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Trans people in Ukraine: transition process, legislations, healthcare, and social attitudes

Kyiv, 2024. A protest for adopting bill #5488 that defines hate crimes and introduces harsher punishments for them. The author stands second to the left. Photo source

Whether it’s Ukraine, Palestine, or other “third world” countries, the issue of queer rights is often used even by the relatively well-meaning liberals to claim: “We shouldn’t help them, look how badly they treat their queers!”

Of course, the ethical argument against it would be that no one deserves genocide and not that “the situation is not that bad.” But anyone who has argued online at least once knows that’s not how it works. So the argument I'm here to make is:

Trans rights and lives in Ukraine are not that bad.

I’m a trans man living in Kyiv. I’m currently medically and legally transitioning, I have a lot of trans/nb friends and try to involve myself in activism. So I have both first-hand experience and up-to-date info to talk about the issue.

Let me be very clear here: things are not perfect.

We still don’t have a lot of legal protections we need. The human factor and community networks matter a lot. But it’s not the “leave the country if you’re trans” levels of bad, and haven’t been for a while.

Compared to some Western European countries with rights for self-id and third gender markers, Ukraine is obviously not that progressive.

However, after learning more about the UK’s trans issues, as well as the various US states’ anti-trans legislations, I was compelled to write this text because I wanted to say from the bottom of my heart: “Shut the fuck up” to everyone who wants to say something about how backward Ukraine is.

In Ukraine, trans and other queer people can live their lives relatively freely. And what’s even more important: in contrast to a lot of “developed” countries, the situation with trans rights and social acceptance is actually improving.

(Am I afraid that our society and legislators will slide backward with the influence tr*mp will have over the whole world? Yes. But that’s another issue entirely. And historically, even during his first term, our laws actually improved.)

So, if you ever find yourself arguing about Ukraine, here is everything you need to know to also politely ask everyone bemoaning “poor” Ukrainian queers’ fates to shut up.

In the first part, I talk about general vibes, and in the second one, I go into the transition process in way more depth than was necessary. This monstrosity absolutely got out of hand, if I’m honest. Maybe I need to try to shoot a YouTube video so people can use it as background noise.

Read on Medium or keep reading here.

In any case, enjoy!

How do trans people in Ukraine live? Laws, attitudes, and vibes

Kyiv, 2024. A protest for adopting bill #5488. The author stands second to the right. The poster says “Stop violence against transgender people. Adopt 5488.” Photo source

So, you’re transitioning. What life in Ukraine has in store for you?

Ukrainian trans legislations

There’s a clear legal procedure that allows Ukrainian trans people to change their gender marker and all of their legal documents.

In Ukraine, there are some laws to protect against discrimination based on sexual orientation and gender identity.

There are also laws prohibiting hate speech/discrimination in the media. They don't protect from misgendering, insensitive jokes, and stereotyping. But show me a country where they do.

There are no laws prohibiting trans people from using the right bathrooms.

Unfortunately, you can only transition medically and legally once you turn 18. Minors can get a psychiatric diagnosis (but not F64.0) but they don't have access to puberty blockers.

There are still quite a lot of hate crimes. Police are often not investigating them properly. They get classified as “hooliganism” instead of a hate crime. The good news: more people are reporting them, and NGOs are actively working on these cases. Bad news: the bill to define hate crimes specifically and introduce harsher repercussions for them has been lying in the parliament for more than 2 years. Activists are actively advocating for adopting this bill. In general, there’s an understanding that it might be done in the coming years.

Same-sex marriage is not legal. However, there's a bill to introduce civic partnerships. And there is an explicit understanding in society that queer people will benefit from it the most. Unfortunately, it's also been lying in the parliament for 2+ years. Activists work hard to change that. The main detractor is the council of the churches.

There's some gray legal area around the issues but there's a common understanding that trans people are not allowed to adopt children. They also can't retain custody over their under-18 children if they change their documents.

Society at large

The author presents his painting “A time to plant and a time to uproot” about his experience of transitioning during the full-scale invasion during the Ljubljana Pride events in 2023.

According to recent polls, social attitudes toward LGBT+ people are improving by the year. In 2023 a poll showed that 64% (info in Ukrainian, use Google Translate) of people expressed neutral or positive attitudes towards queer people (compared to 54% in 2022). The number of people who have negative attitudes towards LGBT+ was 33,9%. Contrast this with 60,4% in 2016.

For some trans people, it's hard to find work if their documents do not match their looks. When it comes to hiring practices, the anti-discriminatory laws often don't work because obviously a business can refuse to employ you citing other reasons. However, all of this depends highly on the industry and specific employers. For example, most Ukrainian IT companies are okay with gender-nonconforming and trans people. They, along with NGOs, often have anti-discriminatory company policies. It’s harder to get employed when it comes to customer service jobs. However, I’ve heard positive personal anecdotes there as well. In general, the situation is improving compared to even 5-10 years ago, but there's still room for growth.

The major public force that opposes queer rights, and one with the most influence, is the Council of churches (which includes most major denominations that exist in Ukraine.)

In general, in mainstream liberal circles, it's no longer acceptable to be openly transphobic or homophobic. For example, a lot of large bloggers, who consider themselves nationalists (which used to be synonymous with anti-queerness) are publicly supporting queer rights as a marker of a civilized society and progress regardless of their personal beliefs.

Increasingly more mainstream liberal media is trying to give positive coverage to the queer community, from using the right lexicon to shooting special materials dedicated to queer and trans issues. Still, it’s also quite common even for some of the well-meaning media outlets, and especially bloggers to misgender trans people, use clickbait headings, and so on. The vast majority of media were incredibly confused regarding the right pronouns when covering Nemo’s Eurovision victory.

3rd Forum for Transgender and Nonbinary People, Kyiv, 2024. The slogan reads “TRANS*forming the reality.” The author stands to the right.

Increasingly more queer books are getting published, including those by Ukrainian authors.

There are right-wing organizations that specifically target queer people, harass them online, even attack physically, and threaten queer events. Just yesterday (November 9th, 2024) a bookshop canceled a presentation of two Ukrainian LGBT+ books because they were threatened. However, by year right-wing organizations with explicitly queerphobic agenda are becoming more and more inconsequential in mainstream society. There's an understanding that most of these groups, although claiming to be ethno-nationalists, are actually funded by russians, and they look up to russian "traditional values" as opposed to the "decadent" West even to the detriment of our victory.

TERFs are also not mainstream and don't have any actual political sway. They’re only loud on X and Facebook but they don't have their own organizations and most mainstream feminist NGOs are explicitly queer- and trans-friendly.

Ukrainian queer community

There are a lot of LGBT+ and trans NGOs that promote queer rights, advocate for the community, collaborate with the legislators, and help out the community (including materially).

There are a number of publicly open trans and nonbinary activists.

The hormones are quite costly and there's no way to get them free from the country. However, the NGOs are often offering hormones as humanitarian help for free. Most of the time, I myself get hormones this way.

All in all, since 2010 (and especially 2016) the number of trans organizations grew and their work has become more influential.

Military

Ukrainian LGBT Military NGO. On their website, they state they have a separate online community for 15+ trans people who are currently serving in the military or are veterans.

There are no legal protections or mechanisms to regulate the relationships of trans people with the military. That's also a huge zone for growth the activists are working on.

The state also doesn't provide people in the army with hormones.

There's an NGO for the LGBT military.

There are open trans people in the army. But most trans men I heard of are in stealth.

LGBT+ people, even the open ones, may face some discrimination in the army from their comrades and officers. However, the mainstream idea communicated by lots of military people is “I might not personally like queers but I don't care who you are as long as you're busting your ass for the victory.”

When going through the TCRSS (Territorial Center of Recruitment and Social Support, local military administration) evaluation, except for the good old regular transmisogyny, transfems may face additional scrutiny and negative attitudes from medical professionals and officials because they may be seen as “draft dodgers.”

A personal note: I'm in the process of changing the documents so I haven't communicated with TCRSS yet. I won't dwell upon it but I have to say for the record that I'm absolutely willing to accept not only rights but also responsibilities that come with an “M” gender marker in documents. So, if I'm considered to be fit for the military, I won't try to avoid it. Moreover, my consciousness dictates that I do have to serve. Still, the process of going through the military medical board scares me a lot – way more than the military service itself.

A bit of history: the transition until 2016

The author’s art.

Until 2016, the transition process was frankly all kinds of fucked-up.

To get access to legal recognition and healthcare, a person had to go through a doctor's board evaluation. The doctors (including psychiatrists and sexologists) were predominantly educated in the Soviet Union where all kinds of queer people were considered deviants with psychiatric disorders (and often, in the case of gay men, criminalized.) So, the board was incredibly transphobic and homophobic. It used a questionnaire full of questions relying on the worst kinds of gender stereotypes: “Would you rather be a plumber or an artist? If you were a journalist would you write about sports or art?”

If you didn't look like a very stereotypical version of the gender you're transitioning to, down to the underwear, you were fucked.

If you let them know you're not straight, you were fucked.

And there was only one board for the whole country, in Kyiv, so if you haven't "passed" the assessment the first time, it was way harder to get reevaluated.

Even if you got the psychiatric diagnosis and got access to healthcare, to be able to change your gender marker and documents, you had to get sterilized.

I personally know some people who didn't want to go through this shit so they went on HRT and instead of changing the gender marker just changed their name and surname in their documents (we are allowed to do that for non-trans reasons without any issues.) This way, at least when they are signing documents and so on, they won't see their deadname constantly. They also kinda hoped that people checking their documents would just skip over the gender marker or think it's some kind of mistake.

Side note: both a sad and funny aspect is that you can change your name and surname just because you want to, but you can't change your patronym or drop it altogether. And it's always, always gendered, so if you went this way, from Olexandra Olexandrivna Ivanova you'd become an Olexandr Olexandrivna Ivanov (-ivna being female suffix, the male version would be -ovich.

Thankfully, thanks to the efforts of activists, the legislation around the transition changed, becoming way, way more relaxed. It's been in place since.

Legal and medical transition in Ukraine

Kyiv, 2024. Author at a protest for adopting bill #5488. The hashtags read “human rights,” “inclusivity,” “equality,” “safety.” Photo source.

After some confusion in 2016 around the procedures, they’ve become quite established. I started the medical transition in 2023 and legal – in August of 2024, so the info is as up-to-date as it can be.

#1. Getting a psychiatric diagnosis of “transsexualism”

If you go about your transition the proper way, the first thing you need to do is get a psychiatric diagnosis. Ukraine's healthcare system is still working with ICD-10. The country is committed formally to moving to ICD-11 but there’s a common understanding it’s really unlikely to happen until the war ends.

Under ICD-10, the diagnosis you need to get is F64.0 “transsexualism”. Yeah, yikes.

You need to go to a state psychiatrist, the diagnoses from the private ones are not valid.

De jure, you should either keep in touch with a doctor to be observed for 2 years or spend 2 weeks in a hospital. Most of the time, it's understood to be a day hospital, so you visit every day but don't sleep there. But it’s up to the doctors, so there were cases when a person spent the whole time in a psychiatric hospital. Obviously, the person is kept in the ward of the gender they were assigned at birth. You can imagine that for a lot of peopl,e the experience is quite distressing, especially considering that Ukrainian state psychiatric clinics are really not fun places to be in.

Considering this, a lot of people look for workarounds – and find them.

In some hospitals, you can pay a "voluntary contribution" (a bribe basically). The price tag for this in Kyiv’s main psychiatric hospital is around UAH10.000 ($250).

In some hospitals, fortunately, there are friendly doctors (and/or doctors who themselves belong to the queer community) who can help you out willingly.

In any case, if you can get arrangements in place, you just visit a couple of times and the hospital puts the necessary dates on the documents without actually keeping you there.

How do you get evaluated for F64.0

In a psych hospital, you get the bloodwork and some other physical examinations done (for example, a cardiogram, a lung x-ray, nothing invasive.)

You talk to a psychologist who assesses your general mental state.

And you talk to a psychiatrist and write an auto-biography focusing on your transness specifically.

The evaluation is still often based on strict gender binary and gender stereotypes. It is implicitly understood within the trans community that for example as a trans man you have to present the narrative that you always played with cars and not dolls, preferred the color blue, befriended only the boys etc, etc. Friendly psychiatrists know that this is bullshit but often still ask to narrate your story like this in case some of the higher-ups have any questions.

Correspondingly, even if psychiatrists are aware of the nonbinary spectrum, nonbinary people still have to present a very binary narrative to get the diagnosis.

Being non-straight does no longer automatically mean you don't get the right diagnosis. However, a lot of people still prefer to hide it if possible. I told my psychiatrist I'm bi with a preference for women (which is true) and had no problems because of that.

It is implicitly understood that if you're already on HRT (DYI, found a very friendly private endocrinologist, etc), the whole process is likely to go easier for you. That was my experience: I just emphasized that I've already been on HRT for half a year and so much happier for it.

When getting a diagnosis gets more complicated

Because of the war transfem people now come under more scrutiny and the evaluation has become way more strict than before 2022. Some doctors plainly refuse to do it at all. The reason is that the doctors are afraid that people trying to go through an mtf transition just try to avoid the mobilization.

There are cases, especially in the regions, of doctors refusing to deal with our trans shit. But legally doctors are not allowed to refuse to provide trans healthcare. So if you know your rights you can either press them or file a complaint. In any case, you can just go to the next state hospital and try your luck there.

A lot of psychiatrists refuse to give you F64.0 if you are currently depressed or especially have some more serious psychiatric diagnosis. A lot of them go like "well, go treat your depression and then come back." Obviously, it's absolutely bullshit because a lot of trans people are depressed because of gender dysphoria but it is what it is. Most trans people advise their peers not to disclose their other diagnosis when undergoing this evaluation.

This part is often the most hard and stressful. If you have your diagnosis, the rest is usually easier. Well, mostly.

#2. Endocrinologist, HRT, and the certificate of transing your gender enough

The author after 2 years on HRT.

Once you have your F64.0, you go to an endocrinologist. For HRT, private ones are okay. They make you do a lot of bloodwork and then prescribe HRT.

Most of the time, trans people go to the doctors that other trans people recommend. There's an understanding that there's a high chance a random state doctor won't be educated enough in trans healthcare. Because of this, I haven't heard of cases of mistreatment or refusal to work with a trans patient.

When you're on HRT for some time, you get a medical document from your endo that you've been on hormones for long enough and your secondary sex characteristics are now aligned with your desired gender.

#3. “Sex correction” certificate from a family doctor

With the document from the endo, you go to your family doctor (a GP). They get you a medical document that states you have "corrected your sex". Except for the family doctor, it should have the signature of one other doctor and the head doctor of their hospital.

Most of the time it's just a formality. Legally, family doctors can't not do it. So, if they are refusing to help you, you can file a complaint and pressure them legally.

In my case, I signed a contract with a family doctor who's explicitly queer-friendly and has already helped quite a lot of trans people. I needed to go to her hospital (in Lviv) to be physically present, but everything went quickly. There were no additional examinations or assessments, no questions asked, we just needed to sit in a queue for a bit and the head doctor signed my documents.

#4. Birth certificate change

To change your gender marker, you first go to a civil registration office, and with the documents from the psychiatrist and the family doctor, you file a request to make changes to your birth certificate.

There are cases when the officials try to refuse to do so, quite often out of ignorance. The officials are not legally allowed to refuse to file a gender marker change request if your documents are in order. So, once again, you can file a complaint and pressure them into registering your request.

There are also cases, however, when the document from the family doctor is not done 100% right according to the regulations (most of the time because the doctor didn't know how to do it right, not out of maliciousness), and the officials refuse you because of it. In this case, they are legally right, so most of the time you have to ask the doctor to reissue the certificate.

Because of the war, you can go to any registration office in Ukraine, and they request the info from the registration office where your birth certificate was issued. The downside is, they legally have 3 months to do so.

Side note: I'm at this point now. The registration office made a request to the hospital that issued me the "sex correction" certificate to confirm it, and they haven't gotten a response yet although it's been more than 2 months. This request is not necessary but also not illegal. If my birth certificate is not ready in 3 weeks, I'm likely going to contact the paralegals from a queer NGO and file a complaint.

#5. Changing the national ID and other documents

The sign reads “to the European country – progressive laws.” Photo source.

With your new birth certificate, you go to a center for providing administrative services (just as well, during the war any is okay, not just in the neighborhood you're registered in) to change your national ID. I was shocked to learn that in some countries, including the UK, national IDs are not mandatory. In Ukraine, they are, and they are a primary document you use for identification. Basically, no one ever sees your birth certificate. It takes about 2 weeks. Then you can change the rest of the documents: passport, driver's license, tax documents, educational documents (if you want to), and so on.

#6. Registering with the military office

Regardless of the "direction" of your transition, after changing your ID, you're supposed to go to the Territorial Center of Recruitment and Social Support (TCRSS) – the local military registration organ. That’s where things get tricky once again.

For context: all people with a “Male” gender marker are registered with a TCRSS when they are teenagers. People with “Female” markers are not. They are only registered if they become bound for military service for other reasons (for example, doctors.)

Under the military time law, all people who have an "M" marker have to be assigned to a TCRSS, and have their personal information updated in person or in a special app ("Reserve+"), and go through a medical board’s assessment in a TCRSS. The whole process is quite complicated even for cis men as on the one hand it is highly bureaucratized. There are literally cases when a trans man who had his uterus removed had to go through and have the certificate to confirm it still has to go through an assessment by a state gynecologist to prove he hasn't somehow grown his uterus back in the meantime. And on the other hand, there’s a lot of gray legal areas where decisions depend on the individual official’s assessment.

The main decision dependent on the human factor is: whether a person is considered fit for military service (then they get mobilized effectively immediately), "unfit for military service," or "fit in a limited capacity.” Before the full-scale invasion, “limitedly fit” was equal to "unfit." Now it usually means you either have a temporary delay of mobilization and you have to show up every 6 months to prolong it, or you're mobilized and get assigned to a second-line position pushing the documents instead of being on the front lines.

Most psychiatric diagnosis, including F64.0, is a reason to consider a person either "unfit for military service" or "fit in a limited capacity." So, what does it mean for trans people?

Transfems who changed their gender marker to an "F" have to show up to a TCRSS and get themselves excluded from the military register because now they’re not bound for military service.

Transmasc people with an “M” marker, as it follows logically, have to show up to get registered. They go through a military medical board like cis men.

Most of the time, transmascs are considered permanently "unfit for military service." However, this decision is up to the TCRSS’s head officer.

Communication with the TCRSS is honestly a huge issue trans activists are working on. People transitioning in both directions often face a lot of misunderstanding and outright hostility from the military medical board and officers.

Most trans women want to get excluded from military service and face discriminatory attitudes basically because the state doesn't want to exclude them, and a lot of officials think they are just transitioning to avoid military service. So they can face a lot of hate and contempt.

A lot of trans men on the other hand may be willing to serve in the military but can't do so because of the psychiatric diagnosis. There’s a conundrum because often trans men willing to serve don’t get to, and those unwilling to serve get told “well, you’re a man now so fuck off to the front lines because you’re disposable.”

As I’ve already mentioned, it all comes down to the human factor, and unfortunately in a lot of cases, people working in TCRSS are uneducated and bigoted. And because there are no specific legislations regulating the relationships between trans people and the military, the officials get to exercise their bigotry.

Crossing the border

Besides not getting mobilized while walking down the street, getting your documents right with the TCRSS is important because it defines whether or not you can leave the country.

Transfem people with an "F" gender marker who get the documents done and are excluded from military service can travel outside Ukraine. There are unfortunately quite a lot of cases of trans women having trouble crossing the border if their documents are not crystal right. Recently there was a case of a trans woman who wasn't allowed to cross the border: despite having an "F" in her passport, she skipped the TCRSS step, so officially she still was bound for military service. Unfortunately, the border guards were legally right.

Quite often the border guards are putting under a lot of scrutiny even those trans people who are legally allowed to cross the border (transfems and transmasc with an “F” marker.) That's also an issue activists work hard on.

#7. Gender-affirming surgeries in Ukraine

The author’s art. On Instagram

People are allowed to get gender-affirming surgeries and are not required to get any to change their gender marker.

The context you need to have about Ukrainian medicine: we have free state medicine; insurances exist (but they are not really widespread. Some companies, especially in IT, pay for them, but according to 2019 data only about 9% of the people have them); and there are also lots and lots of private clinics. Those are often quite costly. But they are also well-staffed and well-equipped, and in most cases, you can get an appointment with a doctor for the next day or within a week.

So, gender-affirming surgeries are available, but almost exceptionally at private clinics. This means people have to save up quite a lot and often travel to Kyiv or other large cities to get them. But there are no waitlists and patients can get good healthcare without facing any discrimination.

There are however cases of trans people getting free healthcare at a state clinic. Mostly that happens when the doctors are willing to help them out. In the documentation, they state a diagnosis that qualifies for free healthcare (any trans-related diagnoses are not.) For example, one trans man I know got free top surgery at an institute for cancer research, presumably because in the documents the doctors claimed he was at a high risk of breast cancer. Another trans man got a free hysterectomy at a state hospital. Although he was put in a women's wing he claimed he got treated well.

I got a mastectomy at a private clinic just over a month ago. For that, I had to provide the F64.0 diagnosis and the "sex correction" certificate from my family doctor. Another doctor I consulted with only does the surgery if you've already changed your ID.

The price both doctors asked was UAH75.000 (about USD 1850). (For reference: the median salary in Kyiv is UAH 25.000 (USD625) a month.) My surgeon claimed that in part the price is so high because she has to rent a surgical room only in private hospitals as the state ones don't want to deal with this kind of surgery.

From the initial consultation till the surgery, it took about 2 months and it was mostly because I was gathering the funds.

At a recent trans event for activists, I got the information that there's a group of doctors in Kharkiv that do bottom surgeries for both trans men and women and they are quite good at it. I haven't looked into it more properly yet but still – good for us.

TL;DR

Trans people do face discrimination. There are no opportunities for legal and medical transition for minors. And there are some legal gray areas, especially concerning military service, when the lack of explicit anti-discriminatory laws and proper regulations leads to bigotry from officials.

But the legislation around trans rights is improving, not getting worse, and there are procedures for legal and medical transition.

Social attitudes are also improving steadily – the acceptance of queer people in society grew almost twice since 2016, and more than half of Ukrainian society is neutral or positive towards the LGBT+ community.

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