OPINION
The recent prohibition of gender transition in Russia has had significant repercussions for a large group of individuals, commonly referred to as transgender people. They are now left without access to medical assistance, forcing them to seek alternative, underground options, leading to increased stress and higher suicide risks. The following is a brief explanation of why it is essential to understand that gender dysphoria is not a disease or a mere whim.
The legislation prohibiting gender transition was approved by the State Duma and the Federation Council and subsequently signed by Vladimir Putin. What does this mean for people with gender identity incongruence (so-called transsexuals/transgender individuals) according to the “official” criteria? Consequently, not only changing legal documents but also any form of surgical treatment and hormone therapy is now fully prohibited for transgender individuals in Russia.
This marks the first time in Russia's history that such extensive and direct restrictions have been imposed on certain medical procedures, which are widely accepted in other progressive societies as a means to alleviate human suffering. The last time Europe encountered something similar was during the time of Hitler's Reich.
The last time Europe encountered something similar was during the time of Hitler's Reich
Is the desire for gender transition just a whim? Is it something unworthy of discussion and attention in a “respectable” society? Or is it an illness? And if not an illness, then why is the involvement of doctors so crucial in this matter? What could be the consequences of such a prohibitive decision for transgender individuals and society as a whole?
Transsexuality is not an illness
First and foremost, it is essential to acknowledge that transsexuality is not a disease, and there's a consensus on it among all psychiatric specialists. Nonetheless, it is classified as a psychiatric disorder under the code F64 in the International Classification of Diseases, Tenth Revision (ICD-10). However, in the Eleventh Revision (ICD-11), which is not yet fully implemented in Russia, transsexuality has been removed from the category of disorders and placed under “gender incongruence.”
Transgender individuals often experience various forms of anxiety and depressive disorders, which is why they seek the help of psychiatrists and psychotherapists. After all, the psychiatric norm is, to a significant extent, influenced by society's attitude towards individuals facing particular challenges.
Indeed, transsexuality itself is not an illness. However, this does not mean that transgender individuals do not require medical assistance. This is precisely why gender incongruence is included in the classification of diseases. Medical assistance is vital for these individuals, and currently, they are being deprived of it in Russia. Often, from the age of 4 to 5 years old, transsexuals and transgender individuals live with the feeling that their secondary sexual characteristics do not align with their sense of belonging to a specific gender. They are born this way, and their percentage in the population remains unchanged. They experience chronic stress, which frequently leads to depressive states.
How to ascertain the need for gender transition
In Russia, the issues concerning transgender individuals have been more or less addressed through specific procedures, and this has been the case until today.
Claims that someone can simply approach a surgeon and say, “I want to change my gender,” are mere speculations by some politicians. There is a series of sequential commissions that assess and determine how to assist each individual specifically. Transsexuality does not mean that a person starts feeling like a member of the opposite gender only during moments of sexual attraction. No, these feelings persist constantly, 24/7, as if they are trapped in the wrong body.
The first step taken by such individuals is to approach a psychiatric expert commission, established under the orders of the chief physician and governed by the regulations of the Ministry of Health and the specific medical institution where it operates. The primary task of the psychiatrists at this stage is to understand whether the desire to undergo a gender transition might be a result of another mental disorder, such as schizophrenia.
For those with a mental disorder, of course, gender transition is not possible and has never been attempted. They require a different form of therapy under the supervision of a psychiatrist. But that's a completely different story.
For people with a mental disorder, of course, gender transition is not possible
However, if it is determined that an individual has what is commonly referred to as “true” transsexuality (and in Russia, this practice has been applied only to adults), which deeply resides within the person and is not a result of a mental disorder, but rather gender incongruence, or gender identity disturbance/disorder, then and only then does the commission decide that gender transition is necessary.
The process of gender transition
In the next stage, the individual visits an endocrinologist, where a collective decision is made on which hormones and in what doses the transgender person should take. For instance, if a woman is transitioning to become a man, she (he) should develop male-pattern facial hair. On the other hand, if a man is transitioning to become a woman, facial hair should not grow. Of course, there are many more changes, but these are simplified for better understanding.
The third commission is the surgical council. Several highly qualified surgeons discuss with the patient the specific scope of operations needed in their case. They determine what procedures are required to help the transgender person no longer feel like they are in the wrong body. For instance, if the person identifies as male but has a female body, they usually begin with a mastectomy. For some, this may be sufficient. If not, the next steps may involve a hysterectomy, followed by vaginoplasty with perineum reconstruction, lengthening of the urethra, and phalloplasty for constructing a functional male genitalia.
The commission determines what procedures are required to help the transgender person no longer feel like they are in the wrong body
Indeed, the surgeries involved in gender transition can vary significantly depending on individual preferences, age, and medical considerations. However, it is a complex, multi-stage, often microsurgical treatment. For some individuals suffering from transsexuality, if they are not young and have spent their entire lives in the wrong body, enduring depression, the removal of mammary glands and changing legal documents might be sufficient and fulfilling.
Finally, the fourth commission, the medical-legal commission, based on the conclusions of all specialists, decides at which stage the person's passport should be changed. Figuratively speaking, someone named Lydia will become Leonid with the replacement of all relevant data.
Triumph of ignorance
Therefore, gender transition is not a mere “whim,” as some members of the State Duma believe. It is a lengthy medical and legal journey. It is a transgender transition that cannot be done hastily, a path that, unfortunately, is now inaccessible to these individuals in Russia. Moreover, previously, these surgeries were covered by obligatory medical insurance, as they rightly should have been. The surgeries and therapies should be available because they constitute medical assistance. The suicide rate among those with “true” transsexuality and an inability to undergo gender transition can reach up to 50%. In Russia, medical assistance for gender transition was first removed from the obligatory health insurance coverage, and now it has been outright banned, which is akin to passive murder.
Therefore, gender transition is not a mere “whim,” nor is it “pornography” or “prostitution”, as some members of the State Duma believe
It is for these reasons that during the first reading of the discriminatory law, Health Minister Murashko put up a resistance, albeit quite weak. The Ministry received numerous letters from individual psychiatrists and the Russian Society of Psychiatrists expressing their concerns. However, ignorance prevailed.
Psychiatrists, with whom The Insider spoke, fear an increase in suicide rates and a surge in depressive disorders. They also anticipate the criminalization of gender transition, with similarly dire consequences for individuals with gender identity disorders. Transgender individuals already face profound psychological conflicts in self-perception, even without any prohibitions, they say. Therapy only partially addresses the issue and is more significant for the well-being of those around the individual (which is precisely why intolerant people in their surroundings exhibit such negativity).
In parallel with the law banning gender transition in Russia, it was decided to establish sexology units in all out-patient clinics beginning from July 1. On one hand, this may seem like a reasonable decision. On the other hand... Considering the growing trend of prohibitions, could these units be used for forced “treatment” of both transgender and LGBT individuals?
Experts believe that although in psychiatry, assistance may be provided against the will of the patient in certain cases (to prevent suicide or harm to others), it remains so only until the reasons for its compulsive nature subside, and then the question is raised again before the patient whether or not they are willing to receive help.
Will the first such obvious ban on medical assistance for a specific group of people affect not only transsexual/transgender individuals but also others? Just recently, Health Minister Murashko announced measures to restrict the sale of drugs for early-term medical abortion. Although these medications are sometimes inaccurately referred to as hormonal contraceptives, it does not change their purpose. As a result, the idea of banning abortions does not sound as fantastical as it did before.