Anastasia Eva Domani is one of the best known transgender women in Ukraine. She began to transition in 2016, and two years later received her new legal documents. Anastasia is a consultant and member of TransCoalition in the post-Soviet Space, which helps people who want to begin transitioning legally, medically and socially.

Even as a child, Anastasia would secretly dress in girls’ clothes. In her student years, she realised her identity and started meeting other transgender people online. Before her transition, she worked in various jobs, including property sales, which meant frequent travel around Ukraine’s regions. Before each trip she would go online to search for transgender people in the area and meet up with them in her free time.

In 2006, Anastasia got married, as she wanted to have children, and her parents had begun to hint that it was time to marry. Four years later, the couple had a daughter, but in 2016 she secretly started hormone replacement therapy (HRT), taking advice on appropriate drugs and dosage from transgender women she knew.

Hormone therapy

“The first endocrinologist I consulted about going on HRT advised me not to start transitioning because I had a family,” Anastasia tells me. “At that time married people with children weren’t officially allowed to change gender.”

In Eastern Europe and Central Asia, Anastasia says, transgender people rarely consult a doctor before starting HRT. They know in advance that they won’t get past the “Sex Realignment Commission”, which is regulated by the Ministry of Health. In other words, the state won’t allow them to start medical treatment and take steps to change their sex officially later.

“But that doesn’t stop people. They just start taking HRT on their own,” says Anastasia. “They can’t change their ID papers, but they can change their bodies to feel more natural in them. Then they might be able to get a new official ID photo and take a gender neutral name. Lots of people resort to this kind of compromise.”

This self-directed approach to HRT is a result of Ukrainian doctors’ general lack of sympathy towards transgender people, says Fridrikh Chernyshev, who heads the Trans*Generation organisation. According to Chernyshev, even just three years ago people turning to Ukraine’s “Sex Realignment Commission” could be refused the diagnosis of “transsexualism” which is essential in order to receive HRT.

“Despite the fact that the commission was officially obliged to prescribe hormone treatment, people already taking HRT were more often prescribed it than those who weren’t taking it when they applied to their doctor,” says Fridrikh.

According to Chernyshev, hormone treatment, like any other medication, has side effects and can lead to complications. Serious effects such as malignant tumours are, however, not common.

“I only know of one or two cases,” he says. “The idea that HRT can lead to cancer is unproven and was used in the past to justify sterilisation, which transgender people had to undergo to get past the commission right up until the end of 2016.”

The medics

Once she started HRT, Anastasia Domani started wearing makeup and bought herself a new wardrobe. The difference in her appearance was visible after only a few months, and changes to Ukrainian law motivated her to continue her transition. At the end of 2016, as a result of the efforts of a working group that included ministry officials, LGBT+ organisations and individual activists, Ukraine’s then acting Health Minister Ulyana Suprun simplified procedures for gender transition and sex reassignment.

“Despite the fact that the law in Ukraine changed at the end of 2016, it took until 2018 for transgender people to start changing their documents en masse. By that stage, a few sympathetic doctors had appeared and people could legally change gender,” says Anastasia Domani.

According to Ukraine’s new regulations, anyone looking for sex reassignment has to start with a visit to their doctor. In 2017, Anastasia, with the help of the Ukrainian LGBT+ organisation Insight, met one of the few sympathetic medical specialists in Kyiv, who agreed to help her, studied the new legislation and helped collect the necessary medical documentation.

Anastasia then went through an assessment by an endocrinologist and a psychiatrist, who issued her a diagnosis of “transsexualism”. (The old procedure for gender reassignment involved a month in a psychiatric in-patient clinic in a general male or female ward.)

“Transgender women could be placed in a male ward, sometimes alongside soldiers and ex-soldiers. You can imagine the conflict,” says Anastasia. “The doctors realise that transgender people are perfectly sane, but that was the system.”

Anastasia took her psychiatrist’s diagnosis back to her doctor, who set up a Medical Supervisory Committee that drew up a document relating to gender transition or sex reassignment. One copy remained with the medics; the other was given to Anastasia, so that she could begin the process of acquiring new legal documents.

Documents

Ukraine’s Ministry of Health did not respond to openDemocracy’s information request about the number of people who applied to the “Sex Reassignment Committee” before 2016 and how many were given permission, and also how many applications and authorisations there have been since the changes in the relevant laws. Last year, however, ministerial official Serhiy Shum stated that of 55 people who had requested sex reassignment under the old regulations, 35 were given an official diagnosis of “transsexualism”.

Damian Hort of TransGeneration confirms that there are still very few doctors, endocrinologists and psychiatrists who are sympathetic to transgender people, and feels that the Ukrainian government needs to set up state awareness and training programmes for doctors.

“Doctors still believe in the old stereotypes about surgery being the only route to transition,” says Fridrikh Chernyshev. “They think: I’ll sign a form, they’ll have an operation and then wish they hadn’t and it will be all my fault.”

However, according to Fridrikh and Insight coordinator Inna Iriskina, most transgender people don’t have surgery on their sexual organs. The most common procedure is plastic surgery on their breasts, usually carried out abroad.

Anastasia’s legal sex change process took about five months. She received a new birth certificate incorporating a new sex and given name (her last name wasn’t changed as it was gender neutral). Then she got new ID papers, also with a new sex and given name. She also took the decision to change her last name and went through the same procedure again.

“They were helpful to me because they realised that I knew my rights, felt confident and wouldn’t give up,” says Anastasia. “And I changed all my other documents – my ID number, my university graduation certificate, my driving licence and my employment record book – quickly and without any problems. But from what I’ve heard from other transgender people, it seems that problems can arise at any stage. Officials can start making jokes or calling their colleagues to look at the transgender person.”

The most traumatic part of Anastasia’s process was the visit to the military commissariat. To remove her name from the register, she had to bring all her ID papers and medical certificates and be checked by the military-medical committee.

“This is a basically male space,” she says. “I imagined how I would sit in a queue with men and how they would look at me. I just wanted it to be over as quickly as possible.”

Transgender women, however, can’t alter their marriage certificates or children’s birth certificates. These documents can’t have two women’s names on them, as Ukraine doesn’t recognise same sex marriage.

“In a lot of countries – Argentina, Malta, Denmark, Norway, Belgium – the law allows you to change gender-related documents without any reference to medical diagnoses or procedures,” says Inna Iriskina of Insight. “This approach is also recognised at UN and Council of Europe level. But change like this still isn’t realistic in Ukraine.”

Coming out

Over the last three years, Anastasia Domani’s appearance has changed considerably. She has lost touch with old friends and colleagues, although she is still in contact with her family. But she hasn’t come out to them.

“My parents pretend that nothing has changed,” she says. “But my wife can’t avoid noticing the changes. She has known about this for some time: she’s seen photos on my computer and read my posts on social network forums. But she never took it seriously, said it was a passing fashion and thought that I was just cheating on her.

Transgender people regular encounter hostility from their friends, family and co-workers, and suffer from depression as a result. “A few years ago a transgender lad told me he had made around 30 attempts at taking his own life,” Anastasia tells me. “I couldn’t understand that then.”

In June 2018, the World Health Organisation dropped being transgender from its list of mental health conditions. “We removed it because nowadays it’s no longer regarded as a mental health condition, and to define it as such would be tantamount to stigmatisation of transgender people,” commented WHO specialist Lale Say.

Between now and 2022, WHO member states must introduce health systems that comply with a new classification of illnesses. Last October, some activists held a protest outside the Ukrainian Ministry of Health, demanding a prompt implementation of the WHO ruling. In Ukraine, however, such a change would have to be a political decision, says Insight’s transgender department coordinator Inna Iriskina.

Because in Ukraine transgender people are diagnosed as “transsexuals”, they are banned from adopting children. “This problem will be solved when Ukraine implements the WHO ruling. But it could happen earlier if the relevant law is passed,” says Demion Hort of TransGeneration.

Transgender men and women are also barred from certain professions, especially those connected with education and defence. TransGeneration’s Fridrikh Chernyshev said in an interview last year that transgender persons’ problems with education and employment mean that they live on the verge of poverty. He also mentioned that parents often reject their transgender children, throwing them onto the street to earn their own living.

“If I lost my job in a human rights organisation, what would I do?” asks Anastasia Domani. “Transgender people’s only opportunities for employment are in the human rights field and distance working, such as IT.”

Transgender people have also often restricted access to healthcare. “Young transgender men, for example, find it hard to sit in a gynaecology waiting room. People try not to go to hospital, they allow illnesses to develop,” Anastasia tells me. She admits that she herself avoids male doctors: she can’t count on their understanding.

“Transgender men and women may also be afraid to tell their doctor that they are on HRT, in case he or she might say that this was the source of all their problems,” Fridikh Chernyshev of TransGender tells me.

Transgender people also encounter psychological and physical violence. In September, Anastasia Domani was detained in a bank in Kyiv. According to Anastasia, the bank manager used masculine forms of address to her, said that she knew her story and suggested she “go and see a doctor”. Anastasia wrote about the incident and posted her account together with a photo of the manager on her Facebook page, after which the bank security guard blocked the door and tried to make her delete the photo. Anastasia called the police and wrote a statement complaining about her unlawful detention and attempts to disclose her identity details.

Last November, a right-wing radical groups broke up a march in Kyiv to commemorate transgender people who have been killed or subjected to violence, while members of ultra-nationalist organisations held a counter protest. Two marchers were injured while police, they said, stood around doing nothing. And transgender people are not the only group to be targeted: right-wing and ultra-conservative groups regularly attack members of the LGBT+ community during and after Equality marches in Kyiv and around the regions.

After a visit to Ukraine this spring, Viktor Madrigal-Borloz, a UN expert on LGBT+ issues, stated that he hadn’t noticed any signs of rough treatment or mass violence against the LGBT+ community. He did, however, voice his concern about discrimination on the part of some bureaucrats, ultra-nationalists and church officials, as well as the fact that these crimes take place with impunity - and senior officials fail to lend open support to the LGBT+ community.