Citizen by gender: How transgender people fought discrimination in the USSR

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In the first decade after the 1917 October Revolution, Soviet society experienced a period of relative liberalism regarding sex and gender. The Bolsheviks abolished the imperial legal code, which had included criminal penalties for same-sex relations between men. Soviet psychiatry began to develop, and many psychiatrists in the USSR were familiar with the scientific work of Magnus Hirschfeld on transsexuality.

However, this period of relative sexual freedom ended quickly. With the ascent of Joseph Stalin, sexological science effectively ceased to exist, homosexuality was recriminalized, and the subject of gender identity was pushed out of public and academic discourse. Any deviation from traditional heteronormativity was treated as a pathology. Until Stalin’s death, almost no one in the USSR studied sexuality — let alone transgender issues.

Dr. Aron Belkin and his patients

One of the few Stalin-era experts in the field of transgender studies was psychiatrist Aron Isakovich Belkin. He first encountered the phenomenon in 1951, when he was sent to a large prison camp to evaluate inmates suffering from nervous breakdowns and possible mental illness. After finishing his rounds, a camp official asked, “Want to meet our Dusya?”

It was an odd wording, Belkin noted, given that this was a men’s camp.

Belkin agreed and heard the inmate’s story. The prisoner was serving time for a minor criminal offense. Inside the camp he called himself Dusya and, as conditions allowed, tried to appear female. Fellow inmates considered him “odd” but treated him with apparent kindness.

“I simply didn’t know then that disturbances of sexual self-awareness can occur in an otherwise stable mind,” Belkin later wrote. He never returned to that camp, and so Dusya’s fate remains unknown. But Belkin went on to work at Moscow’s Institute of Endocrinology, where he discussed Dusya’s case with colleagues.

After Stalin’s death, the political climate changed, and the period known as the Thaw began. Doctors realized the USSR lacked a dedicated science of sexual health, and in 1965, Soviet sexology was born. Scholars began to discuss male and female sexual disorders and phenomena such as homosexuality and transgender identity.

As the field developed, patients seeking gender transition began turning to Belkin at the Institute of Endocrinology. In his memoirs he describes his first such patient — likely in the 1960s or 1970s. The patient, Rahim from Tashkent, had felt female since childhood but long believed nothing could be done to change the situation. One day, colleagues in the dance troupe where Rahim worked said it was supposedly possible “to turn a man into a woman and vice versa.”

Rahim’s inquiry marked the start of a small but real practice of gender-affirming care in the USSR — a practice that would expand during perestroika, contract under the early decades of Putin’s reign, and now faces renewed pressure as wartime restrictions tighten.

Rahim began searching for doctors in Tashkent but could find no one who could help, or even offer advice. Eventually, the dancer decided to travel to Moscow, where he ended up in the care of Belkin. Although it was common in such cases to issue a psychiatric diagnosis, neither Belkin nor his colleagues found any signs of mental illness. The patient was calm, friendly, and seemed fully aware of how absurd his wish to change his sex might appear to others.

He attracted the attention of Professor Andrei Snezhnevsky, a leading authority in Soviet psychiatry. Initially, Snezhnevsky was convinced he was dealing with schizophrenia. But after Rahim spent an extended period under observation in a psychiatric hospital, the diagnosis was dropped. It became clear that the patient exhibited no psychiatric disorders. He became the first person in the USSR to be officially diagnosed with a new term: “transsexualism.”

After that, Rahim pursued surgery with renewed determination. Belkin tried to dissuade him, warning of the risks of such a radical surgical procedure and the unpredictability of the outcome. But Rahim was steadfast. The debate between patient and doctor stretched on for nearly six years.

Looking back on those events, Belkin later admitted that the easiest course would have been to defer to the system: to say that he and his colleagues were bound by Ministry of Health regulations, which indeed made no provision for such operations. But in reality, what held him back was something else — “a profound sense of boundaries beyond which no one dares to go when dealing with living creatures of nature.”

At some point, Rahim disappeared, and Belkin breathed a sigh of relief, thinking perhaps he had finally given up.

But Rahim had spent that time fighting for a legal gender change — and he had succeeded. Belkin suspected a bribe may have been involved. When Rahim returned with a new passport, listing his gender as female, his legal status had completely changed. He no longer asked doctors to change his sex. He now came as a Soviet woman whose physical characteristics did not match her legal gender. And he demanded that this medical “anomaly” be corrected.

Under the new circumstances, no special authorization from the Ministry of Health was required.

But even after that legal switch-up, Belkin and his colleagues still refused to operate. Rahim found a small municipal hospital far from Moscow — one that had never conducted such procedures — persuaded two surgeons, reportedly with another bribe, and finally realized the dream. Later, however, Rahim reported that the surgery did not ease the distress, but “made it a hundred times worse.”

Inna to Innokenty: the USSR’s first female-to-male transition

Belkin was not the only Soviet physician approached by people seeking gender transition. Under Nikita Khrushchev and Leonid Brezhnev, those with gender dysphoria searched blindly, by trial and error, for any specialist they might be able to trust.

In the late 1960s, a young woman entered the office of biologist Vladimir Demikhov and insisted on surgery to become male. Demikhov, sympathetic but lacking a surgical license, sought advice from his Latvian colleague Viktor Kalnberz, who had experience correcting hermaphroditism and performing rare phalloplasty procedures.

“A very pleasant woman with an engineering degree wants to become a man,” Demikhov told Kalnberz. “You are skilled in plastic surgery; please consult her and, if you can, help.”

The woman’s name was Inna.

When Inna arrived, Kalnberz hesitated. He had never performed a full sex-reassignment operation, and his colleagues were divided. He also doubted there would be a positive outcome — too many unknowns. Inna then wrote a detailed letter explaining why surgery was a necessity, not a whim:

“Dear Viktor Konstantinovich,

Knowing of your unique operations, I turn to you in hope. From early childhood I have been certain I am a boy who will one day become a man… With a female appearance I developed purely male habits that have cut me off from people, deprived me of friends and family… At 12 I fell in love — with a person of the female sex. That love, which lasted until I was 18, showed me the hopelessness of my situation… Doctors always advised intimacy with a man; to me that is equal to suicide… I am now 30, deeply attached to a woman I wish to give simple human happiness. I beg you to help me live according to my inner needs, to be a person among people.”

After long consultations and tests, Kalnberz agreed. The series of female-to-male operations began on Sept. 17, 1970, and ended April 5, 1972. Each stage was followed by about three months of recovery. Inna would be discharged, go back to work, then return for the next procedure.

The patient insisted on secrecy. She was placed in a private isolation ward, and staff were told to stay silent. Still, rumors spread among relatives of other patients about how a woman was being “made into a man.” In his memoirs, Kalnberz recalled many people opening the ward door, apologizing, and pretending they were lost — while Inna lay under the covers, a blanket pulled over her head.

When the surgery was complete, legal issues remained. A special commission of forensic experts, physicians, and Interior Ministry passport officials met to change Inna’s documents — including by granting her a new name, Innokenty. Kalnberz provided medical records and photographs documenting every operation.

After that, Innokenty was invited into the hearing room. Since the commission members had already reviewed the case materials, there was no need for a physical examination — they simply asked how he was feeling. Innokenty replied that he felt happy. The members drafted an official protocol, and on that basis, Innokenty received a new passport with his male name and gender.

Kalnberz himself did not take part in the document process and even asked Innokenty not to tell him his new name or address. Still, the doctor gave the patient his contact details and requested that he return for follow-up exams in the coming years.

Innokenty, however, developed a deep fear of medical boards, checkups, and screenings. On one occasion at work, he was forced to undergo a routine medical exam and undress in front of a panel. Seeing the scars, the doctors asked, surprised, “What happened to you?”

Innokenty replied that he had been beaten and cut by gang members, and ended up in intensive care. The doctors grew concerned, asking whether the attackers had been caught. One of the surgeons never realized that Innokenty’s penis was artificial. As Kalnberz later recalled, “Even surgeons at the time couldn’t imagine that someone in our country had undergone a sex change.”

Innokenty later wrote another letter to Kalnberz:

“Dear Viktor Konstantinovich,

Thank you for everything you did for me… The result of the surgeries exceeded all my expectations. I never hoped that all my secondary sex characteristics would change — but they did.

Most importantly, the split that tormented me for years is finally gone. I can now live among people in a new legal identity. That alone is a miracle, and I owe that miracle to you.

My previous life pushed me into a dead end. I even considered whether there was any reason to go on living.

Now all those dark thoughts are behind me. I feel great, like someone reborn, with a new thirst for life. I feel strong enough to make up for everything I lost in my previous life.”

Despite the patient’s gratitude, Soviet Minister of Health Boris Petrovsky was furious at Kalnberz for carrying out what he called an “un-Soviet” procedure. In a private meeting, Petrovsky unleashed his anger:

“Do you understand your actions are criminal? You’re doing something entirely improper. This kind of surgery is alien to socialist order. The Justice Minister is looking into you. You belong behind bars! You should be prosecuted!”

In the end, Kalnberz received only a formal reprimand for performing a “mutilating surgery” that, according to the authorities, contradicted the structure and ideology of the Soviet state.

Other doctors, like sexologist Yan Goland from Gorky (now Nizhny Novgorod), believed “transsexualism” was purely a psychological disorder that could be cured. He wrote that treating transsexualism with psychotherapy took three to four times longer than treating homosexuality. Goland still offers such therapy at his clinic in Nizhny Novgorod today.

Perestroika: a positive shift in discourse

With the onset of perestroika, previously taboo topics gained public attention in the USSR. Corruption, bureaucratic inefficiency, and so-called “risk groups” — including homosexuals, sex workers, and drug users — became widely discussed topics, especially amid the growing HIV/AIDS epidemic. Although transgender people were not formally categorized as a “risk group,” their issues were increasingly covered by the press.

Doctors who worked with transgender patients began sharing observations and insights. Many advocated for trans people to be seen not as threats or anomalies, but as part of a diverse society deserving respect and empathy.

Journalists frequently interviewed both doctors and their transgender patients. In 1989, the newspaper Vechernyaya Moskva published a story about a young woman who approached a Moscow medical center with what seemed at first to be an unusual request: to become a man.

Before introducing the subject of the story, the reporter explained that as early as the 1960s, “remarkable sex reassignment surgeries” had been performed in the capital — not out of curiosity, but for those burdened from birth by “a heavy stigma” known as transsexualism.

The article described transsexualism as “a mismatch between one’s biological and legal sex and gender identity,” and stressed that such individuals are “deeply convinced” their biological sex is incorrect:

“Can a normal person reject what nature gave them? But that’s the point — transsexuals are mentally healthy people… Yet every hour, every day, they suffer, because their minds and souls are male, but their bodies — with all the primary and secondary sex characteristics — are female.

If your head aches, you take a pill. But nothing can ease this pain, because it’s the soul that hurts. And it won’t stop unless decisive steps are taken. By changing these people’s sex, doctors are, in fact, saving some of them from suicide.”

The journalist then described the article’s subject:

“A teenage boy — smooth facial skin, slightly puffy lips, long but not too long hair, a jacket, ‘acid-washed’ jeans, trendy sneakers, a gym bag.”

Seeing the reporter’s notebook, the youth insisted that his real name not be published. The interview began with the reporter asking for a name.

“Which name do you want — passport or the one I use with strangers?” he asked. “You can call me Yura, but on my passport, it says Svetlana.”

The reporter asked if Yura was afraid of the surgery: “You’ll stop being a woman, but will you become a real man?” He noted that, in his view at least, “male-to-female surgeries had more reliable outcomes than the reverse.”

Yura replied that surgery was his “only chance to become a complete person” and that he hated waking up every day in a female body. The journalist called sex reassignment surgery “a last resort” and suggested Yura begin by changing the gender marker in his passport.

But Yura explained it wasn’t that simple: “If you make that request at the passport office, everyone finds out right away.” He knew others who had tried — and their lives became even harder afterward. “I’ve been reading everything I can about transsexualism,” Yura said. “And every time, I come to the same conclusion: surgery is my only hope.”

His parents, he said, saw his suffering but were still against it:

“They’re afraid it would mean ‘social death.’ That I’d have to leave town so no one would recognize me or point fingers… I’d have to start my life over somewhere new.”

Two years later, just months before the Soviet Union dissolved, Vechernyaya Moskva ran another story about transgender identity. One Soviet doctor who was interviewed stated:

“Transsexualism is a relatively common phenomenon. We just couldn’t talk about it publicly, not even in medical journals. These operations are now being performed in Moscow and St. Petersburg. The methods are well developed. But not everyone needs this surgery. Special medical commissions — composed of psychiatrists, endocrinologists, and other specialists — decide each case. It’s essential that society treat these people with civility, not hostility. The suicide rate among them, especially teenagers, is high. This issue must be addressed on all fronts: medically, socially, and legally.”

Subsequent articles also reflected understanding and empathy toward transgender people. But despite this more compassionate coverage in the USSR’s final years, life for trans people in post-Soviet Russia remained both difficult and unstable. Many could only access surgery in Moscow, and some didn’t even know that the word “transgender” existed.

In a 2003 interview with Vechernyaya Moskva, a transgender man described his difficult transition. Born a girl in Siberia in the 1990s, he admitted to having no access to the Internet or any writings on the subject: “I didn’t even know the word ‘transsexual’ until I moved to Moscow.”

In 1997, Russia added Article 70 to the Civil Status Act, allowing people to change their legal gender provided they presented proper medical documentation. Commenting on the law, Dr. Andrey Akopyan of the Ministry of Health’s Family Planning Center said:

“In practice, it means anyone can do it, if a medical institution agrees. And our fears of abuse never came true. In fact, doctors and patients have become more responsible.”

Akopyan stressed that surgery remained the only real way to help those diagnosed with transsexualism and that there was no point in trying to dissuade them.

In later interviews, Akopyan described the progress that had been made:

“In the early 1990s, when these surgeries first got media attention, there was a wave of transsexuals contacting clinics, mainly because civil registry offices refused to change their documents. Now the process is clearer.

A panel of three psychiatrists confirms the diagnosis and checks for psychological stability. After that, surgery is handled like any other procedure — same methods, same pricing. A hospital discharge summary is then used to update the person’s passport and other records.”

However, the situation worsened dramatically in 2013, when Russia passed its “gay propaganda” law. A climate of fear and stigma enveloped queer communities. Ten years later, amid Russia’s full-scale invasion of Ukraine and the ramping up of political repression, the State Duma unanimously passed a law banning “sex change.” Transgender people can no longer update their gender markers in official documents, nor can they legally obtain vital medications. Many have been forced to flee the country.