How is the transgender transition commission?

At the request of “such cases”, psychiatrist-sexologist Dmitry Isaev, chairman of the commission for examining people with gender dysphoria, answered questions about the transgender transition in Russia and debunked the prevailing myths around it.

Psychiatrist-sexologist, candidate of medical sciences Dmitry Isaevfoto: Oleg Ponomarev

- Is transgenderness a variation of the norm or disease?

- In the International Classifier of Diseases (ICD) No. 10, which is still valid, it is written that transgender is a disorder, and it is in the section of psychiatric diagnoses. But for a year, as the World Health Organization has adopted ICD-11, and according to the new classification this is not a disorder.

It doesn’t matter what you think about this whether you like it or not, transgender is a variant of the norm, or, if you want, a psychological feature.

It doesn’t matter if you like it or not, transgender is a variant of the norm

For example, it does not suit me how I look, because of this I try not to leave home, it seems to me that others perceive me with a freak. Do I need help? I certainly need it. Is it possible to say that I'm abnormal? No.

If a certain condition deprives you of the possibility of normal communication, normal work, it needs correction. The condition needs correction, not the reason. If I react painfully when someone concerns me in transport, should I be isolated from transport? No, this is a question of my reactivity.

- Is there a difference between transgender and transgenderness?

- Transsexualism is a pathological condition in which you are 100% not a man, but a woman, or vice versa. Based on this, you hate your body, for you it becomes impossible to exist within its framework. You deny 100% the essence that you have by nature. If we say that the diagnosis of “transgender” exists, then it will exist until the gender is considered as a rubicon, a tough border that you can cross under certain conditions. These conditions are dictated by society. It says that the appearance should be like that, there are such genitals and then we will consider you related to one or another gender. To say that I am not Petya, but Masha, it’s simply impossible, because again there is a convention that is invented by society.

Transgender is a milder concept that suggests that there are a lot of variations. “I feel that I would like to have a more masculine appearance and take hormones for some time, but it does not follow at all that I want to remove the genitals.”

- You lead the commission for the examination of people with gender dysphoria. What is the commission and what is the certificate for?

- The procedure suggests that a person must undergo an examination before the commission. This examination solves two problems. First: make sure that we have a mentally healthy person. If he is in a state of psychosis , inadequately assesses the surrounding reality and himself, then we are talking about his treatment.

The second task is more important. We must make sure that a person has the identity that he claims. If, as a result of testing, we get a picture that differs from what the person says, we make a solution that is argued not by our personal sensations, but by the results of the examination. We can offer a second meeting , re -examination.

The commission exists to confirm the decision [on the transition], which acquires a legal nature. [Based on the results of the commission, a person can receive] two certificates, with a diagnosis of and without. The first certificate is about the change of social sex, that is, the change of documents for presentation in the bodies.

The second certificate is with a diagnosis, since issues of a medical nature require contacting doctors, and contacting doctors implies a diagnosis. The endocrinologist has the right to prescribe hormones only if the transsexualism is diagnosed, the surgeon has the right to do some corrective operations, only when there is this diagnosis.

- Is the commission's term for the commission shall be fixed by law?

- The previous ideas said that a person should be observed for two years, and this was spelled out in the order of the Ministry of Health of 1999, but that order was canceled in 2012. Then the idea was formulated that a person should be observed in the dispensary for a year. Then there was the last order in the project of which it was written that a person should be observed for a year and a half. As a result of discussions of this order, the deadline was removed, and there was no new term.

The term should be sufficient to answer two fundamental questions: human mental health and his gender identity. In some cases, we are dealing with a person who has been engaged in the transition for a long time, somehow finds hormones. What will we tell him: “And now you will be observed for two more years”? Although his appearance is no longer in doubt, he cannot work calmly anywhere, because his appearance does not meet the documents. For what?

Or another option: we see a person who is not mature enough, and his ideas have the character "well, I would like me to have this and that." "Okay, you change the documents, and what will happen next?" And a person is psychologically not ready.

- Could the commission of suicide be the reason for the refusal of the commission?

- Historically, it was believed that a person who did not make a suicide attempt cannot be diagnosed with “transgender”, because he can live calmly and so. So it was formulated in the late 60s: "We save a person from death, giving him permission to change the floor." And in many cases, back in the 90s, many commissions were guided by this. Currently, such a concept, of course, is not. This is not a reason for refusal.

- Can a difficult life situation, serious problems with the family?

- It is more correct to talk about the following: do we deal with a mature person who lives an independent life? If so, then this is his problem, he solves them or does not solve them. This is not the basis for refusal.

Another thing, if a person is dependent on parents, lives with them, but hides his desires from them: “I am already 18 years old, I have accumulated a commission, pass it and come with a certificate to my parents.”

"I am already 18 years old, I will go through a commission and come with a certificate to my parents"

We understand that parents pay for his life, and there will be a question to such a person: “Have you agreed with your parents? When you agree with them, if you are a dependent, then for God's sake. ”

- What is working with adolescents if it exists at all?

- To date, there is a law to combat the propaganda of homosexuality and transsexualism, which claims that a teenager must be protected from this kind of information.

If a teenager seeks help, then in principle his parents can accuse the doctor that he is engaged in propaganda. And propaganda lies only in one thing: the specialist said to such a teenager that nothing terrible happens to him, that this is normal. The word "normal" is already illegitimate according to this law.

When a teenager knows that there are such people and there is nothing wrong with this, then he will not make suicide if this issue touches it, and will not poison another person. To imagine that from the fact that the teenager learned about the existence of transgenderness, he will immediately run to change the floor is stupidity. The output is only in the enlightenment.

Previously, before the existence of this kind of laws, it was formulated that a teenager from 15 years old has the right to independently and without the consent of his parents to seek psychological help. And no one canceled this. But the commission can only come from the age of 18.

- What do you think about the concept of testosterone blockers at an early age, because by the age of 18 it can be two meters in growth, with a beard and a formed male physique?

- The concept of blocking is distinguished by certain clinics in different countries of the world, which say that this is why we should begin to help a person from adolescence.

But using blockers that prevent hormones from making bodily changes, we are faced with another very serious and slippery problem. By blocking the effects of certain hormones, we block the process of development and growth. Sex hormones are not only a beard and shoulder width, but also organs and systems, including the central nervous system.

No one says that chemical castration and menopause are good, but in fact we are offered to do this with a teenager who who wants to make a transition]. Should he feel better from this? No. From my point of view, blockers at an early age are not a blessing.

- A person who felt that he needed help should definitely contact the neuropsychiatric dispensary? I heard a lot of stories how a person came across an inelent attitude of doctors, and after the dispensary I left for a psychiatric clinic, having left a new traumatic experience from which his problems was added to his problems.

- A trip to the PND is anachronism. According to the previous model [healthcare system], a person had to go to the hospital in order to put or, more precisely, to exclude some kind of diagnosis. But the concept itself is strange: if you want to prove that you are healthy, you need to lie down in a psychiatric hospital.

The need for detention in the hospital was canceled back in 2012. Now there is no need to go with this issue in the PND, since a person is not attached to him. Feeling that he needs help, he can safely choose between the medical center or PND.