On June 21, the Russian State Duma voted to ban gender-affirming care for all transgender people. The ban applies to any “medical interventions aimed at changing the sex of a person” and prohibits transgender people from changing their name and gender marker on official documents.
The ban on legal and medical gender transition marks the latest escalation in Russia’s crackdown on LGBTQ+ rights. In November 2022, Russian President Vladimir Putin signed a law prohibiting any activities that promote “non-traditional sexual relationships,” effectively outlawing any books, films, media and online resources that discuss LGBTQ+ people.
The bill outlawing gender-affirming care must still pass through Russia’s upper house of parliament and be signed by Putin, but in the event of its likely adoption, it will prevent transgender people from accessing life-saving treatments, ranging from psychological care to hormone therapy to voluntary surgeries.
According to Egor Burtsev, a clinical psychologist who has worked with transgender and LGBTQ+ patients in Russia for over 10 years, the abolition of gender-affirming care amounts to “torture.”
Burtsev, who left Russia in April 2022 out of concern for his safety and now lives in Lithuania, worries that the new law will precipitate a mental health crisis in Russia’s trans community, amplify the stigma that LGBTQ+ Russians have long faced and trigger violence against transgender people in Russia. To better understand the far-reaching consequences of a ban on gender-affirming care, I spoke with Burtsev on Telegram.
This conversation has been edited for length and clarity.
The Russian parliament has passed a law banning legal and surgical sex changes. What impact will this have on access to medical and psychological care for transgender people?
What they are proposing is a complete abolition of gender reassignment procedures, surgeries and hormone therapy for transgender people. It is a complete ban. What consequences will this have? Transgender people remain, but the procedures are banned. A transgender person — someone who has been undergoing hormone therapy for 10,15 years, who’s looked completely different for a long time, socialized in a completely different way — is suddenly deprived of the possibility to receive hormone therapy. The body changes, not quickly, but it changes, there are all kinds of reversals, transformations. And the relationship with one’s body, for transgender people, is quite complicated. What we will see is the highest risk of depression, the highest risk of self-harm, the highest risk of suicide.
All possible channels of any kind of medical care will be cut off. Transgender people are not going anywhere. They can’t change how they feel, what their gender identity is, because the authorities ordered it. They’re being thrown overboard. And I would equate this to torture: depriving transgender people of medical care, hormone therapy and any psychological help that might have been available before.
Trans people have been left completely without help and in a terrible position of fear, humiliation, discrimination, stigma.
Russia is not the only country adopting laws against gender-affirming care. In the U.S., for example, Florida recently passed a bill that made it illegal to provide gender-affirming care to trans children under 18. From a medical perspective, is it necessary to have any restrictions on who, and at what age, should be able to undergo a gender transition?
There is a wave of such anti-gender movements in the world right now. Conservatism and neoconservatism are coming to the fore. The wave of anti-trans movements is sweeping the world, and Russia has actively, happily joined in. Even some quite democratic countries are not succeeding on this front right now. But that doesn’t mean that this situation won’t change, because democracy works somewhat differently. Democracy doesn’t work like this, with one vulnerable group receiving help while another gets discarded.
As for helping trans children under 18, that’s a very controversial issue. There is no uniform policy on this. It’s understandable that the first feeling the idea evokes is probably bewilderment: ‘How can we allow something like this to happen before a child turns 18?’ But as a psychologist who’s worked mostly in Russia, where gender transition was allowed from the age of 18, I usually recommend to parents to simply provide support, to call the person by their name and use their pronouns. And according to statistics, this dramatically reduces the risk of suicidal behavior — just accept the child, call them what they like.
It is important to give people the right to decide for themselves, from a certain age, what will happen with hormone therapy and to give endocrinologists the opportunity to help people intelligently, clearly, taking into account their circumstances.
Based on what you’ve seen in your practice, what have been some of the challenges — medical, interpersonal, social — for transgender people in Russia?
The first problem has to do with socialization. It begins with a person becoming aware of themselves and bringing themselves before society — this is the coming-out process. And the first problem is usually related to acceptance: by family, friends, colleagues, classmates and so on. Of course, there’s the constant stigma. There is also a huge problem with accessing healthcare that has always been there.
Because the stigma is so layered, so varied, trans people experience different challenges. Often they experience trauma, stress and suicidal ideation. Episodes of depression can be pretty severe. A large percentage of transgender people experience depressive states. Anxiety is also extremely common. All of this happens because the stigma and the discrimination all over the world, and especially in Russia, are quite strong.
Can you briefly explain the legal and medical process that a trans person in Russia needed to go through if they wanted to transition, before this law was passed?
The transition procedure in Russia was one of the best in the world. We were even a little proud of it, because in recent years, Russia was preparing to adopt ICD-11. This is the 11th revision of the International Classification of Diseases, in which ‘transsexualism’ is excluded from the list of psychiatric conditions. The removal of this psychiatric diagnosis was a huge victory for the trans community. Plus, with the exclusion of this diagnosis, the procedure for changing one’s gender marker has been simplified in many countries. That is, people simply come in, declare their desire to transition and have different procedures.
We had commissions in Russia that issued permits [to transgender people]. The commission consisted of a psychiatrist, a clinical psychologist and a sexologist. People came before these commissions, had conversations and were diagnosed. Afterwards, they received written permission to change the gender marker in their passport without any legal obstacles. The procedure was quite humane. Before that, less than 10 years ago, this process still required surgery. You had to have at least one surgical procedure. And, in many countries of the world, this requirement still remains.
There has been a lot of talk from the Russian government about protecting “traditional values.” Putin often says that soon, in the West, children will have a “Parent #1” and a “Parent #2,” instead of a mom and a dad.
One of the major problems that Putin and some other politicians — or, rather, the entire State Duma — have is that they don’t pay attention to science-based approaches. They don’t look at the science, they don’t look at the research, they don’t know what they’re proposing. They just engage in populism in the service of power.
The whole world is moving toward greater diversity, there is no stopping it. We see it in our teenagers — who are 15-16 years old, who are not interested in politics because of their age, who are more interested in relationships and their own identities — and in how they construct their identities, how they look at relationships, how they experiment. They have a much more open view on things. The world, for them, is much more multilayered, not black-and-white like it is for government representatives, who tend to be quite old.
Does the government’s position reflect prevailing attitudes toward transgender people?
I think in many ways it does. Because there is such a thing as propaganda, and propaganda shapes the average Russian’s public opinion. And if propaganda works, then quite a few people really are transphobic, homophobic. I’m afraid there will be a lot of violence against LGBTQ+ people and against transgender people. There will be murders, there will be violence. It’s very scary. It’s a nightmare.
So, fearing exactly that, LGBTQ+ people are now panicking and trying to escape to somewhere else. But trans people tend to be financially disadvantaged. It’s very hard for them to move, they don’t have the right documents, they don’t always have passports. They find themselves trapped inside [Russia] with this society.
But there is an alternative, there are, of course, people who are more progressive, who think for themselves. Some have left for now, but many have stayed in the country. They just shut down, they keep quiet, they don’t actively speak out, because staying safe right now is paramount. As soon as there is a chance to exhale, we will hear those voices. And I really hope that someday the situation will begin to change for the better. We must all work together to change it.