This week, Russia established an official procedure for transgender people to obtain medical certificates confirming their gender identity. Previously, individual civil registry servants could decide whether to grant updated certificates, and could often impose strict requirements, such as requiring people to take steps to transition surgically. Unlike in many U.S. states, the new procedure does not require any surgery.

Requiring transgender people to undergo surgical procedures before their gender can be legally recognized is a human rights issue with which countries across the entire planet have wrestled. That’s because such procedures generally result in the individual losing their reproductive ability and because not all transgender people want, need, or can afford to undergo such procedures as part of their transition. Last year, the European Court of Human Rights ruled against such requirements in France, setting a new legal precedent across the continent.

The decision was the culmination of many countries and organizations arriving at that conclusion on their own. In 2014, the World Health Organization (WHO), which still diagnoses transgender identities as a mental disorder, nevertheless issued a statement calling for “eliminating forced, coercive, and other involuntary sterilization.” The language of “sterilization” — uncommonly deployed in the United States around this issue — has been at the center of the debate in European countries like Sweden, which famously practiced forced sterilization throughout the mid-20th century. Sweden ended its surgical requirements for transgender people in 2013.

Several South Asian countries, like India and Nepal, have also been leaders in legally recognizing transgender people, issuing them documentation that identifies them as “third gender” — a culturally relevant equivalent.


But in the United States, a patchwork of laws creates a very inconsistent experience for transgender people hoping to update their birth certificates. Like the WHO, the American Medical Association has also called for the end of surgical requirements when updating records. According to the Transgender Law Center, however, there are only 17 states that offer clear policies for changing birth certificates and do not require surgeries for recognition.

A few states, including Tennessee and Idaho, have no way of amending birth certificates. Last year, Lambda Legal filed a lawsuit challenging Idaho’s limitations, as well as Puerto Rico’s. Another 18 states have policies that explicitly do require surgery: Alabama, Arizona, Arkansas, Colorado, Delaware, Georgia, Kentucky, Louisiana, Michigan, Missouri, Montana, Nebraska, New Mexico, North Carolina, North Dakota, West Virginia, and New Jersey, where Gov. Chris Christie (R) twice vetoed bills that would have removed the surgical requirement. Several other states have no stated policies, and trans people’s success at seeking changes through the courts has been inconsistent.

Russia has been internationally scrutinized for its anti-LGBTQ laws and environment, and transgender people still experience rampant discrimination there, such as in employment. But Tatiana Glushkova of the Transgender Legal Defense Project said she’s optimistic the new policy “significantly improve the situation of trans people in Russia.”

“We welcome the adoption of the Ministry of Health’s order in its final version, and we believe that its entry into force will significantly improve the situation of trans people in Russia,” she said in a statement.