“The State Only Sees Your Genitals”

When Russia banned “gender reassignment” in July 2023, it left many people stranded mid-transition. Their appearances may have changed, but their passports still list their former names and genders. In this piece for The New Tab, journalist Miron Ronin looks at how they navigate everyday life — the workarounds they use to find jobs or access healthcare, and the rare, risky ways some still manage to change their papers despite the ban.

“A Person Visits the Doctor With Male Identification Documents, but Has Breasts.” 

Sasha is a tall, slender brunette with green eyes who works at a military hospital in a small village in the Urals. Her documents identify her as “Alexander” and list her gender as male.

Sasha began her gender transition in 2021, when she was 35 years old. It was not an easy decision to make. 

“I was worried about how it would be, how I would tell my mom, and how I would go to the doctor once I had breasts. In the end, I thought, ‘What do I have to lose?’ I’ve lived half my life as a guy; I’ll live the rest however I want,” Sasha explains. 

Before starting her transition, Sasha quit her job at the military registration office, where she had worked previously. She then took a position (Sasha requested that her occupation not be disclosed. It is not the medical profession.) at a military hospital so she could be “under the supervision” of doctors. During hormone therapy, regular monitoring of blood counts and examinations is necessary for health and safety.

In 2022, as her appearance began to change, Sasha started posting new photos on her VK page. Her former colleagues from the military registration office removed her from their friends list. “Some began to ask, ‘Why are you dressing up as a woman?'” Sasha shares. “But I’m not dressing up; this is how I look.”

At the hospital, she chose not to disclose her hormone therapy, but her colleagues still noticed the changes in her appearance. At work, she attempts to conceal the breasts that have developed due to hormone replacement therapy (HRT) by wearing tight bras and vests over her shirts.

“Some therapists, especially men, when I’m unwell or something… they say, ‘Let’s lift your T-shirt in the back; I will listen there…’ They do not mention anything about my gender, but I think they suspect.”

Sasha started taking hormones on her own and didn’t approach the endocrinologist at her hospital for assistance, as hormone therapy for gender transition (Hormone therapy, whether masculinising or feminising, helps transgender people alter their bodies to align with their gender identity.) is prohibited in Russia. She believes it is best if no one at work knows about this part of her life because they would not understand.

However, one time she needed to see a doctor. Sasha experienced side effects from incorrectly prescribed hormone therapy — specifically, panic attacks. A transgender friend recommended an endocrinologist who had treated her. Sasha consulted with the doctor online and bought hormones at a pharmacy without a prescription.

Shortly after the law banning gender transition was passed in July 2023, the doctor stopped communicating with her.

“I don’t have an F64 certificate, so the doctor became afraid to communicate with me. Because I’m taking all this illegally,” Sasha says.

Ekaterina, a consultant at an organisation (Ekaterina requested that the organisation remain unnamed due to the risk of state persecution) that supports transgender people, says that in Russia, transgender people are effectively outlawed, leading doctors to fear accepting such patients or prescribing hormone therapy. According to Ekaterina, the situation varies from clinic to clinic and depends on the head doctor:

“We have encountered situations where some medical professionals say, ‘My head doctor has forbidden me from treating transgender people.’ Following that, everyone acts at their own discretion: some try to treat transgender patients discreetly, while others switch clinics. Consequently, self-medication is on the rise among transgender people.”

Sasha wanted to undergo a medical examination to obtain a certificate that would enable her to change her documents, but she was unable to do so. Her mother was diagnosed with cancer. “I had to go to Moscow, be there in person, and talk to the doctors. I could not do it; I could not leave my mom. I had to sacrifice something,” Sasha explains. She never told her mother about her transgender identity out of fear. Her mother passed away without knowing.

While Sasha was caring for her mother, the State Duma passed a law prohibiting changes to the “gender” in passports and operations related to gender transition. Like many others who have already undergone gender transition but have not had time to change their documents, Sasha now has to lead a double life. She tries to balance her self-perception with her male role at work, where she dresses in a unisex style:

“When I have to carry something heavy at work, I change my clothes, put my hair in a bun, and that is it: I am just a regular guy. But I can not do that for long. I want to be a ‘tyanka’ (Tyanka, or chick, is derived from the Japanese word ‘tyan’. It is a slang term commonly used in Russian-speaking online communities and anime culture to refer to a young woman).”

Sometimes, Sasha enjoys dressing up, putting on makeup, and going to another city for shopping.

Anya, a 30-year-old IT specialist from Moscow, has not yet updated her identification documents. The young woman, who has long blond hair and loves makeup and miniskirts, still has “Maxim” listed as her name. When Anya needs to consult with an endocrinologist, she reaches out to a doctor from Kazakhstan online, as “local doctors are not permitted to prescribe hormone replacement therapy even with an F64 certificate”.

Anya avoids using her health insurance from work because she fears that doctors might report her, leading her employers to discover her transgender status. “A Person Visits the Doctor With Male Identification Documents, but Has Breasts…I am scared to undress anywhere or undergo tests that could compromise me,” Anya explains. She does not take sick leave when she is unwell; instead, she tries to rest at home.

“Fear has begun to spread throughout the community, leading many people to avoid going to the doctor. They are anxious and put off seeking help. For instance, there was a case of a transgender man who let his illness escalate. Despite being in pain, he endured it and did not consult a doctor. Eventually, he fainted and ended up in intensive care. Fortunately, he was rescued. This was not due to indifference but rather the overwhelming fear of seeking medical assistance,” explains Ekaterina.

While it is easier to obtain medical help in private clinics, not everyone can afford this option.

“There Must Be a Clear Dual Role If We Want to Secure Employment.”

Adele is a delicate 48-year-old woman with a high voice and long blonde hair. However, according to her official documents, she is named Alexei.

Adele embraced her transgender identity around the age of 40 and decided to come out almost immediately. She arrived at work wearing a dress and makeup. At that time, she was fairly well-known in a small town in the Murmansk region.

“I was involved in government contracts, tenders, and public procurement. I was recognised in the fields of medicine, the local educational institutions, and the city administration. When I came to work looking different, I felt as though I had turned everyone who knew me against me,” says Adele.

Rumours spread throughout the city, and many people abandoned Adele, including her mother. Adele recalls a visit when she wore a dress and said, “Mum, hello… well, that’s it… You no longer have a son; you have a daughter. Her name is Adele.” According to Adele, her mother could not accept this change: “My mother is the only family I have left. I lost everyone — those who were close to me, dear to me.”

Due to the adverse reactions from those around her, Adele decided to move to Moscow, believing life would be easier in the big city. However, finding a job that matched her qualifications and experience, given her male identification documents, proved to be challenging. Adele’s attempts to secure a good job often ended in rejection.

Currently, she works in a chain store selling alcohol. The store manager, whom she met in Moscow, helped her secure the position. “The manager understands me, she’s a lesbian. She said, ‘Let me help you,’” Adele explains. When a vacancy opened up, the manager warned her that she would need to present herself as masculine as possible during the interview at the central office.

“There Must Be a Clear Dual Role If We Want to Secure Employment,” says Adele. 

Because of her male documents, Adele tries to suppress her femininity at work. She ties her hair back in a ponytail, applies clear nail polish, and even speaks to her colleagues in a masculine voice. “I can speak in different voices — I studied music,” says Adele. She adds that she only has to restrict her presentation at work; the rest of the time, she expresses her femininity. 

Adele believes that the ban on gender transitions is tied to the “propaganda of non-traditional relationships” and holds a negative attitude towards LGBT people. She explains, “I have fought against LGBT individuals myself because I am against this propaganda. There is either ‘M’ or ‘F.’ There is no third gender, and there shouldn’t be. Psychologically and emotionally, I am a woman in every way. That’s the difference.”

Anya, an IT specialist who works remotely in Moscow, tries to tone down the changes in her appearance when she needs to go to the office. “I go there dressed in a unisex style. I have long hair, pierced ears, and I often show up at work with a manicure,” she shares. Anya believes that the gradual nature of her appearance changes gave her colleagues time to adjust, which has helped maintain good relationships at work. She thinks that, for most people, the quality of work is more important than appearance. Although Anya notes that her boss often expresses homophobic and transphobic views, she has not encountered any conflicts with him. “He also looks disapprovingly, but he does not say anything; he just sighs. It is clear that he is uncomfortable.”

Anya has a “grand plan”: she wants to undergo “bottom” surgery (Gender-affirming surgery, often referred to as “bottom” surgery, involves the surgical alteration of the genitals in accordance with a person’s gender identity. For transgender men, this usually includes phalloplasty, while for transgender women, it typically involves vaginoplasty), change her passport, and find a new job so she can start a new life under a new name, with female identification documents.

Anya is primarily concerned about finding a new job. She fears that her transgender status may be revealed — to validate her experience, she will need to showcase projects she has worked on in the past, which are associated with her male name.

Similar to Anya and Adele, Sasha is also navigating the workplace environment at a military hospital while wearing unisex clothing. Her colleagues have mixed reactions to her transition: some continue to interact with her as if she were a man, while others do not even say “hi”. According to Sasha, her colleague, who does not shave his stubble, receives better treatment at work than she does. Sasha is reluctant to explain to her colleagues that she is a transgender woman, believing they may not understand. “I only joke with one colleague at work, saying things like, ‘Yes, I’m a trans woman, a trans woman!’ He laughs, not believing, but he suspects it might be true,” Sasha shares.

Patients and new employees who did not know Sasha before perceive her as a woman. “Old women whisper when I walk by: ‘She’s so big.’ We even had a new employee who said, ‘At first, I thought you were a girl. Do you like that?’ I replied, ‘Yes,’” Sasha recounts.

Pic 9. Ray is surprised by those who condemn him: “They told me, ‘You are going against God because that’s how you were created.’ How selfish do you have to be to claim that you know God’s plan?”

Ray, a young man with a pleasant baritone voice and stylish sideburns, is still listed as Marina in his passport. He has been fortunate with his job. At the beginning of his transition in the winter-spring of 2023, he taught at two educational centres for neurodiverse children in Siberia: one state-run and one private. He left the first one almost immediately due to the “too homophobic environment” and decided to come out at the private centre. His supervisors were supportive, and they worked together to determine how to present this to the children; they explained that after his vacation, Ray would return as the “brother” of their tutor, Marina. Although Ray worked there for a time, he eventually decided to leave.

Now, he is a barista in a small-town café. Ray got the job by using female documents while presenting as a male. He initially did not want his colleagues to know about his female passport, but the information soon became known.

“Everyone took it calmly. New people come in, and no one tells them anything anymore. The bosses were accepting; the main thing is that you are a good person,” Ray says.

“Are you spreading propaganda?”

The hospital where Sasha works receives wounded soldiers from the war, many of them former prisoners. Sasha tries to avoid interacting with them, but it does not always work. Once, a soldier from PMC Wagner wanted to approach her, and Sasha told him she was not a girl but a boy. It took some time, but eventually he left her alone.

A former prisoner who lives in a nearby village shouts threats at her. The village is small — everyone knows each other — and Sasha can’t stay unnoticed. Counting on the police for help is unrealistic in her situation. To protect herself, she took a course to get a license for a civilian weapon.

“I bought two traumatic pistols, and now I am not afraid of anything. I practice regularly at the shooting range. There is no other choice now — that’s just the reality in this country. Plus, there are a lot of criminals,” Sasha says.

Ekaterina advises transgender people not to turn to the police, even for everyday problems: “It used to be possible, but not anymore. If there is even the slightest risk your trans status could be revealed, it is unsafe — it can easily be used to pressure you.”

Anya prefers to wear feminine clothing and light makeup when she is not at work or in government institutions. Still, she tries to avoid situations where she must present her documents. For instance, she only buys alcohol in the company of others because when she shows her passport, people sometimes tell her, “That’s not you.”

It becomes more challenging on the roads when traffic police officers ask to see her documents. However, Anya has not faced any aggression from them. Only once did she experience a thorough search of her car. 

“At first, they did not understand the situation. They asked, ‘Whose bag is this?’ I replied, ‘Mine.’ They responded, ‘This is a woman’s bag.’ I confirmed, ‘That’s right, it’s mine.’ Then they questioned, ‘And the documents are yours too, then?’ I answered, ‘Yes, they are.’ They rummaged through my things and asked, ‘Are you spreading propaganda?’ I said, ‘No.’ That was the end of it, but it was very scary, of course,” Anya recounted.

Adele has found a way to minimise her risks when presenting her “male” documents by changing the photo in her passport to a female one. She is also considering changing her first and last names to more “neutral” ones, such as Alex Winner, so that people will no longer pay attention to the “gender” column.

According to Ekaterina, mismatches between photographs and gender references in passports cause significant challenges for transgender individuals, particularly when travelling by air or train. She notes, “This gender mismatch is astonishing. After changing the photo, these issues typically no longer occur.”

Ekaterina, whose documents also display a male name, advises handling such situations with confidence and refraining from apologising for one’s identity. She explains, “If someone comments on my passport, I respond in a manner that avoids discussing transgender issues. Even when directly asked, ‘Have you changed your gender?’ I reply, ‘As you can see from my documents, no.'”

Prior to the passing of the law banning “gender reassignment” in July 2023, she frequently faced questions at airports regarding why she had not updated her documents. Since the law was enacted, these inquiries have diminished.

“They can’t do anything about it. They just look at the documents, stamp them, and that’s it,” Ekaterina states.

“All it does is burden the courts, burden people.”

Anya desires to change further her appearance to look as feminine as possible and undergo gender-affirming surgery. However, to eliminate the need to live a double life and “dress in unisex clothing for visits to government agencies”, she must update her identification documents. This change is only possible through the courts, and even after her surgery, there is no guarantee that the judge will rule in her favour.

Ray received a medical commission report from a commercial clinic in Moscow before the law banning gender reassignment was enacted in May 2023. He submitted his documents to change his passport at the civil registry office in his regional centre (Before the law against gender reassignment took effect, it was possible to change one’s gender marker based on certificate No. 087у. To do this, one simply needed to apply to the registry office, have the birth certificate amended to reflect the change of gender, and then update the passport using the new birth certificate). He then returned to Moscow to undergo a mastectomy. “The doctor did not stop; he performed eight operations a day, removing excess tissue. There were many requests before the law was passed,” Ray explains.

His application to change his documents at the civil registry office took too long to process: Ray did not manage to get a new passport before July 2023. So, he turned to Elvira, a human rights advocate who helps transgender people in court. Ray’s legal battle lasted two years. According to him, the head of the local registry office actually supported him: “She told me, ‘I was instructed to object in court, but I’m on your side — I understand this whole situation.’”

Ray’s parents, even though they were against his transition, also came to court to support him. Elvira says that this kind of backing from family and community greatly increases the chances of winning. In the end, the judge in Ray’s hometown ruled in his favour.

What else matters to judges when considering cases on changing gender markers in documents

According to human rights advocate Elvira, the decision is ultimately left to the judge’s discretion, but there are common patterns. In particular, judges pay attention to passing — a person’s ability to be perceived by others in line with their affirmed gender. Medical documents are also important, including records of gender-affirming surgeries (medical interventions aimed at aligning a person’s body with their gender identity).

“If surgeries were done before the ban on ‘gender changes,” then before filing a lawsuit, you need to go through a state commission, which determines gender based on those changes. At the moment, there is only one such commission — at the National Medical Research Centre for Endocrinology of the Russian Ministry of Health. If surgeries were performed afterwards (meaning those done outside Russia — Ed.), then you have to go to court to establish the fact of a ‘gender change.” On the basis of the court’s ruling, documents can be changed,” Elvira explains.

She noted that since July 2023, there have been approximately 150 court cases in Russia concerning gender marker changes: 24 were lost, some are still ongoing, some were dismissed without consideration, and 20 were won (16 of which were led by Elvira herself). She considers this a good outcome, since many human rights defenders “didn’t believe it was possible to win anything in court at all.”

Now, Ray is waiting for the court decision to take effect and hopes to have his documents changed by the summer of 2025, in time for his 30th birthday. After that, he wants to marry his girlfriend Lena. It is something Ray has dreamed of since school, when they were close friends. When he moved away for university, they lost touch for a while, but five years ago, they started dating. Lena supported his decision to transition. For Ray, the case wasn’t just a legal battle — it was a fight against “rigid people who can’t understand me.”

“For me, this victory isn’t just personal. Cisgender people get married, divorced, have children — it all just happens for them. But for me, just to marry the woman I love, I had to fight so much. <…> When the state doesn’t see you as yourself but only as your genitals — it’s not okay.”

Adel hopes to change her documents and go stealth (Stealth is a way of life for transgender people in which they hide their trans status): to completely change her life and job, keeping only close friends in her circle. But she worries that state authorities will always have access to that information.

Sasha would also like to change her documents, but she does not have the time or money for court cases and surgeries. She has no plans to leave her village — she wants to take care of her mother’s grave.

“I’ll live here the way I always have. I buried my mom here, and I’ll stay here. People will just have to get used to it.”

Anya is saving money for surgery, which she hopes to undergo in Thailand. She does not understand the point of all these restrictions: “All it does is burden the courts, burden people. No one benefits from it at all.” Despite having the option of working in her field abroad, Anya wants to stay.

“In short, I don’t want to leave Russia. I’ll fight to get female documents here.”