurt, we are scared, we are offended. And now we really need support. Whether it's kind words to familiar trans people in a personal conversation or a heart-to-heart conversation, whether it's escorting to various authorities to support them in changing documents or going to doctors or donations to organizations who purposefully help trans people and know what and how to do in a given situation.

Human rights activists helping LGBTQ+ people said that due to the war, mobilisation and new repressive laws, the number of requests for consultations has skyrocketed. Is it true?

Anna E. The military situation has obviously taken a toll on the transgender community, as well as throughout the country. But it especially affects those who are additionally stigmatized, who as a group are more vulnerable. The risks involved in cases of improper mobilization are doubly affecting transgender people. Because the attitude towards such people is systemically negative.

Over the past few months, we have received more than half a thousand requests for support, legal assistance, and things like that. This is only in the human rights and trans organisations that I work for.

Tsvetkova. Naturally, with the crisis of society, repressive laws, mobilisation, war, many people seek peer consultations (this is peer-to-peer consultations, which are provided by a person with [similar] experience in trans- and non-binary organizations). They seek legal advice, advice on emigration. And the number of requests, of course, is increasing.

How do you help trans people now? What can be done before the law is passed?

Anna E. Before, we were engaged in visibility, representation, representation, professional development of specialists, now we are focusing on requests within the community. This is, in fact, terrible, because the more such requests, the less independence is possible for these people. We provide psychological and legal assistance. No matter how people from the State Duma represent us, we do not have millions of grants from the State Department. We operate on very limited funds, we help only with the most necessary things.

Tsvetkova. All organizations help in the best way they can: some have opened additional support groups, some began to provide more free consultations with psychologists. It is important to sustain yourself, your stability. To ever receive gender-affirmative help, one must live up to this moment.

There is a project now set up by three organisations that help pay medical fees for those who do not have enough money. During this time, we have already managed to help a fairly large number of people. What you can do now is to pass the commission while they are still working and change the documents. And if someone has been putting off the operation for a long time, now is the time to do it.

Goldman. Centre T organises free support groups with our psychologists, helps to pass commissions, shares information, provides support in our 122 chat rooms throughout the country and abroad, keeps up to date with all the news thanks to our media team, provides all possible volunteer assistance on domestic issues.

The head of the Investigative Committee Alexandr Bastrykin claimed that changing the gender marker is a “deception,” and stat TV programme Vesti talked about a clinic that allegedly helps cisgender men avoid being drafted in this way. Obviously, his did not happen, but what are the risks for trans people in connection with the mobilisation?

Anna E. We have stories of transgender women who were drafted to the army before the change of documents. Not hundreds, but dozens of such cases. People did not change their documents and remained in the bases of military registration and enlistment offices. Someone was afraid of discrimination and hazing—or that if they talk about their status, they will be sent to where they will die faster. We do not know much about some of the stories, but we guess that they could have sad endings.

Tsvetkova. The state rhetoric about the violation of Russia's defense capability is, of course, is very funny. To me, this sounds like an extremely inadequate statement, as are so many others.

The situation with those who are threatened by mobilisation is bad. When mobilization was announced, quite a few people who did not change their documents or changed, but had a military registration specialty, in general, one way or another falling under this mobilisation, left the country. For a number of people, this has become a reason not to change documents right now, because it is simply not safe for them.

Transgender people who ended up in the military registration and enlistment offices faced discrimination and transphobia in almost 100% of cases. They were required (even people who received a certificate, passed the commission, changed the documents), for example, to go to a psychiatric hospital for a month to confirm their diagnosis.

In general, returning to Bastrykin's statements, this does not even look like some kind of relevant pretext at all. I don't know cisgender men who would go to all the expense associated with changing their gender marker and risk their lives [to avoid being drafted]. To even assume that someone will go for it is simply ridiculous.

Goldman. A priori, according to the law (today), trans people do not serve. Transfeminine—because of the female gender marker in the documents, and transmasculine can have several reasons: psychiatric (“diagnosis” F64.0), surgery (absence of the penis), endocrinology (lifelong hormone therapy). But there were cases, especially after the start of mobilisation, when they tried to take transmasculine people into the army or refused to deregister transfeminine people; in both cases, they could demand some additional commissions, checks, examinations from “their own.” In military registration and enlistment offices, it seems, in general, their laws work.

The position of the Ministry of Health on this issue was considered key, but it was never officially formulated. How does the medical community react to the bill?

Anna E. Those who at least somehow helped transgender people try to speak out as specialists. That this initiative is the wrong way, very dangerous for their patients.

I can say that medical specialists were involved in the discussion of the bill. As it turned out, no one listened to them. There are specialists known for their radical, let’s say, limiting view, who nevertheless do not agree with the complete ban on the possibility of changing documents and access to gender-affirmative medical procedures: specialists may have different attitudes towards the number of people they consider to be transgender, but most of them do see the need for such assistance.

The current norm was considered the best option and, no matter how our deputies imagined it, this norm was by no means easy in many aspects. But it remained fairly balanced in terms of accessibility.

Tsvetkova. All normal doctors whom I know, of course, are horrified by this bill, write letters to the Ministry of Health and express their protest in every possible way about this legislative initiative. Naturally, along with adequate people there will always be inadequate ones. As a rule, these are transphobic specialists.

And yes, the Ministry of Health, unfortunately, has not yet said anything about this. In unofficial sources, they indicated their negative attitude, but nevertheless did not express it publicly.

Goldman. As far as I know, most doctors—not publicly—support the trans community, understanding all the absurdity and barbarianism of the bill. For the most part, people in general do not care about the LGBT community, and if they encounter such a person for the first time, they react with interest and/or surprise, without negativity. Many do not even know about our existence. And doctors who are aware of us support us.

From the side of officials there were calls to “treat” transpersons - to send them to conversion therapy. Is the threat of forced therapy real?

Anna E. In the short term, this will most likely not be possible. Obviously, if this is carried out, it will be used in the media, as a selling point for politicians. And just now, according to the reaction of the public, they are evaluating the prospects for future investments in such repressive, punitive, but, fortunately, expensive projects.

The processes that are taking place actually speak not only about the rights of LGBT people in a broad sense, but also about the rights of civil society as a whole: about the rights of those who at any moment in the eyes of this state may turn out to be “different.”

Tsvetkova. I think the threat of conversion therapy is very real. It actually exists in Russia at the moment. Take a look at the Moscow Community Centre for LGBT Initiatinve's report on conversion therapy in Russia in 2021, and you will see what enormous numbers there are

Personally, I have heard stories from at least two transgender people in the last four weeks about their personal conversion therapy. And this has all happened in the last few months. Naturally, it was not their decision, they were forcibly sent there.

If it is also legally justified, then these risks will increase.

Goldman. I am surprised how strongly our country is resisting the ICD-11, adopted by the WHO, where transgenderness is listed as one of the normal conditions that require medical attention only if necessary.

Conversion therapy is contrary to the new ICD. You can't cure something that isn't a disease. How can this develop legally? This will probably apply to minors. Because legally capable adults cannot be forced to undergo medical procedures, if it is not a threat to the life and health of them and those around them. That is, for conversion therapy, it is actually necessary to recognize trans people as insane.

It is possible that private “hospitals” for teenagers will be opened, but I'm not sure that this will develop quickly. If it happens, it will be another rollback in the history of the state. Degradation, which, as you know, does not bring anything good.

Editor: Maria Klimova

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