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Kazakhstan: New Rules of Gender Transitioning Make it Difficult to Access Medical Assistance

Human rights activists are concerned over the updated rules of medical examination of transgender people in Kazakhstan. They restrict access of transgender people to medical assistance, deprive them of a chance to socialise and live in security.


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In November 2020, Kazakhstan updated the rules of the sex reassignment procedure and medical examination. The opinion of the medical board is now valid for 6 months and the previously required 30-day psychiatric hospital stay is cancelled. However, despite the expert suggestions and protests of transgender people, age restrictions still apply – only Kazakhstanis who are 21 years old and older may undergo medical examination. 

Human rights defender, trans woman Victoria Primak said it was the violation of rights of transgender people.

Виктория Примак. Фото из личного архива

“Full-aged transgender people in Kazakhstan who reach the age of 18 may not undergo medical examination of the psychiatric board, get access to medical consultations, change their identity documents as they need medical assessment of the board,” said Primak.

According to her, now full-aged transgender people have to undergo medical psychiatric examination in other countries that do not require the age of 21+, for example, in Russia and Kyrgyzstan.

“Some transgender people who reach 18 but who don’t have a chance to go to medical specialists start hormone therapy on their own, which can lead to bad consequences for their health,” the human rights defendant said.

The World Association for Sexual Health has issued a statement in this regard

“The proposed age limit would violate the spirit and letter of the WAS Declaration of Sexual Rights as well as other important rights documented in the international human rights law and the Constitution of Kazakhstan. The Declaration of Sexual Rights explicitly states that everyone has “the right to the highest attainable standard of health, including sexual health” (Article 7), which includes trans-specific healthcare without any arbitrary restrictions of access,” the statement reads.

“They beat me with a whip to ‘beat the freak out of me’”

22-year-old Albina is a trans woman who was born in the most southern town of Kazakhstan. She came to the capital five years ago and now is working at a bar. Her icon is Ines Rau, a prominent model who was born as a boy in Paris and underwent sex reassignment surgery at the age of 15. It is a pipe dream to become a woman, Albina said.

“There are so many bureaucratic procedures, not speaking of the price of the sex reassignment surgery. Can you imagine me going to the Public Service Centre to change my name, sex and school completion certificate?” she said.

Albina attentively studies the websites of domestic and foreign clinics, counts the cost of required sex reassignment surgeries.

“At first, I want to undergo the breast augmentation surgery, it costs from one million tenge (2,388 dollars),” she said.

However, she cannot even imagine how she would come before her family in Shymkent as a girl. Her traditional family cannot bear that the boy feels like a girl.

Visits to hoodoo women, clairvoyants, tarot readers continued for a few years. She was dressed into the skin of a recently skinned sheep, was beaten with a whip, sprinkled with wax to ‘beat the freak out of her.”

“As you see, it didn’t work,” Albina shrugged her shoulders and showed her slit wrists. A few suicide attempts have failed, fortunately.

No access to quality medical assistance

Human rights defender Viktoria Primak said that the updated rules of medical examination have significantly complicated access of transgender people to medical and social company. She herself started the transitioning process when she was 15-16 years old.

“Back then I started to grow long hair and looked very feminine. When I went to college, I was totally in women’s gender role,” Primak said.

She was lucky – her parents, colleagues, friends understood her choice. She was training as a cloth designer, and now is involved in human rights activities.

According to her, Kazakhstan has no clinical protocols or medical standards, describing provision of gender affirmative medical care to transgender people.

Gender affirmative medical care is a kind of care that includes respect, acceptance and support of identities and life experience of transgender and gender non-conforming people.

“Medical universities do not teach the standards of endocrinologic care related to feminisation or masculinisation for transgender people. Psychiatry students are provided with 15 minutes of obsolete pathology information about transgender people. What can we say about the quality of medical care to transgender people?” the human rights defender said.

The biggest problem of transgender people in Kazakhstan is that they must first undergo sex reassignment surgery to be able to change documents according to their identity.

“Not all transgender people need surgeries. Any mandatory surgeries feel like torture,” Primak said.

According to the study that was held in 2020 by the Kazakhstan transgender initiative, ALMA-TQ, nearly 90 per cent of respondents among transgender people wanted to change their documents to make their life at least secure, and only 25 per cent wanted to undergo some surgeries. Many of them cannot afford surgeries because they cost a lot and they require good health. And a transgender who has documents that do not meet their identity finds it hard to find a job.

The World Professional Association for Transgender People (WPATH) urges Kazakhstan to remove the age limit, and also to increase support to the trans community with legal protections in terms of healthcare.

In future, human rights defenders recommend to remove medical examination in any form as a reason for legal recognition of gender. According to them, in future the issue of legal recognition of gender must be considered by administrative means only on the basis of a petition by a person seeking legal recognition of their gender. And the medical care to transgender people must be separated from the procedure of legal recognition of gender and must comply with the standards of personal right to health. 

What is a gender transitioning?

A gender transitioning is a time period when people change their gender role/presentation that was assigned to them at birth to another one that they want (that matches their gender identity), as well as events and actions intended for such changes.

It includes:

  • “social transition” (change/formation/finding ways of comfortable gender presentation/role; change of the gender marker, mastering ‘new’ life skills, etc.),
  • “medical transition” (hormone replacement, surgical masculinisation/feminisation in any volume, and/or other).

The nature and length of the transition depend on a person.

Gender transitioning is the same as the gender change?

Yes. Gender change is a common term of the 90s that does not have anything in common with the medical terminology. Moreover, it is incorrect to say “change of gender” about gender transitioning. The assigned sex cannot be changed. It is only possible to perform surgery on feminisation or masculinisation according to one’s gender identity.

What is medical examination and what is it for?

Medical examination of transgender people in Kazakhstan is a procedure meant to examine a trans gender to diagnose them with ‘F64.0 Transsexualism’ according to ICD 10. It also means detection of psychiatric and behavioural disorders, genetic and chromosome pathologies or somatic peculiarities, which, according to the Ministry of Health of Kazakhstan, are an obstacle to the gender transitioning.

What is the procedure for gender reassignment in Kazakhstan?
  • Gender reassignment is performed only upon positive conclusion of the commission.
  • Gender reassignment consists of hormone replacement therapy (first stage) and sex reassignment surgery (second stage).
  • Gender reassignment (hormone replacement therapy and sex reassignment surgery) is performed at medical facilities licensed for the relevant type of activity.
  • The hormone replacement therapy for gender reassignment is held according to the standard of endocrinology treatment in Kazakhstan.
Who may undergo gender transitioning?

According to the updated rules of medical examination, gender transitioning may be done by capable transgender people who have reached the age of 21.

People with psychiatric, behavioural disorders (PBD) may not undergo medical examination and surgical interventions.

What is the procedure of medical examination?
  1. First, a transgender person must write a petition to the facility that provides psychiatric care.
  2. A psychiatrist examines the person and studies the documents to find PBD that is a contraindication to surgery.
  3. If there are any doubts in the mental health of the patient, the psychiatrist refers them to mental clinic for indoor examination.
  4. If no psychiatric or behavioural disorders are found, the psychiatrist refers the transgender to a local policlinic for medical examination.
  5. After medical examination, the psychiatrist refers the patient for the medical check-up to the commission approved by the head of the medical facility.
Who are the members of the commission?

The commission responsible for medical check-up of persons who want to undergo gender transitioning consists of the following specialists:

  • Three psychiatrists, one of whom has special knowledge in the field of sexopathology;
  • Urologist;
  • Gynaecologist;
  • General practitioner;
  • Endocrinologist;
  • Psychologist.

The head of the commission is the chair appointed by the head of the medical facility among psychiatrists.

What are the competencies of the commission?

The commission deals with all matters that result in one of the following conclusions:

  • Hormone replacement therapy may (not) be held;
  • Sex reassignment surgery may (not) be held;
  • Additional examinations may be held to the applicant.
Are there any reasons to deny surgical intervention?

The reasons to deny the intervention are:

  • Acute or chronic PBD;
  • Genetic or chromosome anomalies;
  • Somatic peculiarities that can directly cause complications hazardous to life and health during sex reassignment surgery;
  • Negative results of the first stage of sex reassignment events (hormone replacement therapy).

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