The sex change commission in Ukraine

It is a time of great change in Ukraine. Changes have taken place in Kyiv’s political order and its state borders; and military conflict continues to rage in the east of the country, all of which has captivated the imagination of the international media industry. As these ‘priority’ topics continue to dominate the debate, ‘peripheral’ issues such as feminism and LGBT activism inevitably fade into the background; on the rare occasions that they make it on to the radar, it is in a fragmented and one-sided manner.

If the mainstream media is to be believed, the LGBT community has faced two problems in ‘post-Maidan’ Ukraine: the cancellation of the Kyiv Gay Pride in July of this year and the decision of the new government – with EU consent – to defer the inclusion of sexual orientation or gender identity in anti-discrimination legislation. However, there are other things being ignored: the exclusion of particular issues from any debate, and the unequal distribution of power and resources within the LGBT community itself. In this situation, the experiences of Ukraine’s transgender citizens are forced out of the public arena, excluded from the activist agenda, and ignored in academic analysis.

A transgender blackout

Of more than 40 registered LGBT organisations in Ukraine, Insight is seemingly the only one which advertises itself as an LGBTQI-inclusive organisation (lesbian, gay, bisexual, transgender, queer and intersex). The organisation gives priority to some of society’s most vulnerable groups – lesbian, transgender and intersex people. Since 2009, it has been helping and advising transgender people, and providing them with information, and psychological and legal counselling.

Issues faced by transgender people in Ukraine are, more often than not, the very last item on the LGBT agenda – that is if they appear at all. According to Olena Shevchenko, director of Insight, this is partly due to the fact that Ukraine’s LGBT organisations tend to follow the vision and priorities of their Western funders, leading to a situation where those organisations are often insensitive to local contexts, and view the problems faced by Ukraine’s LGBT community in a narrow light.

Ukraine’s LGBT organisations tend to follow the vision and priorities of their Western funders.

‘Most organisations in Ukraine work with so-called MSM groups (men who have sex with men), and focus primarily on HIV/AIDS as this area received a great deal of funding at one time,’ says Olena. ‘At the last national LGBT conference, where 80% of the attendees were gay men and 20% "the rest", there was a particularly animated debate about lesbians, bisexual women, and transgender people. I am always surprised by people who say that they only work with gay men, and that transgender issues should be an optional issue.’

Though many LGBT and feminist activists skirt over or ignore the transgender subject, the word is neither new nor unknown in Ukraine. The dominant Western (Anglo-American) understanding of ‘transgender’ is extensive and inclusive, and encompasses a diverse range of gender-variant subjectivities and experiences such as transvestism, transsexuality, genderqueer, female and male drag etc. In many non-western contexts such as Ukraine, ‘transgender’ is often re-defined and/ or reduced to particular meanings. Thus, in Ukraine, the term ‘transgender’ refers to what in the West is usually meant by ‘transsexual’; it is used to describe those people whose gender identity does not match the biological gender assigned to them at birth, and who opt for medical procedures in order to ‘transition’ to the opposite sex (both medically and legally). In Ukraine, the term is reduced to the procedure and practice of sex change, and has this narrow meaning both amongst the general public and within the LGBT community. However, it is crucial to understand that the trans community in Ukraine is loath to ally itself with the term ‘transsexualism’ because this is how the state medical institutions have translated ‘Gender Identity Disorder’ (the diagnosis described in the International Classification of Disease-10). Keen to distance itself from this pathologising medical label, the trans community has largely accepted the term ‘transgender.’

That being said, it is important to acknowledge that the transgender community in Ukraine (and indeed everywhere else) is not a homogenous group that thinks and acts in unison. Some view the prefix ‘trans’ as temporary, unnecessary and/or humiliating, and aim to transition into the neat category of ‘man’ or ‘woman;’ others wear the label ‘transgender’ with pride and consider it part of their social and political identity; and yet others feel that the term ‘queer’ is more appropriate to them.

In Ukraine, the term ‘transgender’ refers to what in the West is usually meant by ‘transsexual.’

For all its diversity, however, the transgender community in Ukraine is united in the struggles its members face when dealing with the country’s medical and legal institutions during the ‘gender reassignment’ process.

The sex change commission

In Ukraine, the procedure for sex reassignment – or ‘sex change (correction)’ as it is called in official documents – is regulated by the country’s Ministry of Health, according to Decree No.60 (03/02/2011).

This decree determines how the procedures should be carried out and stipulates the 'medico-biological' and 'socio-psychological' indications and counter-indications for changing (correcting) sex. It also provides for a commission of doctors, with the power not only to permit or refuse medical procedures (both surgical and hormonal) but also to determine whether transgender individuals have the ‘necessary’ and ‘sufficient’ grounds to have the sex stated on their official documents, legally changed. Any such change may only be made with the permission of this commission.

When I met Max, a transgender man who has already passed the scrutiny of the commission, he described it to me as such: ‘these are people who determine the fates of others. And they behave like people who determine the fates of others. They are conscious of their absolute power and this is reconfirmed to them the moment you first appear before them. They understand that you are utterly dependent upon them and that your life is in their hands. You can do nothing but play according to their rules as long as you possibly can. It is a totalitarian machine…’

According to Insight, the 12 doctors who make up the commission do not change. The rigidity of the commission’s structures makes it almost impossible for transgender people to try again, having already failed, to pass or to challenge the verdict of the commission. The commission’s structures also appear corrupt as some of its doctors actually provide (for payment) the very services they then force upon applicants. Corruption within the medical sector, the imbalance of power, and the victimisation and demonisation of transgender ‘patients’ in Ukraine makes the process of going before the commission a humiliating, traumatic, almost Kafkaesque experience for Ukraine’s transgender citizens. This situation is rendered even more difficult by the fact that they have little say (literally) at the commission hearings.

‘These are people who determine the fates of others. And they behave like people who determine the fates of others.'

Anna Kirey, a trans activist, has attended commission hearings in the past (to support transgender ‘patients’ and monitor how they are treated by the commission): ‘during the two evaluations that I attended, there was hardly one word uttered by a transgender person. The doctors didn’t seem interested in their individual needs and didn’t even think to ask them whether they in fact wanted medical or surgical procedures. The evaluations felt more like criminal trials than a process in which the rights and interests of the individuals under discussion were being taken into account.’

For most transgender people in Ukraine, the commission is a necessary and unavoidable evil which they must confront in order to have the sex on their documents legally changed so as to reflect their desired gender identity and, often, their appearance (many begin hormone treatment long before the commission, and without medical advice). Having this change made to their documents is of extreme importance to transgender people because the documents have a profound impact upon their daily lives.

Documentation

Anton, a transgender man, has been taking hormones for quite some time, and his appearance barely differs from that of a ‘natural’ man. However, the discrepancy between his physical appearance and the stated sex in his official documents can make situations, which for most people are safe and unproblematic, both uncomfortable and dangerous.

‘Of course it’s very important for me to have these changes made to my documentation. My current documents make life pretty complicated, from finding work to simply boarding a train. Even the most banal situations can be uncomfortable and difficult for me. For example, I earn extra money by working for a foreign company that transfers the money to me from abroad. For this, you need to open a foreign currency account, and to open a foreign currency account you need to go to the bank. Going to the bank always involves some sort of drama for me. I hand over my passport with a kilometre-long queue of customers waiting impatiently behind me. The girl behind the counter starts to ask questions about my appearance and the name in my passport. Everyone in the crowded bank stops and begins to stare at me. It’s like that everywhere I go. It’s annoying, to say the least. It’s bearable if people just take a look and then move on but some people get aggressive. It’s even worse now with Ukraine’s current situation where there are many threatening people walking around, some with guns.'

‘Voluntary’ hospitalisation

Despite the challenges Anton faces on a daily basis, he continues to delay appearing before the commission. His personal reasoning for this is the requirement stipulated by Decree No. 60, for transgender people to admit themselves into a psychiatric hospital before being allowed to come before the commission. According to the decree, individuals must spend between 30 and 45 days in a closed psychiatric hospital, and be officially diagnosed as ‘transsexual’ before being permitted to appear in front of the commission. Ukraine is the only country in Europe, which forces its transgender citizens to be hospitalised in a closed psychiatric facility, before they can be classified as ‘transsexual.’

Being hospitalised in a psychiatric facility is often a humiliating, uncomfortable, and traumatising experience for transgender individuals. Some transgender people succeed in coming to some sort of arrangement with their doctors. Max, for example, took the time to acquire a complete understanding of the nuances of Ukraine’s medical system during his transition process, and managed to secure a partial hospitalisation agreement, whereby he would alternate between one week in hospital and one week at home where he had both work and school commitments.

‘One day you’re a “regular” person, and the next day you have to admit yourself into a psychiatric hospital.’

‘Nonetheless, it’s a traumatic experience’, says Max. ‘Just imagine, one day you’re a “regular” person, living independently in society and socialising, and the next, you have to admit yourself into a psychiatric hospital. These hospitals have their own regimes. In some of them there are metal bars everywhere, and you can’t just leave or go somewhere. For example, you can’t just pop to the shops to buy a chocolate bar or whatever else you might want. It’s no sanatorium. You’re conscious of everything that’s happening, but you need to stay put inside this nightmare.’

Though some ‘patients’ may wind up under the care of more knowledgeable and caring doctors, and others are able to work the system so as to avoid the very harshest conditions (this is dependent upon the social skills, connections, and financial situation of individuals), it is impossible to avoid hospitalisation completely. This means that, no matter who you are, you will have to communicate with insensitive medical staff, undergo psychological and psychiatric examination, and receive a final diagnosis, which substantially affects and restricts your social opportunities in the future.

The contra-indications

After receiving the diagnosis of transsexuality, from doctors at the psychiatric hospital, transgender people next have to undergo an examination by the commission of doctors, working under the auspices of Decree No.60, which will then confirm (or not) the diagnosis, and provide (or not) the authorisation for medical and/or surgical interventions. To confirm the diagnosis the commission is guided by the terms of the decree, which stipulates a list of ‘medico-biological and socio-psychological’ contra-indications that must be determined before a ‘sex change’ can be allowed. The list of contra-indications is long, and some of the points give rise to legal complications: for example, being a parent of children under the age of 18 and being married at the time of application. How does one describe a transgender parent on the birth certificate of a child – as the father or the mother? And how is one to understand ‘marriage,’ if in changing the sex of a transgender person, the commission of doctors also changes the marital status of the individual in question to ‘homosexual,’ given that Ukraine’s Family Code does not recognise same-sex unions? Instead of transforming the legal norms, however, the bureaucratic, legal, and ideological apparatus of the State opts for the less complicated route of simply excluding and brushing aside those individuals or minority groups that do not fit into the prevailing binary system and its normative thinking.

The list of contra-indications is long, and some of the points give rise to legal complications.

Being in ‘violation of social adaptation’ (for example, being unemployed) is a further contra-indication. At the same time, however, demonstrating endocrine, morphological, neurophysiological, psychological, and physical signs of the desired (opposite) sex can speak strongly in the applicant’s favour at the commission hearing, that is to say that, if you want to have surgery to become medically female, you will have a higher chance if you look like a woman, and vice versa. This encourages many transgender people to begin taking hormones without consulting doctors, and before undergoing the commission tests so that their physical appearance is more in keeping with their desired gender. This was the case with the aforementioned Anton who selected his dosage of testosterone based solely upon information he found online and received from his transgender friends. According to Anton, 90% of transgender people in Ukraine do this in order to increase their chances of passing the commission tests. But whilst changes to their physical appearance may help their chances at the commission hearings, they also create other problems for transgender people, as they begin to look less and less like the photos in their passport and other documents. As such, it becomes more difficult for transgender people to find or hold on to a job or to secure housing, all of which falls into the category of ‘violations of social adaptation,’ which, according to Decree No.60, is grounds for refusing a medical and legal ‘sex change.’

Policing transgender bodies

The double standards and dictatorial logic of the decree becomes even more apparent when you take into account the final point in the list of contra-indications, which is ‘the refusal to agree to the diagnostic and therapeutic measures recommended by the commission.’ This is a common reason for refusing transgender people the right to medical procedures and alterations to legal documents. What constitutes the recommended measures, however, is not made clear in the decree, and is determined arbitrarily by the commission, which does not take into account the desires or needs of transgender people. In response to a request from Insight for more information on these recommendations, the commission gave the unequivocal answer that ‘all reproductive organs must be removed from the transgender person’s body.’ This response reveals that forced sterilisation is still being practised upon transgender people in Ukraine today.

Forced sterilisation is still being practised upon transgender people in Ukraine today.

But state control over transgender bodies does not end here. The legal diagnosis of ‘transsexualism,’ which paves the way for potential gender reassignment surgery, and changes to documentation, in turn is a contra-indication preventing both adoption and assisted reproductive technologies (including surrogacy and the cryopreservation of sperm, ova, embryos, and other biological material). Thus, the State seeks to maintain a status quo, in which transgender people are deprived of reproductive and parental rights, and left without any ability to overcome these limitations. Unless they agree to sterilisation, transgender people are not permitted to undergo transformative surgery or to have their documents legally changed; and without changes to these documents it is difficult for transgender people to lead a ‘normal’ life.

But what is ‘normal’

Anton is waiting for me in a café. Summer is in full swing and the heat is unbearable but Anton is wearing a fleece, and he is slouched so far down in his chair that he is hardly noticeable. I am familiar with this posture from my other transgender friends. I sit down, take out my notebook, and we start talking.

‘Yes, I take hormones but I don’t think that's what defines me. Hormones are necessary for my bodily transformation – to feel more comfortable and at ease. I’m lucky, right now I can afford not to go before the commission because I have a job where I am accepted as a transperson. And I still hold on to the hope – perhaps foolishly – that there will come a time when the law will change so that we don’t have to go to the nuthouse or go through all these operations. And, let me tell you, if we lived in a society where people responded normally to men who have both a beard and breasts, then I wouldn’t even have the operation. Not ever.’

As Olena Shevchenko of Insight points out, many (but not all) transgender people just want to move quietly from one box to another, to transition from one gender to another, and start living a new and ‘normal’ life. Those who strive for this should undeniably have the right to do so. However, as a society perhaps we should also be placing the concept of ‘normality’ under the microscope. Perhaps we should be asking ourselves whether we want to make space in Ukraine for variation, diversity, and for alternative ways of life. If the answer is yes, then we must find ways to challenge the state systems and institutions, which so zealously monitor and preserve what is ‘normal.’