“You should care by prohibiting all this obscenity”: a public policy analysis of the Russian law banning medical and legal transition for transgender people

ABSTRACT

Gender-affirming care and legal gender recognition (LGR) have been relatively well developed in Russia since Soviet times. During the past decade, in line with the general authoritarian and conservative turn, transgender (trans) rights have increasingly come under attack. In 2023, anti-trans forces succeeded in bringing about the adoption of a law that prohibited gender-affirming care and LGR, preventing marriage and adoption of children for trans people. This article uses the Authoritarian Gender Equality Policy Making framework to understand the structural opportunities, actors, framings, and the autocrat’s signaling that led to this result. The policy reversal resulted from increased visibility of trans issues in Russia and worldwide coupled with their reframing from a medical problem to a geopolitical threat in the context of a military and cultural confrontation with the West following Russia’s “special military operation” against Ukraine in February 2022.

KEYWORDS:

• Transgender
• LGBT
• legal gender recognition
• gender-affirming healthcare
• right to health
• authoritarian policy-making

Introduction

“The war is underway not only on the front line, the war is under way in heads and souls, and we want to defend our country from destruction from within” – these words by Deputy Chair of the Russian State Duma Pyotr Tolstoy on 14 July 2023 (Tolstoy 2023) outline the logic of much Russian policymaking since the onset of the so-called “special military operation” against Ukraine on 24 February 2022. Specifically, these words were aimed at supporting a bill banning gender-affirming care and legal gender recognition (LGR)¹ for trans people. In its final version, the law (Federal Law No. 386 of 24 July 2023) introduced a “prohibition on the change of sex in humans” by means of hormone-replacement therapy (HRT) and surgeries, limited access to LGR only to intersex people and trans people who had already undergone a surgery, and forbade trans people from adopting children and maintaining marriage following gender transition.

This article provides a public policy analysis of the process leading to adoption of this law, delineating the main actors who supported and opposed the bill, their framings of trans issues, and structural opportunities.

Background

Trans issues in Russia: past and present

No comprehensive review on trans history in Eastern Europe and Central Asia is available to date, so this background section will focus on a few facts important for the subsequent discussion. LGR was first legalized by the Circular No. 146 of 22 April 1926 issued by the People’s Commissariat for Internal Affairs (NKVD) and later by the Resolution of the Council of Ministers No. 1006 of 10 December 1976. Although these norms were intended to help intersex people, trans people could also use them because “transsexualism” was considered a “psychic version of hermaphroditism” (Bukhanovskiy 1994). Medical care for trans people has been provided since the late 1960s. In 1972, Soviet doctors published their first academic publications devoted to the “change of sex.” In 1991, the Soviet Ministry of Health issued the first guideline on the provision of care to transsexuals, including diagnostics, hormone replacement therapy, surgeries, and LGR, with medical interventions not being required for LGR (Belkin and Karpov 1991). Issued at the end of perestroika and just before the USSR’s dissolution, the guideline combined experience of Soviet doctors with international Standards of Care developed by the Harry Benjamin International Gender Dysphoria Association.

In post-Soviet Russia, LGR was permitted by the 1997 law “On the Acts of Civil Status” (Federal Law No. 143 of 15 November 1997) and required a “medical document of the established form.” Because of disagreements among doctors on the prerequisites for issuing such a medical document, no form could be established for years (Dmitrieva, Tkachenko, and Karpov 2002). LGR was being performed on a case-by-case basis until 2018, when the form was finally developed by the Ministry of Health and approved by the Ministry of Justice (Decree 850н of 23 October 2017). LGR did not require any medical interventions except for the diagnosis of “transsexualism” and a medical document, which could be issued by a medical commission consisting of a psychiatrist, sexologist, and medical psychologist. The decree used vague phrasing, a situation that allowed doctors great freedom in establishing their own assessment practices. The state’s general non-involvement in this sphere meant that trans people were neither supported/protected nor purposefully persecuted. Likewise, the pharmaceutical market was not strictly controlled, leading to a situation in which trans people could easily buy hormones without a prescription. This existence of a gray zone made it possible for trans activists to establish an environment in which trans people could receive the diagnosis “transsexualism” in one day, change all legal documents in a couple of months, and get more or less qualified endocrinological and surgical care (Kirey-Sitnikova 2022).

The authoritarian and conservative turn in Russia

Following the dissolution of the Soviet Union in 1991, Russia experienced a period of democratization and a rapid transition to a market economy. Liberalization, which started in the Gorbachev era, made it possible to speak more openly about previously censored topics, including sexuality and gender roles. The first LGBT rights organizations appeared. In 1993, sexual relationships between men were decriminalized (Lukinmaa 2022). At the same time, the country’s economy was in a devastated condition and crime proliferated. On the international stage, Russia lost its former prestige and became more dependent on international institutions. As a result, many Russians today consider the 1990s a time of national humiliation, a condition that led to a thirst for revenge and growing authoritarianism since the mid-2000s under the rule of President Vladimir Putin (Kailitz and Umland 2019).

Unlike classical authoritarianism, Russia is better characterized as an electoral or competitive authoritarian regime, in which elections are regularly held but the opposition faces barriers in access to money and media coverage, making it difficult for them to win. The illusion of democracy is further supported by the existence of semi-opposition parties (currently there are four of them in the State Duma) that are allowed to criticize the ruling party (United Russia) on minor issues but vote unanimously on important issues (Gel’man 2015). While independent media still exist, their audience is far too small to exercise meaningful effect on policymaking; recently most independent outlets and journalists were labeled as “foreign agents” by the Ministry of Justice, further impeding their work (Paskhalis, Rosenfeld, and Tertytchnaya 2022). The Russian Orthodox Church, which faced repression during the Soviet period, gained considerable influence over state politics in the post-Soviet era (Shakhanova and Kratochvíl 2022). In foreign policy, Russia is pursuing the ideal of a multipolar world order as opposed to the unipolar world of today, which is characterized (according to Russian leaders) by the hegemony of the West, especially the United States. Branding itself as a separate civilization, Russia seeks sovereignty not only in the political but also cultural sphere (Chebankova 2017). Thus, promotion of “traditional values” within and outside the country, exemplified by the 2013 law banning “propaganda of non-traditional sexual relationships,”² has become the hallmark of Russian politics in recent years (Moss 2017). At first, increasing homophobia and transphobia, exemplified by the “propaganda” law, were among the motivators for LGBT protest activism to develop (Buyantueva 2022). However, further intensification of state repressions led LGBT people, including activists, underground (Buyantueva 2021) or abroad (Novitskaya 2023). State repressions were not limited to LGBT activism but affected all sectors of civil society with “foreign agents” legislation (Moser and Skripchenko 2018).

Theoretical framework and methodology

Several frameworks for policy analysis in pluralist political systems have been developed, including Advocacy Coalition Framework, Punctuated Equilibrium Theory, and discursive approaches, to name a few (Peters and Zittoun 2016). However, their applicability to policy change in non-democratic contexts has been questioned (Howlett and Rarncsh 1995; Parsons 1995). Legislators in these contexts are often believed to “rubber-stamp” pieces of legislation proposed by the executive branch (Brancati 2014), making futile any attempts to apply theories inherently based on competition between policymakers. However, modern electoral autocracies are more complex than that, and combine relatively unrestricted power of the autocrat with democratic-style institutions. According to Guriev and Treisman (2020), such “informational” autocracies rely on manipulation of information (censorship of independent media, propaganda in state-owned media, bribing/co-optation of elites) instead of brute force or ideology. In these semi-authoritarian contexts, the parliaments are viewed as either proto-democratic institutions or institutions aimed at limited power-sharing to stabilize the political system (Gandhi, Noble, and Svolik 2020). In either case, members of parliament (MPs) can promote their own interests and serve as targets for lobbying efforts. When it comes to Russia, even a unanimous vote should not mislead one about the lack of contestation behind the scene (Noble and Chaisty 2022). This contestation sometimes results in major amendments of bills between readings in the Duma (Noble 2020).

In line with the considerations above, attempts have been made to propose frameworks that would describe policymaking in these not entirely authoritarian (in the classical view) but still non-democratic contexts. One of the recent examples is Johnson’s (2023) three-tier Authoritarian Gender Equality Policy Making (AGEPM) framework, consisting of opportunities, agents, and mechanisms. Analyzing Russian reforms of domestic violence legislation, Johnson found that, in the absence of a clear signal from Vladimir Putin, outcomes were determined by structural opportunities (both domestic and international), agents within (MPs) and outside (anti/feminist movement) power institutions, and shifting framings (mechanisms). The applicability of this framework to the case of trans rights is justified by the similar political context (Russia), the topic’s gendered nature, involvement of a vivid social movement, and changing framings.

I have been working on trans issues in Russia since the beginning of the 2010s, first as an activist, then as a researcher. Therefore, the events under consideration developed before my eyes. Furthermore, I was deeply involved in opposing the 2023 bill. To substantiate my personal experience and identify opportunities, agents, and framings of trans issues over time, I analyzed public statements in the media, policymakers’ personal social media accounts, and video recordings. In a few instances, I complement the discussion with information obtained via personal communications. Where possible, comparisons with Western anti-trans rhetoric are made.

Results

Anti-trans legislative initiatives before 2023

Trans issues first became the subject of legislators’ attention in 2012. Between 2006 and 2013, several regions of Russia introduced prohibitions on the “propaganda of homosexualism.” Each region had a slightly different formulation and scope of prohibition. In five regions (Bashkortostan, Kostroma Oblast, Samara Oblast, St. Petersburg, Vladimir Oblast), the ban extended to the “propaganda of transgenderism.” In 2013, a federal-level prohibition on the “propaganda of non-traditional sexual relationships” was introduced, making region-level laws redundant. However, in Samara Oblast, legislators decided to keep the ban on the “propaganda of transgenderism,” claiming that the federal law was not covering trans issues. These developments coincided with the birth of public trans activism in Russia in the beginning of the 2010s, for the first time making the suffering and political claims of trans people visible (Kirey-Sitnikova and Kirey 2019). At the international level, the period marked the beginnings of the anti-gender movement in Europe (Datta 2018). The language of protecting children from “gender ideology” is well documented in anti-gender movements around the world (Paternotte and Kuhar 2017). Yet, in the Russian case, ultraconservative groups tend to avoid explicit use of “gender” and “gender ideology” in favor of the “traditional values” discourse (Edenborg 2023).

In 2015, MP Alexey Zhuravlev and colleagues introduced a bill prohibiting marriage between individuals of the same sex assigned at birth. Their goal was “ruling out the possibility of using the procedure of the change of sex for the state registration of marriage between individuals of the same sex” (Gazeta 2015). Thus, trans rights were not the main target but came under assault as a result of being associated with lesbian/gay rights. The bill was rejected by the Committee on Family, Women, and Children Affairs. Its chairwoman, Tamara Pletnyova, said that same-sex marriage was already prohibited by existing laws and “asked colleagues not to introduce such bullshit again” (Gazeta 2016a). Another member of the Committee, Inga Yumasheva, commented: “A person who undergoes a surgery, receives a new passport … the staff of the Registry has no right to look under his clothes and check whether it is a man or a woman … They look at what is written in the passport. What is beyond that is a violation of personal and medical secrecy” (Gazeta 2016b). Thus, the framing of gender transition as a threat to traditional values was juxtaposed to its framing as a personal matter and a medical problem, in which the state has no right to intervene. MPs were the main actors on both sides.

In 2017, the Ministry of Health finally developed a draft of the “medical document” required for LGR by the 1997 law. The reasons why the Ministry of Health finally developed it after 20 years are not publicly known. What is known, the initial draft was rejected by the Ministry of Justice. In the final version, approved by both ministries, some criticism raised by trans activists and their allies was taken into account, specifically, the 1.5-year evaluation period was removed (Kirey-Sitnikova 2018). In response to this news, MP Vitaly Milonov, who became famous as the principal supporter of the “propaganda” law, proposed a ban on gender-affirming surgeries. In his opinion, “after these procedures, lifespan diminishes, various health problems come into being, suicide risk increases.” He also believed that “people seeking to change their sex need not surgeries but psychiatric or psychological care” (TASS 2017). The increased mortality rate among trans people is substantiated by research (Asscheman et al. 2011). However, it is still unclear whether it results from the effects of hormonal treatment or social factors (discrimination, violence) leading to poor mental health outcomes and HIV (de Blok et al. 2021). So, Milonov took the results at face value without considering more complex explanations. The bill was not formally introduced at that time, indicating that Milonov’s statement might have been an act of self-promotion rather than a serious attempt to stop surgeries. The framing of surgeries as a harm to oneself was not effective in spreading moral panic and bringing other MPs behind the bill – another reason why the bill might not have been introduced. Nevertheless, this is the first time when trans rights, including the right to medical care, were questioned in a way unrelated to the broader discourses on LGBT.

In January 2018, the decree of the Ministry of Health was officially adopted. Two months later, participants of the Convention of Russian Parents (Association of Parents’ Committees and Communities), which is probably a government-organized non-governmental organization (GONGO), endorsed a statement calling for a ban on LGR in all identity documents. The Association’s chair, Olga Letkova, explained: “Sex received once is a specific set of chromosomes. And it cannot be changed with a sex-reassignment surgery…. By doing a surgery, a person changes appearance but not sex. It is a deception because sex cannot be changed” (Anisimova 2018). This statement is strikingly similar to the position of trans-exclusionary radical feminists (TERF). Compare, for example, with Janice Raymond (1979, 10): “It is biologically impossible to change chromosomal sex, and thus the transsexual is not really transsexed.” The TERF ideology was first introduced in Russia in 2013 (Kirey-Sitnikova 2016); however, it is not known whether any co-operation between TERFs and Russian ultraconservative groups existed. The initiative was supported by Milonov, who agreed that sex cannot be changed and emphasized the importance of promoting collaboration between parents and MPs (Anisimova 2018). Senator Valery Ryazansky believed that LGR led to erosion of national values and could be harmful for children raised in families where one parent was trans (Fedorenko 2018). This is the first time when national values were specifically juxtaposed to trans rights. This is also the first time we see public promotion of anti-trans narratives from below, i.e. by non-governmental actors. On the other hand, MP and former chief sanitary doctor Gennady Onischenko opposed the initiative: “The issue of the change of sex is being resolved very correctly, considering preservation of the psychological status of a person, so we should not adopt any solutions – they exist…. It is not a mass phenomenon, so for now we are doing fine with these measures” (Trefilov 2018). Again, gender transition was framed as a purely medical issue that applied to small groups of individuals who could not harm the society at large. The idea of restricting LGR probably faced further opposition from policymakers as the bill was not formally introduced, despite the plans to do so in April of that same year (Anisimova 2018).

In July 2020, MP Elena Mizulina and colleagues introduced a bill (No. 989011–7) aimed at “strengthening the family institution” that would, among other things, complicate removal of children from abusive parents and prohibit changing sex in the record of the birth act. The bill came a few days after marriage was defined as a union between a man and a woman in the new Russian Constitution – a clear win for the international anti-gender movement that has been attempting to inaugurate similar amendments in other Central and Eastern European countries (Juroš, Dobrotić, and Flego 2020). According to Mizulina, the bill would prohibit marriage between individuals of the same sex, including those who had changed their sex (Mishina 2020), echoing Zhurvlev’s 2015 proposal. The working group on the bill was established back in 2016 with support of Senator Valentina Matvienko and included representatives of the Ministry of Education, the Russian Orthodox Church, and conservative NGOs (Mishina, Vasil’eva, and Dyuryagina 2020). The constitutional amendment created a window of opportunity for these ultraconservative MPs to finally put their legislation on the table. The bill received criticism from trans/intersex/LGBT groups (Mishina 2020), doctors (RTVI 2020), and lawyers (Kuznetsova 2020). MP Oksana Pushkina, a unique member of United Russia who promoted pro-feminist legislation, emerged as a prominent critic of the bill: “Can we in the 21st century from the tribute of the State Duma recognize that people with non-traditional sexual orientation are second-rate citizens in Russia? That a person whose personal life is different from ours is an untermensch” (RBC 2020). These critics relied on the frames of human rights and non-discrimination and were supported by international human rights organizations. Later, the bill was criticized by the Presidential Council for Civil Society and Human Rights (Astapkovich 2020) and the Cabinet of Ministers (Krasil’nikov 2020). Their criticism did not mention trans rights but focused on the removal of children from families – a controversial issue that required more public discussion. In the end, the bill was sent for revision and never introduced again. Thus, as with the previous failed proposals, the bill’s failure resulted from disagreements between elites rather than external criticism by human rights defenders.

Later in 2020, a representative of the Russian Orthodox Church called for the ban of “propaganda of the change of sex” among minors (Blinov 2020). In May 2021, participants of the conference on family values organized by United Russia called for a ban on “propaganda of the change of sex, bisexualism, polyamory, and abortion” (Mayshev 2021). However, the topic of “propaganda” did not receive traction until the summer of 2022, when Russia’s relations with the West further deteriorated following the onset of full-scale military actions in Ukraine, creating a window of opportunity for promotion of ultraconservative, anti-Western legislation. Several groups of lawmakers proposed various versions of the ban. For example, the bill by the Legislative Assembly of Sevastopol’ aimed to extend the 2013 ban on “propaganda” to all age categories (Vedomosti 2022), while MP Nina Ostanina proposed criminal liability for “propaganda” (Frans 2022). First, only “propaganda of non-traditional sexual relationships” was on the agenda, but “propaganda of the change of sex” was added later at the request of ultraconservative activists and MPs. The bill received positive feedback from the Government and was adopted unanimously in November 2022 (No. 479-FZ).

A few days later, Milonov introduced a bill (No. 242098–8) banning the change of sex without medical indications. By medical indications, he meant intersex conditions. He reinforced his opinion (inspired by TERFs’ ideology, as seen above) that “the change of sex is a profoundly anti-scientific story. Sex is what is written not in our external appearance but in our genome. The genome cannot be changed” (Gazeta 2022). Milonov also believed that doctors helping trans people acted out of financial interest: “There is a whole industry of such doctors, by means of simple manipulations they give this certificate for a small amount of money” (Gazeta 2022). This argument echoes Raymond’s “transsexual empire”: “the word transsexualism cloaks the power of the medical empire to generate a unique group of medical consumers. Thus the actions of a primary agent, the medical establishment, are rendered invisible, and the so-called need of the transsexual, the patient, is highlighted” (Raymond 1979, 13). At that point, the bill did not receive attention and was not adopted. However, several months later, those same arguments won the day (see next section).

As for President Vladimir Putin, trans-related issues appeared several times in his public speeches. Answering journalists’ questions after the 2019 G20 Osaka summit, he exemplified excesses of Western liberalism by saying “they invented five or six sexes – transformers, tran … I don’t understand what it is, you know. God bless everyone. It’s not a problem. The problem is that a part of the society rather aggressively imposes their point of view on the vast majority” (President of Russia 2019). This rhetoric is typical of Putin’s attitudes toward LGBT issues. First, he positioned himself above the debate by pretending he does not even know the word “transgender.” Second, he admitted that such individuals have a right to exist but they should not impose their values on others, an idea underlying the bans on “propaganda.” Further examples of Western impositions were provided in his 2021 speech: “parent number 1 and parent number 2, ‘person who gave birth’ instead of ‘mother,’ prohibition on the word combination ‘breast milk’” (Kondrat’eva 2021). Later in 2021, he reiterated TERFs’ concerns about participation of trans women in sports, claiming that “women’s sport will cease to exist” (Vitchenko 2021). He further criticized Western “cancel culture,” using the example of a prominent TERF, J. K. Rowling (Naraeva and Grobman 2022). Again, it is not publicly known how Putin learned about TERF argumentation. Similar arguments about “parent 1 and 2” and “dozens of genders” were used by Putin as a justification for the “special military operation” in September (Mettsel’ 2022) and November 2022 (TASS 2022). Putin’s trans-related remarks were brief and criticized an imagined picture of the liberal West, which was far from the lived realities of Western non-binary and trans people, who also suffer from discrimination and lack of recognition. Never has Putin mentioned trans people in Russia or called for a ban on LGR and gender-affirming healthcare.

The 2023 bill on the “prohibition of the change of sex in humans”: initiation

On 24 April 2023, Minister of Justice Konstantin Chuychenko announced that the Ministry was developing a bill aimed at restricting LGR. In his opinion, the existing norms of LGR were imposed on Russia by foreign organizations in the 1990s: “The ability to change sex was enshrined in Russian law back in 1997. At that time, various international organizations, including the World Health Organization, set the tone for forming various norms” (TASS 2023). Blaming UN agencies for imposing progressive values is not unique to Russia and is widespread among anti-gender movements (Paternotte and Kuhar 2017). In addition, the minister cited alarming statistics: between 2018 and 2022, as many as 2,700 Russians changed their legal gender (this number growing each year) and around 190 marriages were registered where one of the partners was trans. However, not all of them underwent surgeries. Thus, the bill prepared by the Ministry prohibited changing legal gender “on paper,” i.e. without surgeries (TASS 2023). The bill, if adopted, would legally define “man” and “woman” through the form of genitals. This initiative is a remarkable reversal of the Ministry of Justice’s approach to trans issues. Only five years before, the Ministry approved the decree of the Ministry of Health inaugurating a very simple procedure for LGR. The reasons for this reversal are not known, albeit in 2018 the Ministry was headed by another person (Alexander Konovalov).

MP Nina Ostanina supported the bill, explaining the growing statistics of LGR cases with attempts to avoid mobilization that started in Russia in September 2022: “Today, out of fear for being mobilized people not only rushed abroad to CIS [Commonwealth of Independent States] countries … they rushed to medical organizations to easily change sex and introduce amendments in the passport” (Sudakov 2023). The head of Russia’s Investigative Committee Alexander Bastrykin also supported the proposal because “changing sex on paper is a deception, a fraud. If it is a fraud, this deception violates the interests of the state, our defense capacity” (Gazeta 2023a). This framing of gender transition as evasion of conscription and thereby a threat to national security is absent in most Western countries with professional armies, but appears in countries with compulsory conscription such as South Korea (Yi and Gitzen 2018).

While the proposal by the Ministry of Justice gained more media attention, a similar bill was being prepared in the Duma at the same time. According to Pyotr Tolstoy, the process was led by the Inter-Faction Group on Preservation of Christian Values (IFGPCV) (United Russia 2023). The group, established a few months before, aimed at analyzing bills and laws for compliance with the Presidential Decree on traditional values adopted in November 2022 (Vedomosti 2023). In this Decree (No. 809 of 9 November 2022), preservation of traditional values was presented as a cornerstone of national security, because destructive ideologies instilled by “extremist and terrorist organizations, certain media, the U.S.A. and other unfriendly foreign nations, some transnational corporations, and non-commercial organizations” led to deterioration of the demographic situation in Russia. State Duma Chair Vyacheslav Volodin fully supported the initiative: “A person gets up in the morning and decides that he is no longer a man but a woman; not a woman but a man. Goes to a private clinic, the service costs between 30 and 60 thousand rubles [$300–$600], receives a certificate and with this certificate goes to a Registry office” (Gazeta 2023b). The latter statement echoes accusations of trans people by anti-gender activists for “changing gender several times a day” (Kuhar 2017).

The development of the bill(s) started as early as February 2023, when a trans woman I personally know was informed by a staff member of the Moscow Department of Health that “everything will be banned.” However, it is not clear whether and how the legislative and executive branches co-operated in creating two versions of the bill, which contradicted each other: one imposed surgeries as a prerequisite for LGR, while the other banned them. At the end of April, Vyacheslav Volodin stated: “A consultation with participation of the Ministry of Health, Ministry of Justice occurred. The Ministry of Justice supports the proposal for the ban, there is no other way” (Gazeta 2023b). No information on the position of the Ministry of Health was present in this quote, an early indicator that the Ministry was not fully on board with the initiative.

In the end, the more severe version of the ban (developed by IFGPCV) was chosen. Dmitry Khubezov, Chair of the Committee on Health Protection, explained why he became convinced in the righteous of this approach: “As for transsexuals, there is a certain core type for which there is no other treatment in world practice…. Nevertheless, I support the position that it should be prohibited. Otherwise, we are opening an enormous … not just a slit but a door for LGBT propaganda against our children” (Duma 2023). The division of transsexualism into “core” (yadernyi) and “marginal” (kraevoi) types was invented by Soviet doctors: in the former, the symptoms were more pronounced, making it impossible for patients to adapt in society without transition (Vasil’chenko 1983). Thus, lawmakers were aware of trans individuals for whom transition was a vital necessity. Yet, they wished to sacrifice their well-being for the interests of children and national security. The final text was prepared by Duma Deputy Chair Vladislav Davankov, who claimed: “The change of sex is a psychiatric disorder and we know many terrible stories, they are about children and adults who changed sex but later wanted to change it back” (Kiseleva 2023). This echoes politicization of detransition stories, especially regret, to invalidate gender-affirming care throughout the world (Salaberriaa et al. 2023).

The bill (No. 369814–8) was officially introduced in the State Duma on 30 May and signed by 368 (of 450) MPs. The explanatory note stated: “Currently, in Russia, there is a well-developed industry of the change of sex, including dishonest doctors, psychologists, a well-developed network of LGBT organizations and activists, other individuals. All their destructive activity they direct at adolescents and the youth.” The bill removed from legislation the clause allowing LGR and introduced a ban on the “change of sex in humans.” However, it expressly emphasized that surgeries for intersex children did not fall under the scope of this prohibition and were not to be considered a “change of sex” but a correction of a mistake made at birth.

Opposition to the bill

When this news first appeared, it was not clear how serious was the authorities’ intent, given the history of anti-trans bills that were never formally introduced or failed after criticism. I was among the first to respond with a petition addressed to the Duma and the Ministry of Health (Kirey 2023). The petition’s core was based on my own research on trans health (systematic reviews and discussion papers in Russian peer-reviewed journals) and history of Soviet trans medicine. The petition directly opposed the aforementioned narratives of the bill’s initiators and positioned gender-affirming healthcare and LGR as medically necessary and rooted in Soviet history. References to human rights and non – Russian-language sources were purposefully omitted. This petition, signed by more than 8,000 individuals, was sent to decision-makers and received the attention of journalists, giving me a platform to criticize the bill in the media.

In addition to official channels, Russian-language research articles on trans health were sent to the Ministry of Health by means of personal contacts. I also contacted an MP who held a leadership position in one the vital Duma’s committees on Telegram with a suggestion to help in drafting the bill and send relevant literature. While the first part of my proposal was rejected, the MP agreed to have a look at Russian research articles on trans medicine, which I have been collecting in Russian libraries since 2018. Trans (and to a lesser extent intersex) activists organized a public campaign calling on trans people to write letters to the authorities and explain how the bill would affect them personally. Trans-friendly doctors and lawyers expressed their professional opinions on the bill via private and public channels. According to my sources, doctors specializing in trans medicine were summoned by the Ministry of Health for a consultation to develop the Ministry’s position. In addition, lawyers and doctors met in the office of the Independent Psychiatric Association to draft a statement condemning the bill for violation of human rights, primarily the right to health. The Association’s executive director Lyubov Vinogradova complained that the bill was prepared without consultation with the medical community solely on political motives (Kostarnova 2023a).

Thus, activists and their allies used a wide range of framings to convince their audience: human rights, results of medical research showing effectiveness of gender-affirming healthcare and LGR in improving health outcomes, and Soviet traditions of helping trans patients. They also heavily relied on personal stories. These arguments were broadcast via social networks and opposition media, including Meduza (Zhvik 2023), MediaZona (Pavlova 2023), Radio Svoboda (Torocheshnikova 2023), The Insider (The Insider 2023), and Novaya Gazeta (Egorova 2023). However, these media outlets had audiences far inferior to those of state-owned TV channels and newspapers that published conservative MPs’ comments. Kommersant was the only major newspaper to broadcast the opinions of trans people and their allies (Kostarnova 2023a, 2023b). The bill was criticized by the Libertarian Party (Libertarian Party of Russia 2023), Left Socialist Action (Working Group of LevSD on LGBT 2023), and the social-liberal party Yabloko (Rybakov 2023), which were not represented in the State Duma. The movement was further weakened by waves of emigration of opposition-minded activists, lawyers, doctors, and politicians following the onset of Russia’s “special military operation” against Ukraine on 24 February 2022. International human rights organizations were specifically asked not to intervene to avoid reiterating the “foreign influence” framing.

In this situation, the Ministry of Health emerged as the only force potentially capable of stopping the bill. The Ministry did not give public comments until 14 June 2023, when Minister Mikhail Murashko was summoned to the first reading in the Duma. During that meeting, Vyacheslav Volodin read out the feedback on the bill from the Government prepared by the Ministry of Health: “In case the bill is adopted, there will arise a stalemate, in which people whose gender was officially recognized by medical specialists as not aligning with the sex in the passport would not be able to bring in line their passport details with their [gender identity]. It can cause ethical, medical, and social problems and also lead … to an increase in suicides.” As mentioned above, this position of the Ministry resulted from consultations with doctors. Nevertheless, Murashko acted very cautiously and did not reject the bill right away: “The Ministry of Health supports the unacceptability of changing sex based on just the wish of the patient … In the first reading, now, this law can be supported. Before the second reading, this work will be continued” (Vasil’ev and Gus’kova 2023). Thus, the Minister tried to maneuver between the opinion of the medical community and the new political reality, in which trans people became “enemies of the people.” In addition to the Ministry of Health, Alexey Kurinny, Deputy Chair of the Committee on Health Protection (the committee responsible for the bill), emerged as another provisional ally of trans people. He stated that trans health was a complex issue and the final decision must be made by psychiatrists, psychologists, and sexologists: “If they say that [transition] is the only variant of whatever acceptable treatment, then it makes no sense to prohibit” (Strukova 2023). Thus, proponents of trans rights had to rely on the medical and pathologizing paradigm claiming that “transsexualism” was recognized as a disorder in the International Classification of Diseases, version 10 (ICD-10) and that trans people had a right to medical treatment in the form of hormones and surgeries.

Despite this criticism, the bill was unanimously passed on the first reading. Anticipating opposition ahead, Vyacheslav Volodin forewarned Murashko: “We would like the Ministry of Health not to come up with some amendments before the second reading explaining it with care for people. You should care, if you want, by prohibiting all this obscenity” (Vasil’ev and Gus’kova 2023).

Final struggle and outcome

On 27 June 2023, an anonymous source revealed that “there are so many disagreements around the document that during the Council of the Duma that will occur on 28 June, a decision will probably be made to send the project for approval to relevant agencies, essentially taking it off the agenda” (Kostarnova 2023a). The opposition probably came from the Ministry of Health, which wished to make the formulations more vague to allow trans people to receive at least some care. According to Deputy Minister of Health Oleg Salagay, “some lexical correction is required. The term ‘physiological anomalies’ used in the bill … it would be wiser … so that we do not list all the disorders, it would be wiser to make a reference to [a by-law] with this list” (Duma 2023). This by-law, which would later be developed by the Ministry itself, might well have contained “transsexualism” among the indications for gender-affirming care in addition to intersex diagnoses. Without access to internal sources, it is impossible to determine who supported the Ministry’s position in the Duma. Another explanation might have been a conflict between developers of the two versions of the bill, the IFGPCV and the Ministry of Justice.

One of the bill’s initiators, MP Nikolay Nikolaev, publicly confirmed that the bill faced opposition. In his Telegram channel (@nikpnik), he engaged with the critics of the bill. For example, he believed that doctors opposing the bill were doing it out of self-interest: “In the U.S.A., one transsexual generates 1.3 million dollars of income for the pharmaceutical and medical industry … In our country, I think it is less but I calculated no less than 120–150 thousand dollars. Those 3,000 individuals who changed their sex during the past five years in Russia generated a guaranteed long-term income of 300–450 million dollars! that will go to producers of hormones, medications for surgeries, clinics that perform surgeries and, of course, endless psychologists” (Nikolaev 2023). This high number came from an interview with Scott Newgent, a US detransitioner, who regretted his transition (Wire 2023). In another post, Nikolaev denounced letters sent by trans people to MPs. In response to my petition citing scientific data on the effectiveness of transition, he noted that the paper’s author was a former activist affiliated with an Estonian organization. Instead, he referred readers to an article by a “real” researcher from the U.S.A. Stephen B. Levine, who doubted the benefits of gender-affirming therapy (Levine and Abbruzzese 2023).

To counter letters sent by trans people to the authorities, ultraconservative activists started collecting personal stories of parents who did not support their children’s gender identities (Telegram channel @homo_fideis). The stories followed a familiar pattern of a child, who grew up as a “normal” boy/girl but suddenly declared themselves as a person of another gender after finding information in the internet. These stories were remarkably similar to those collected by a US researcher Lisa Littman to establish her theory of rapid-onset gender dysphoria (ROGD) (Littman and Romer 2018).

While many psychiatrists opposed the bill, there were supporters as well. Olga Bukhanovskaya, director of the Phoenix psychiatric clinic in Rostov-on-Don and the daughter of one of the pioneers of Soviet trans medicine Alexander Bukhanovsky, claimed that “in Russia (and not only here), an epidemic of transgenderism has started. We are dealing with a sect that recruits new and new adepts into its ranks. The sect is ramified and well-funded.” Nevertheless, she did not support the full ban on gender-affirming care, proposing an exception for “true transsexuals” (Sazhneva 2023). The bill was overwhelmingly supported by Science for Truth, a group of ultraconservative doctors and activists aiming to “share the facts that are purposefully silenced by leaders of the LGBT movement” (Nauka za pravdu 2023). On 7 June, the Patriarchal Commission on Family, Protection of Motherhood, and Childhood issued a statement expressing concern about “malicious attempts to discredit the conceptual framework of the legislative initiatives aimed at banning the change of sex.” It reiterated its position that human sex was God’s gift and its change was a “blatant interference in human nature, humiliation of its divine image” (Russian Orthodox Church 2023).

The consolidated work of these forces succeeded, and the bill was adopted on the second reading on 13 July 2023 with the following amendments. Intersex people were permitted to have their legal gender amended upon examination by special medical commissions (the Government was tasked to create a list of medical institutions eligible to create these commissions). Trans people who had undergone gender-affirming surgery before the date of the law’s entry into force were permitted to have their legal gender amended as well. Changing sex became grounds for invalidation of marriage, and trans people were barred from becoming adoptive parents. Thus, the final version represented a compromise between forces calling for softening the restrictions (LGR permitted for intersex people and trans people who underwent surgery) and those calling for more restrictions (ban on marriage and adoption). In addition, the MPs recommended that the Government “maintain codes of ICD-10 related to gender identity disorder (F64.0), including transsexualism, transvestism, disorders of sexual preference (F65), including pedophilia” while implementing ICD-11 in Russia, effectively blocking trans depathologization that was one of the major goals of trans activists.

The bill was adopted on the third reading the following day (14 July) without amendments. After the defeat, the Ministry of Health realigned itself with the “party line” and repealed the 2018 decree on LGR (Decree No. 415Н of 4 August 2023). On 19 July the bill was unanimously adopted by the Federation Council without much discussion except for the statement of Senator Taymuraz Mamsurov, who once more reiterated that the bill was part of Russia’s cultural war against the West: “As soon as eurobureaucrats start praising us, endorse, and encourage, it means we must gather and immediately find out where we made a mistake. And on the contrary, if [they] vilify and criticize, it means we are on the right track” (Alaniya 2023).

During the aforementioned discussions, the Kremlin disavowed any involvement. On 30 June, Vladimir Putin’s press secretary Dmitry Peskov told journalists: “I am not ready to talk about any position. You know, currently there is an expert discussion in the Parliament” (Novosti 2023). Nevertheless, when the discussion was over, the bill was signed by the president to become Federal Law No. 386-FZ of 24 July 2023.

Discussion

Russian anti-trans policymaking through the prism of the AGEPM framework

When analyzing policymaking through the prism of the AGEPM framework, the first task is to discern the autocrat’s attitude and strength of signaling, as these determine all other components of the model, including opportunities, agents, and framings. Vladimir Putin mentioned trans issues once in 2019, twice in 2021, and thrice in 2022. Thus, an upward trend is observed. However, it is not clear whether this reflects Putin’s own growing interest in the topic or that of his speechwriters, who could have detected it from international news outlets where trans issues were gaining traction in recent years. Given the timing, it is safe to assume that Putin’s role was negligible in anti-trans proposals before 2019. The timing also speaks against his direct signaling afterwards: no anti-trans proposals were introduced in 2019 or 2021, although it is less clear for the 2022 inclusion of the “change of sex” in the updated ban on “propaganda.” The timing and content of the 2023 bill also do not allow us to assert a direct involvement of the Kremlin. Vladimir Putin made his most recent anti-trans remark in November 2022, half a year before the bill was announced. His words about “parent 1 and 2” and “dozens of genders” can hardly be interpreted as a directive to ban LGR and/or gender-affirming healthcare. No public references to Putin’s position specifically on trans rights were made during the discussion of the bill. Finally, it is unimaginable that the Ministry of Health (and the Government itself) would dare to oppose a bill (perceived as being) sponsored by the Kremlin. Moreover, I observed a keen interest in understanding the topic on behalf of some MPs, including the one who accepted my proposal to send him research papers. That being said, Putin’s remarks could contribute to creating an enabling environment for such a bill to pass, if some MPs heard/read/remembered what he said. It is also well known that Putin supports the general “traditional values” narrative. However, the extent of such indirect influence cannot be accessed without interviewing key decision-makers, which is impossible for this author.

Without a clear signal from above, actors were more or less free to pursue their own ends. On the anti-trans side, these included MPs, ultraconservative groups, and the Russian Orthodox Church (Table 1). These actors, which first focused on LGB(T) issues in general, started singling out trans issues over time, a trend observed in other parts of the world, especially the U.S.A. and Europe, where trans rights are becoming the “new front” in culture wars (Castle 2019; Rowlands 2023). This shift was likely caused by the increasing visibility of trans people, leading to a state of “hypervisibility” for trans issues in Russia and abroad (Wilkinson 2020). The role of the international anti-gender movement was probably more important than the current analysis suggests. Russia is known to be a sponsor of anti-gender movements globally (Datta 2018), so it is plausible to imagine that some sharing of strategies occurred. However, the tendency of many anti-gender actors to promote their goals non-publicly (Desperak 2023) complicates exact conclusions on their role in this case. For the same reason, it is impossible to discern the extent of co-operation between Russian grassroots ultraconservative groups and MPs or explain how two competing versions of the 2023 bill emerged in the Ministry of Justice and the Duma at the same time.

Table 1. Opportunities, agents, and framings of anti-trans attacks between 2012 and 2023.

Proposals		Agents		Framing
	Structural opportunities	Anti-trans	Pro-trans	Anti-trans	Pro-trans
2012: inclusion of “transgenderism” in the ban on “propaganda” (approved)	Growing trans visibility in Russia and abroad	Regional and federal MPs, ultraconservative groups	LGBT movement, international human rights organizations, foreign governments	Protection of children	Human rights
2015: prohibition of marriage between individuals of the same sex at birth (failed)	Same	MP Zhuravlev et al.	Duma’s Committee on Family, Women, and Children’s Affairs	Homosexuals change sex to enter marriage	Transition is a personal and medical issue that the state has no right to intervene in
2017–2018: ban on LGR (failed)	Same + decree of the Ministry of Health improving access to gender-affirming care and LGR	MP Milonov, parents’ groups, Senator Ryazansky	MP Onischenko	Transition is harmful for health; sex cannot be changed; LGR contradicts national values	Transition is a medical issue; the number of trans people is small
2020: ban on LGR (failed)	Same + new Constitution defining marriage as a union between a man and a woman	MP Mizulina et al., senator Matvienko, Russian Orthodox Church, Ministry of Education, conservative NGOs	Trans/intersex/LGBT groups, doctors, lawyers, MP Pushkina, Presidential Council for Civil Society and Human Rights, the Cabinet of Ministers	Homosexuals change sex to enter marriage	Human rights, anti-discrimination (main criticism centered on children’s not trans rights)
2022: inclusion of the “change of sex” in the updated ban on “propaganda” (approved)	Same + “special military operation” in Ukraine, conflict with the West	Conservative NGOs, MPs	LGBT groups, international human rights organizations, foreign governments	Not trans-specific
2023: ban on gender-affirming healthcare and LGR (approved)	Same + “special military operation” in Ukraine, conflict with the West, growing number of LGR cases	Ministry of Justice, IFGPCV, State Duma’s leadership, Russian Orthodox Church, parents’ organizations	Ministry of Health, trans/LGBT/intersex movements, independent media, political opposition, doctors, psychologists, lawyers, MP Kurinny	Sex can be changed by anyone, who is not trans, for malicious purposes; men become women to evade military service and undermine state’s defense capacity; LGR without surgeries is a deception; LGR was imposed on Russia by West-led international organizations; possibility of the change of sex harms children; fear of regret and detransition; doctors support trans people out of financial self-interest	Human rights (right to health); medical and legal gender-affirming procedures are medically necessary and effective; gender-affirming healthcare and LGR are part of Soviet traditions; personal stories

The pro-trans side included Russian trans/LGBT groups, which received extensive support from international human rights organizations and funding from Western donors. Over time, trans activists were able to build a network of supporting doctors, psychologists, and lawyers, who protested against anti-trans initiatives. However, the trans movement and its allies would not be able to stop anti-trans proposals without what the AGEPM framework calls “allies in power.” This term is somewhat misleading in this case, as no co-operation was known to exist between trans activists and, for example, Tamara Pletnyova or Gennady Onischenko. It is better to call them “neutral” forces within the Parliament and Government, who opposed anti-trans proposals for their own reasons. The Ministry of Health was another major player on the pro-trans side. In 2018, it was able to push through a decree simplifying access to LGR and gender-affirming healthcare – the only progressive development that period saw. In 2023, the Ministry became the only major force capable of stopping anti-trans legislation by drafting the Government’s negative feedback. As to this author’s information, no direct co-ordination between trans activists and the Ministry occurred, but the contacts were mediated by trans-supportive doctors. Thus, the last decade saw the building-up of forces on both sides. Anti-LGBT actors were increasingly focusing on trans issues and gaining support of MPs, as well as the Ministry of Justice by 2023. At the same time, trans activists were building a more cohesive movement supported by doctors and eventually the Ministry of Health. Why the anti-trans side was able to bring the majority of MPs to its position requires an analysis of framings and opportunities.

Anti-trans forces first framed gender transition as harmful to children, to Russian traditional values, and to one’s own body. Western TERFs’ rhetoric that sex could not be changed and trans women posed a danger for women in sport were borrowed by Milonov and Putin. Similarities between Western anti-trans rhetoric and that of Russian ultraconservatives, despite their strong anti-Western stances, is among the interesting findings of this study. Since we are lacking vital information about self-organization within the anti-trans camp, it is not evident by which route these similarities came to be, but at least three options are possible: (1) Russian anti-trans actors conceived these ideas independently; (2) they got to know them by reading Western sources; (3) direct co-operation between Russian and foreign anti-trans actors occurred.

At least for TERF narratives, there is no evidence for direct co-operation: Russian TERFs mostly ignored the 2023 bill and a few even criticized it (Kirey-Sitnikova 2023). In addition to these framings, Putin specifically invoked trans issues as a Western idea imposed on other countries. In 2023, this idea gained further development when trans healthcare and LGR were framed as an imposition on Russia by Western/globalist institutions, in particular the WHO, in the 1990s, when Russia was weak; their goals were destruction of Russian traditional values, sowing discord among Russians, and undermining the demographic situation. Such reframing was facilitated by Russia’s “special military operation” against Ukraine in February 2022 (framed as a struggle against the whole Western world order), providing anti-trans actors with a political opportunity. Another framing facilitated by the same opportunity claimed that cisgender men were changing their legal gender to female to avoid conscription, thus negatively affecting the country’s defense capacity. In the situation of a military and ideological confrontation with the West, these framings proved highly successful in drawing the majority of policymakers behind the bill and overcoming the opposition of the Ministry of Health, which framed transness primarily as a medical issue. Nevertheless, adoption of the bill was not smooth because of the conflict within elites, with the Duma and the Ministry of Justice proposing competing versions.

Thus, this policy analysis provides insights into policymaking on an issue that was not a central priority for the Kremlin. Without a clear signal from above, the process featured many democratic elements: competition between the Duma and the Ministry of Justice, which conceived mutually exclusive versions of the ban, and opposition from the Ministry of Health, which proved to be powerful enough to push its position to become a negative feedback of the whole Government. The eventual victory of Duma leadership over both ministries provides evidence that the Duma is more than a “rubber stamp,” lacking initiative of its own. Moreover, the analysis shows that, despite the unanimous vote at the end, diverse opinions were present within the Duma itself, even though the exact details are unknown. The lack of access to sources within the Duma and the anti-trans camp is this study’s most important limitation.

Since the AGEPM framework is a new approach, a brief discussion of its strengths and limitations is pertinent. The framework differentiates between the types of policymaking in authoritarian contexts depending on the autocrat’s involvement with the topic: when there is a clear signal from above, adoption of bills is smooth, but in its absence, the process becomes more democratic-like, with multiple competing actors using diverse framings that can win or lose depending on the presence or absence of political opportunities. One limitation of the framework is the lack of a clear procedure for measuring the strength of the autocrat’s signal. In this case study, what should be considered Putin’s signal on trans rights: his comments specifically about trans people, his broader statement on LGBT rights, or maybe even broader attitudes toward human rights and Western ideologies? How much time must pass between a bill’s introduction and the autocrat’s public statement for it to be considered a signal?

Second, while the framework provides a convenient structure for classifying actors, framings, and opportunities, in a situation when signaling is unclear/absent and the process becomes more democratic-like, it does not provide a clear explanation of the mechanism, i.e. why certain actors and frames are more powerful than others, why certain opportunities are sufficient for a bill to be adopted and others not. In this case study, the constitutional amendment (2020) and the intensified conflict with the West (2022 onward) provided respective opportunities for Mizulina’s and the IFGPCV’s bills, but the AGEPM framework is insufficient to explain why the first failed and the second succeeded. For such examples of more democratic-like policymaking, frameworks developed for democratic contexts might be more applicable, as originally attempted in this manuscript (this was changed after peer review).

Consequences for trans people and their allies

Despite the lawmakers’ desire to ban gender transition altogether, the law’s wording remains unclear. While it prohibits “forming of primary and(or) secondary sex characteristics of another sex in humans,” no specification is given on whether “sex” refers to gender marker or biological sex characteristics. This loophole creates a possibility to provide gender-affirming healthcare to trans people who had undergone legal gender recognition (WPATH 2024). Furthermore, trans people are free to go abroad to undergo these surgeries. They can also buy hormones without a prescription. Second, the law removes the provision allowing LGR unless a person has intersex traits or had performed a gender-affirming surgery before 24 July 2023. However, legally speaking, LGR is not prohibited. According to Article 69 of the law “On the Acts of Civil Status,” personal details can be amended by a court decision. Thus, the ability to undergo LGR will probably depend on the interpretation of the law by the courts. As of this writing, two cases on LGR have been won by trans people (DELO LGBT + 2023). Third, trans people can no longer keep their marriage after LGR. However, the legal mechanism of marriage dissolution is not yet clear. Finally, trans people are not allowed to adopt children. The law retains many ambiguities that might be exploited in strategic litigation. Importantly, the law has no retroactive effect, so trans people who had changed their legal gender or adopted children before 24 July 2023 will not be forced to forcibly detransition or renounce their guardianship right.

Based on the author’s personal experience and the scattered reports of colleagues, publishing papers in Russian peer-reviewed journals and defending dissertations on trans health has become almost impossible during the past several months due to direct or indirect censorship. Conservative activists are planning to “implement a legal review of previously issued certificates of the form 087/у, bring to justice doctors who had issued them without proper diagnostics, on demand” (Palata 2023). Russian law might inspire similar policymaking in neighboring countries of Eastern Europe and Central Asia. According to Leonid Slutsky, the leader of Russia’s Liberal Democratic Party, “today Russia sets an example for countries, societies, parliaments that will make a decision to adopt similar bills preventing the possibility of intervening in human nature” (Satinova 2023). The first to act could be Georgia, which as of June 2024 is about to borrow a set of Russian anti-LGBT laws, including a ban on medical and legal transition (Civil Georgia 2024). In addition to direct consequences, the law in Russia will lead to even more stigmatization of trans people and serve as an additional motivation to seek asylum abroad. MPs’ statements against implementation of ICD-11 in its current form, made during deliberations on the bill, was among the factors making the Government halt ICD-11 adoption on 31 January 2024, a measure with the potential to affect not just trans people but all patients in Russia.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. Legal gender recognition (smena dokumentov in Russian) refers to the state’s recognition of a trans person’s gender identity by issuing new documents (birth certificate, passport, etc.) with a new gender marker and/or legal name.

2. Federal Law No. 135 of 29 June 2013 prohibited the “propaganda of non-traditional sexual relationships” (which could imply sharing any information on LGBT issues) among minors.