This is a short post ‘answering’ my own question on Twitter: What is life really like in Russia for transgender people seeking to transition when they interact with the very ‘medical gaze’ of the state?
I didn’t get any answer on Twitter so I found out for myself (as far as possible). This is pertinent to my research for three reasons – one, I struggle to explain to my students the nuances of the gender-sexuality reality in Russia. Two, I have a research participant in Russia who wishes to transition. Three, I am writing a follow-up to a piece published this year on ‘everyday homophobia’ [opens as PDF – publisher version here]. That piece got some negative and positive feedback for obvious reasons. See two recent posts I made on this site about homophobia here and here from 2021. The original one from 2019 is here. My follow-up article will touch on the case of my research participant (though in a heavily anonymized and obscured way for ethical reasons).
A key reference point is the ICD standards, published by the WHO. The International Classification of Disease 11th edition is the latest health standard in effect from January 2021 (though unevenly adopted). This ‘update’ in defining disease is important because the 10th edition is 28 years old (though it was revised up to 2016). For a good sociology of science article on how the ICD works in relations to defining sexual health and disease (whose definition is wider than lay people normally use), see this article by Steven Epstein.
Why is this important? Because in the 10th edition of ICD, the diagnosis of ‘transexualism’ (including severe ‘gender identity disorder’ and ‘gender dysphoria’) was defined as a psychological disorder. In the 11th edition transgender identity is described in a separate section and not defined in psychiatric terms, although ‘gender incongruence’ is still a ‘diagnosis’ that a practitioner can make, albeit only in combination with another disorder. In Russia at present even the 10th edition is not consistently applied.
A resource in Russian is this article from Tinkoff journal that talks about the accepted terminology of ‘transition’, versus ‘sex change’. “Переход” not “смена пола”, and associated discussion. This article is useful because it outlines the various things one could do in Russia to transition, pointing out that not all are necessary for varieties of переход. 1. Psychiatric consultation, 2. Medical commission examination (пройти – to undergo) 3. Hormone therapy, 4. Storage of reproductive tissues, 5. Surgery, 6. Change of documents. The standard pathway in Russia at present is to get a medical professional to diagnose ‘transexualism’ under the 10th edition standard. This gives the person a ‘spravka’ – that all-important official document of Russian bureaucracy.
Now ‘spravka’ deserves to be left in Russian because while ‘official’ in some senses, these documents also contain within them the sense of an ex-officio judgement on a case where potentially more than one outcome is possible. In today’s Russia they are often equal to a clarification in a point of dispute/incoherence in a citizen’s encounter with some machinery of state. This summer I sought and obtained a spravka from my village administration head to clarify a legal question. My neighbour also applied (‘supplicated’ would be a better word). He did not get his spravka. No one can clearly define in terms of laws and regulations why. It’s a matter of ‘injustice’ for him. On the unclear boundaries between moral entitlements and legal rights in Russia, see Elena Bogdanova’s new book on complaints [academics among you – tune in our discussion of this book 2 December], or a book I just finished by Mark B Smith on Soviet housing.
It’s possible that the state clinic psychiatrist will not issue a spravka (for multiple reasons including ignorance (those living with lesser known/accepted chronic and psychiatric disorders outside Russia will find little difference here between their own experience and that in Russia), The article gives the following commentary:
“Previously, when more scientific medical ideas about transgenderness трансгендерность had not yet been formulated, a person was often refused help due to the fact that the patient did not outwardly resemble the person of the gender in which he positioned himself. It would be funny if it were not sad, because it is precisely because of this discrepancy that people with gender dysphoria suffer.”
So the recommended pathway is to pay for a private consultation. The cost of this is likely to be only a little more expensive than the state ‘spravka’ – between 25-75 Euros. This spravka in theory gives a person access to hormone treatment and/or the possibility of surgery
A next step is satisfying a medical commission: this is necessary to get a SECOND spravka – in order to get one’s legal documents amended. Interestingly, this second spravka can allow the legal ‘change of pol [sex]’ without undergoing actual medical/hormone intervention. [interestingly, in the article there’s some use of language that indicates ‘pol’ is not only used to mean biological sex, perhaps indicating the incomplete adoption of ‘gender’ as a word. Elsewhere the authors use the term ‘gender-marker’ in place of ‘pol’]. This second spravka is needed in order to approach ZAGS – the civil registration service that can then amend a birth certificate. You need four signatures on the second spravka (see the image above).
The short version: the coverage is patchy in Russia and typically, blurs the boundaries between state and private sector: medical commissions may operate within private clinics. Commissions with sexologists don’t exist in some regions and even then are mainly in large towns. As a private service, the commission may charge a very large fee – up to 600 Euro.
Moving on, we get to one of the most painful experiences of any Russian citizen – renewal of official documents. An interesting point here is that you can simply ditch your patronymic name – which of course inevitably marks gender. I’ve noticed that recently online forms have started to move away from obligatory use of patronymics, even for Russians. Another point is that you might need the services of lawyer to persuade ZAGS to allow you to change your name to a gender neutral one.
Meduza also have a useful article in Russian on this topic, including a description of the term ‘TERF’. There is a Moscow-based legal support project on VKontakte and Facebook in support of transgender people that seems active as of November 2021. They also carried out research on transgender people in Russia in 2016 and 2017. [opens as a pdf]. A more detailed link to case studies of transgender Russians who successfully and unsuccessfully ‘passed through’ medcommissions and so on is here.