We do not publish the names of psychiatrists, since they live in Russia and they can be fined for "propaganda of gender reassignment."
Parade of straights in the State Duma
The new draft law is very short, in fact, it is simply the introduction of a new article into the “Law on the Protection of the Health of Citizens”: “Medical workers are prohibited from carrying out medical interventions aimed at changing the sex of a person, including the formation of a person’s primary and (or) secondary sexual characteristics of another sex." But almost 300 deputies are listed as its authors. Therefore, the meeting on June 14 passed like clockwork: parliamentarians did not skimp on cannibalistic remarks, joked about suicide and called transgender people “abracadabras”.
The need for an urgent ban on "sex reassignment" was explained by the Deputy Chairman of the State Duma Pyotr Tolstoy, United Russia faction:
“The guys who today defend our country with weapons in their hands, they must return to another country, not to the one that was before the start of the special military operation. <…> According to the Ministry of Internal Affairs, from 2016 to 2022, 3,000 people changed their gender. In fact, this can be done today on the basis of simple medical certificates, they are not recorded, they are issued in almost all private clinics in Russia. Unfortunately, the Ministry of Health does not know how many such operations are being carried out. The price of the service does not exceed 30 thousand rubles.
The deputy was answered by the Minister of Health Mikhail Murashko, who tried to maneuver between "patriotism" and professionalism:
“The Ministry of Health supports the inadmissibility of gender reassignment based solely on the patient's desire. Therefore, the tightening and strengthening of the decision-making factor for surgical or hormonal treatment, of course, should be based only on the basis of high-level consultations and, accordingly, federal institutions should be involved in this.
Then the discussion of the topic decided to revive Biysultan Khamzaev, also a deputy from United Russia:
“I have a question that probably worries a lot of people. And what about those three thousand who have already changed their documents today? And they are, as it were, both women and not, so that later someone would not come to the registry office with abracadabra? Such a life question. Here's what to do with them? Do we somehow define them, because they were once not women or men, for example? What are we going to do with them?"
The deputies laughed and clapped. Pyotr Tolstoy explained that the law does not have retroactive effect, but specifically advised Khamzaev to "be careful." The speaker of the State Duma Vyacheslav Volodin summed up the discussion:
“The law – this is a rare case – was initiated by almost all deputies of the State Duma. We are all different here, we represent different parties, the principles are different… But we would like the Ministry of Health to not come up with any amendments by the second reading, arguing that it is caring for people. You need to take care, if you want, by prohibiting all this fornication … "
Psychiatrist exposes deputies' incompetence
At the request of The Insider, psychiatrist O., who works with transgender people, assessed the level of knowledge of the deputies who introduced the bill.
“Regarding the fact that “ you can change your gender on the basis of simple medical certificates, they are not recorded, they are issued in almost all private clinics in Russia, and the cost of the service does not exceed 30 thousand rubles .” First, it is very difficult to get a certificate that gives permission to change gender in documents. The procedure for obtaining it is understandable, but the process is complex and long. And that “it is easy to make a certificate” is the personal fantasy of those deputies who talk about it. In addition, this document has a degree of protection, it is ordered in a special printing house. This is not a simple form that can be printed on a printer. All certificates are numbered, and they are all subject to accounting.
And, of course, it is not true that these certificates are issued in all private clinics in Russia. A very small number of clinics are engaged in this, they can be counted on the fingers. And the fact that “the price of the service does not exceed 30 thousand rubles”, here, most likely, the deputy says that, allegedly, for this amount, a person is guaranteed to receive a certificate. There is no such thing either. There are refusals and there are reasons for refusal, first of all, if a person does not have a diagnosis of “transsexualism”. And in budgetary organizations, by the way, this certificate is issued free of charge and the examination is carried out free of charge. So this whole paragraph is fiction, everything is not true.
Clinics that issue a certificate for transgender transition in Russia can be counted on one hand
Further. “ The Ministry of Health supports the inadmissibility of gender reassignment based only on the wishes of patients …” In general, a very interesting discussion arises. The Ministry of Health supports the “inadmissibility of sex change on the basis of the patient's desire”. So in Russia there is no opportunity to change sex on the basis of desire. In some countries, indeed, it is now being discussed that a person may have the legal right to change their gender documents based on personal choice. But we do this not at will, but according to the presence of medical indications. There is nothing to talk about here. But, unfortunately, with its help, the appearance is created that any person can come and "change sex" at will. This is wrong.
And what needs to be “ tightened ” and that's it “ It should be built only on the basis of a high-level consultation… ” It is not clear what this is about, because the whole system that is now working suits doctors first of all and gives results to patients. The goal is to “toughen up and gather councils” – what will it lead to? Well, except for delaying decision-making, probably nothing more.
The Ministry of Health says there will be suicides. And indeed they will. This law, if passed in the form it was voted for, will only lead to an increase in suicides among transgender people. And the deputies say that this is all fornication and depraved thoughts that should be banned. This suggests that they are ready to sacrifice these lives in order to realize their political ambitions and score political points.”
What is "transsexualism"
In the International Classification of Diseases, "transsexualism" has the code F 64.0 and is classified as a disorder "associated with gender identity: the desire to live and be accepted as a member of the opposite sex." This phenomenon is not new, it was known in the USSR. And the treatment of this disorder is also known: a person is shown hormone therapy and sex change in the documents so that he can live in the gender he prefers. To do operations on the body or not, the person decides later himself. But his sex, of course, remains the same – the chromosomes cannot be changed. That is why it is wrong to say "sex change". A person makes a “transgender transition”.
“Can you not do it? – clarifies the Moscow psychiatrist K. – Of course, they don’t die from this, but a person’s quality of life is low. Living in someone else's body feels quite unpleasant, people can commit suicide, mutilate themselves, trying to make a transgender transition on their own. Many such examples are known. And if medical procedures – the same hormone therapy – reduce health risks or improve the quality of life (and in relation to transgender people this is most often the case), then their expediency is undeniable.
Transgender people who have started hormone therapy and live under their preferred name say about their lives that "everything seems to be getting right, everything is in its place." Those who did not have time, do not want to talk about life at all.
Transgender people who have had time to start hormone therapy say about their lives: “Everything seems to be becoming right”
"Now it's easier for me to commit suicide"
Andrei is a young transgender man who works for an NGO in a large city as a “peer consultant”: he helps other people like him solve problems that arise.
“I chat with transgender people in our city, I am an administrator there. This chat consists of about 60 people, all over 18 years old. Some are 19-20, some are in their 40s. And in a variety of age groups, people who do not have the option of making a transgender transition very, very often show suicidal thoughts and talk about this possibility. And even if they are not going to commit suicide, they doubt that they will live long. So it was before. But now it's really bad. 18 year olds see no hope. They worry that they will have to live their whole lives without transition, and they do not want such a life. They don't believe they can handle it, and so they don't even want to try. They see the prospect of either living a life they don't want or trying to make the transition now that it's illegal and being severely punished. And people see the third option – suicide – and even consider it rational in some sense. Which sounds intimidating and makes me very stressed as a social worker.
It is not easier for adults who are about thirty or over thirty. There is a 28 year old woman in the chat. She did not start the transition, she simply has nothing to do it, she does not even have money to get to the city where the commission is being held. It was not easy for her before, but now she writes: “I see no reason to continue to live in despair that I lived the best part of my life in the wrong role. I can't make the transition myself in a way that looks acceptable as a woman. I will always look like a man. If I try to make my appearance feminine, I will just look ugly and I will most likely be killed by someone else. So it’s easier for me to commit suicide now myself … ”And so I have to constantly talk and work with people in this state.
Transgender people already have so many problems: loneliness, isolation, violence and rejection of the family, complexes due to appearance and voice, regrets about lost time. But now it got worse. The problem is aggravated by the fact that before society simply tried not to notice you, but now it has aggressively taken up arms. Now everyone is interested in getting the media juice out of this topic, and t-people in general feel horrified by this interest in their lives. And when you read in every comment section that people like me should be treated with electroshock therapy or burned alive, only those who are ready to do this to spite the world want to live.
“The passage of the commission can take years”
“If this law is passed, it will directly prohibit the provision of medical care to a doctor,” says psychiatrist O., who regularly participates in commissions that examine people diagnosed with transsexualism. – He will force him to violate the oath of the doctor of the Russian Federation – "to act in the interests of the patient." And I think doctors of all specialties should be excited about this – a dangerous precedent is being set.
Until recently, the path of a transgender person through the authorities was complicated, but understandable and thoughtful. The first condition is that the person must be 18 years old. And then the effect of Order No. 850n “On approval of the form and procedure for issuing a document on gender change by a medical organization” begins. Its meaning is that if a psychiatrist – private or in the PND – diagnosed a person with F 64.0 "transsexualism", then within a month he is sent to a commission that conducts a psychiatric examination to confirm the diagnosis. And there this person can get a certificate 087 / y, which will allow him to change documents and operations on the body.
According to the psychiatrist, the difficulty lies in the fact that, firstly, the order is not scheduled – for example, there is no observation period. Also, the expert believes, most psychiatrists do not know what gender identity is and do little work with gender mismatch. So there are very few commissions. But for those specialists who understand this, the order greatly simplifies the whole procedure.
Most psychiatrists in Russia do not know what gender identity is and do little work with gender mismatch
The commission is essentially a psychiatric examination of a citizen. And it can be carried out by any clinic subject to two conditions: having a license for psychiatry, and a certified sexologist and clinical psychologist in the state. But there are no limits, and the institutions that conduct the commission are guided by their own plans and ideas about how best to do this.
“Somewhere the procedure can be quick,” the doctor says, “the person applied, and within two weeks or a month the commission passes. And in other institutions, this can last for years, because the management has changed, the doctors have changed, the doctors may not have enough knowledge, and they do not want to take responsibility. But I have never heard that a person without a preliminary examination immediately ended up on a commission. Even with an established diagnosis, he will first be referred to a psychiatrist, then to a psychologist and a sexologist. If these specialists have no doubts, then they send him to a commission, which again will consist of a psychiatrist, a sexologist and a clinical psychologist chaired by the head physician. All these four specialists are in the office at the same time, and now they are having a conversation with a person … "
But a certificate may not be issued. For example, a patient was misdiagnosed: the first psychiatrist saw the symptoms, but the commission did not find them. A contraindication is the presence of a mental disorder in the acute period. And if everything is in order, the person is issued a certificate 087 / y, which allows the change of the gender marker in the documents. The process can take several months, then even up to six months – a change of documents.
“We don’t know the further path of people, as a rule, after that they disappear from the field of view of specialists,” the doctor explains. – Have you come for more help? Yes. But the reason here is not that there are more transgender people. This is due precisely to the fear of not having time to do it. Someone thought for a long time, someone prepared. And then they stopped postponing, because there really is a risk that everything can be canceled. And a certificate is vital for them, because the only remedy for such people is the opportunity to live in the only gender acceptable to them. There is no need for medicines and any special medical means, you just need to let them live the way they can and the way they feel.”
“Everyone is worried, the mood is gloomy”
How many transgender people there are in Russia, even the NGOs that help them do not know. This is one of the most closed categories. But there are up to 25 million of them in the world. And it is clear that now in Russia hundreds, if not thousands of people found themselves in a situation where they were told in the forehead that they would not receive help.
24-year-old Karina traveled from Siberia to Moscow to obtain a certificate. She was first asked to write an essay about her life journey up until today. Then there were long consultations and communication with doctors.
“The commission was long and it cost money,” Karina says. – It's not just coming and saying: "Give me a certificate." No. But it was possible. Now I have a certificate, but I planned to change the documents closer to autumn. I am now finishing my studies, getting a diploma. And after that I wanted to change all the documents at once. And I did not plan to do the operation. Vaginoplasty is difficult, hard, long and not every person will decide. There, everything can reach 600 thousand, given our difficulties in finding a job, an unbearable amount. Now this question is completely gone. And if hormone therapy is also banned, then everything will be generally bad. Because in many ways it is she who calms the person, hormones play the main role, and not operations.
It was hard for us to live. 80 percent had a suicide attempt. And when you open up to relatives, and you are not supported simply from all sides, it gets even worse for you. Hormone therapy and changing documents was the only way to live in harmony with yourself.”
For trans people, hormone therapy and changing documents are the only way to live in harmony with themselves.
Nikolai says that he "managed to slip through", but also only with a certificate.
“Less than a year ago I received a certificate and changed documents, started hormone therapy. True, it was a very long way: from the very first thought, then – acceptance by society, family. And money! To save money even for a trip to another city for a commission, even this is hard. All these officials are cut off from life if they believe that an ordinary Russian can wake up in the morning, decide to change sex and pay 30 thousand for a certificate. Commission – it was very long and difficult. And now I had to get up and deregister at the military registration and enlistment office. Operations? And this was unbearable before, the price is approaching the mortgage. Here is hormonal therapy … If they ban it too … I can’t even think about it now.
It's a pity for those who can already do nothing. People had plans to save money, to do everything calmly during the holidays. Now those who planned something for the summer and autumn are trying to start at least something right now. And everyone is worried, the mood is gloomy. My friend was going to pass the commission in the future, when there will be a stable job and housing. And now I fear for his life. The topic of suicide is so close to us. If at the age of 14 I had not found information that I was not the only one, I would most likely have been in the grave for a long time … "
"Plans? Максимально стелсить, то есть скрываться, и валить-валить-валить», — говорит Карина. Она собирается искать работу в любой другой стране, где врачам не запрещают помогать пациентам.
Комментарий юриста: на очереди запрет абортов
«Речь идет о том, что из-за новой идеологии государство может по своему усмотрению отказывать людям в адекватном лечении, — говорит Владимир Комов, старший партнер Правозащитной инициативы «Дело ЛГБТ+». — Диагноз-то остается, государство его не отрицает, однако лечить, как это предусмотрено и международными стандартами, и нашими, больше не собирается. А ведь многие международные стандарты формировались под влиянием советской школы психиатрии. Еще в 1991 году была утверждена инструкция Минздрава СССР, которая указывает, что именно смена документов, гендерного маркера в паспорте является обязательным этапом помощи транслюдям. А понятие «смена пола в документах» известно российскому праву вообще с 1926 года. И любой грамотный психиатр вам скажет, что невозможно при диагнозе F 64.0 облегчить жизнь такого человека, как-то его лечить, кроме как гормональной терапией и социализацией в предпочитаемом им гендере.
Государство не отрицает диагноз, однако лечить его больше не собирается
И тут появляется этот законопроект. И понятно, почему сейчас Министерство здравоохранения осторожничает и боится противостоять государству. Во-первых, страшно. После принятия в декабре 2022 года «Закона об ЛГБТ-пропаганде» Роскомнадзор прямо запрещает, в том числе и врачам, положительно отзываться о трансгендерном переходе. И думаю, мы еще увидим в судебной практике попытки привлечения врачей к ответственности за то, что они исполняют свою клятву и помогают людям. А штрафы там в отношении должностных лиц драконовские.
Во-вторых, все понимают, что это — последовательная политика властей. Ведь кроме закона о запрете «ЛГБТ-пропаганды» в декабре вышло постановление правительства, в котором людям с диагнозом F 64.0 запрещено заниматься определенной трудовой деятельностью. Там длинный список: есть запрет в области транспорта, здравоохранения, образования. А в педагогическую деятельность входит даже секретарь декана. А ведь многие т-люди именно в высшем образовании и находили себе место, потому что академическая среда — принимающая, там уважают не за паспортный пол, а за вклад в науку.
Что это значит для общества? Что государство хочет иметь возможность не только ограничивать права и свободы граждан и наказывать тех, кто не согласен. Но и кого-то лечить, кого-то — нет, фактически, распоряжаться чужим телом. Поэтому, несомненно, если мы продолжим траекторию данной правовой мысли, а право действует по инерции, то дальше будут признание феминистского и ЛГБТ-движения экстремистским, запрет абортов и карательная медицина».