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Alex Shmik stood in the court chancery of the Russian town of Mirny, staring in disbelief at the three pieces of paper delivering the judge’s verdict. After four years in bureaucratic limbo, he would be able to officially leave behind his life as Alexandra and change the gender marker on his passport to male. One question kept repeating itself in his mind: Will I be able to live as a normal person now? Ad Policy

Normality is a sought-after commodity among many transgender Russians. Misunderstood and misrepresented throughout history, members of this minority are accustomed to facing a hostile environment. In today’s Russia, their breathing space is shrinking at an accelerating rate, as they become increasingly vulnerable to hate crimes and outright opposition by the authorities. The Russian government has shown little interest in solving the problems affecting transgender Russians; in fact, a number of lawmakers have proposed transphobic legislation in recent years. Meanwhile, there are few trained professionals that can address trans people’s medical needs, and legal barriers prevent them from undergoing gender reassignment surgery and changing the gender marker on their official documents. Without a strong activist network to campaign for social change, unemployment, poverty, and discrimination push many to find a way out—some through self-imposed exile, other through suicide.

In recent years, the Russian government has become the target of much criticism from the West for its treatment of the Russian LGBT community, particularly following the introduction of the 2013 “gay propaganda law,” which forbids the promotion of a “nontraditional” lifestyle among minors. And even though the Soviet Union’s first successful gender-reassignment surgeries took place in the early 1970s, transphobia, homophobia, and discrimination have afflicted queer Russians throughout history. Russian sexologist Igor S. Kon documented in his book The Sexual Revolution in Russia how persecution and discrimination in the Soviet Union pushed many “blues” (the belittling term Russians use to refer to the country’s queer population) to conceal their identity, while Russian LGBT expert Brian Baer said that the lack of a clear distinction between gender and sex in Russian culture has often compromised people’s ability to comprehend the difference between sexual orientation and gender identification.

As nationalistic and conservative ideas gained a foothold following the collapse of the Soviet Union, Russia remained anchored to its misconceptions. Even in the liberal 1990s most Russians considered queerness a phenomenon foreign to their culture, particularly given the role of Western organizations in the development of an LGBT activist network within the country, Baer notes. “Unfortunately, this reinforced in a lot of Russian eyes that [queerness] was a Western import and didn’t really have a natural place in Russia,” he explains. Even in the liberal 1990s, most Russians considered queerness a phenomenon foreign to their culture.

Shmik tested the harsh reality of life as a transgender person shortly after receiving permission to change the sex on his documents in 2005. He was 25 and had only recently started his hormonal therapy. “I finally had my passport, but it was a small city. I couldn’t find a job,” he told me. “I went into depression. I understood that even with the document I was still not able to earn enough money for the operation. I had run out of energy to fight. I was going crazy.” His former wife, from whom he had just separated, came to his rescue. They put together their savings so that Shmik could afford surgery. He headed to St. Petersburg and underwent gender reassignment surgery at 27. After the operation, he said, he was so happy he would dance half-naked in front of the mirror.

Shmik, who is now 35, was lucky. At 21 he had obtained a certificate from the Serbsky Institute, the main psychiatric establishment in Moscow, diagnosing him with “transsexualism.” The certificate is a necessary step for transgender people who want to start their physical transition. But obtaining the document is becoming increasingly difficult these days. Transgender people normally have two possible options, neither of which is easy. If you have enough money, you can try getting diagnosed by a local psychiatric hospital, said Tatiana Glushkova, a lawyer who provides legal assistance to transgender people. But the doctors might put you under observation for a month. “And you should understand what a psychiatric hospital in Russia is,” Glushkova said. “Staying there for a month is not a pleasure.” Also, not many medical practitioners have the specialized knowledge required to diagnose people with conditions such as gender dysphoria. LIKE THIS? GET MORE OF OUR BEST REPORTING AND ANALYSIS

Alternatively, a transgender person can turn to one of the few state-sanctioned psychiatric commissions issuing the certificate. They are cheaper than psychiatric hospitals, but they can cost anything from 6,000RUB ($78) to 30,000RUB ($397). And there are no medical standards regulating the process leading to the issuance of the certificate. For some, that means up to two years of medical observation and regular check-ups, Glushkova noted.

Until this summer, the St. Petersburg state psychiatric commission was among the cheapest and most popular in Russia. Dmitry Isaev, head of the commission and director of the department of clinical psychology at St. Petersburg State Pediatric Medical University, is one of the few specialists in the transgender-care field in the country. People from all over Russia came to St. Petersburg to seek his care. “I know people who came to his commission from Petropavlovsk Kamchatsky, if you know where it is.… It’s much closer to America than Russia; practically Alaska,” Glushkova said.

I met Isaev in August at a pastry shop on the periphery of St. Petersburg. He looked exhausted. In July, the university administration had asked him to resign from his teaching position and disbanded the psychiatric commission. The Russian newspaper Meduza reported at the time that those actions were likely punishment for Isaev’s pro-LGBT profile, which had elicited the protests of nationalist and conservative activists. Isaev told me that the real problem is the fact that the authorities allowed an atmosphere of intolerance and hate to take root.

Isaev’s dismissal followed a series of attempts by the authorities to enforce discriminatory legislation against transgender individuals. In January 2015 the Russian government issued a list of diagnoses that could lead to a driving ban for individuals affected by specific conditions, including gender dysphoria. In response to criticism raised by the announcement, the Ministry of Health clarified that the ban is effective only if the subject also shows signs of severe mental disorder or has been prescribed psychotropic drugs. Meanwhile, the Russian State Duma is considering a draft bill to ban marriage between transgender people (a date for the bill’s first reading has yet to be scheduled). Conservative lawmakers within the parliament are the driving forces behind this tidal wave against queer Russians, from Vitaly Milonov, the mastermind of the “anti-gay propaganda” law, to Alexei Zhuravlev, one of the authors of the proposal to ban transgender marriage. Their rhetoric, focusing on “traditional family values’ and heteronormative ideas, has grown stronger following Vladimir Putin’s return to the presidency in 2012, when authorities started cultivating a closer political partnership with the Russian Orthodox Church under the leadership of the patriarch of Moscow and All Russia Kirill.

As the pressure mounts, transgender people are left with limited solutions. The most desperate commit suicide, as in the case of Dasha Shtern, a 22-year-old transgender woman who killed herself after losing her job. Others choose life abroad. “They say: I understand that in this country I will never have a life worthy of this name. To solve this, they have to leave. It doesn’t mean that they want to, they just don’t have any other option,” Isaev says. Even though statistics on LGBT refugees from Russia are not readily available, gay and transgender Russians seeking asylum abroad are seemingly becoming more common. In November 2014, the Associated Press published a report on gay Russian asylum seekers in New York, and LGBT nonprofits such as RUSA LGBT, a New York–based organization devoted to helping Russian LGBT people, work closely to support people who chose to leave Russia. Baer, who often serves as an expert witness on asylum cases, also confirmed that he has observed an increase in the number of applications.

Still, many stay behind. Shifra Kazhdan, a 42-year-old “MtF” (the tag she uses to refer to her status as a trans woman) and an artist, said she doesn’t think she will ever leave Moscow. When I asked her why, she explained that she was scared of making a jump into the unknown, without any guarantee that her life abroad would be much better. In 2014, Human Rights Watch denounced an increase in the number of attacks on LGBT individuals in Russia.

Kazhdan’s vocabulary is filled with fear. “I can’t go out and walk down the street; I am always I afraid when I am outside. Always,” she said as we sat in the kitchen of her aunt’s apartment. “I am scared of being outside at night.” Earlier in the day she picked me up from the subway station. She had wrapped herself in a black hoodie and looked hyper-vigilant, as if she was waiting for someone to attack her from behind.

Her vigilance is warranted. Human Rights Watch denounced an increase in the number of attacks on LGBT individuals in Russia in a 2014 report citing multiple surveys and data collected by Russian activist groups. The uptick coincided with the introduction of the “gay propaganda” law. In October 2015, Dante Teodori, a transgender LGBT activist in St. Petersburg, documented in a Facebook post how a young man assaulted him on the subway for wearing a rainbow scarf. “He said that I either took off my scarf and got off the train, or he would kick my ass (I spare you the swearwords),” Teodori wrote as a commentary to two pictures of his swollen face. The activist is only one among the many victims of violence seemingly motivated by homophobia. Just a few days ago, on February 1, transgender woman Anzhela Likina was stabbed to death in the Russian city of Ufa. Likina had gained notoriety among the Russian public in 2014, after the appearance on the internet of a video showing Russian police checking her documents and laughing at her upon noticing her passport carried her male name.

The message is clear, said Tatiana Vinnichenko, an LGBT activist in Moscow: Transgender people are second-class citizens to the authorities. And while some organizations, such as Vinnichenko’s LGBT Set’, try to campaign for their rights, Russia lacks a strong tradition of activism able to bring about significant change. Baer explained that the LGBT activist movement first appeared in the country in the early 1990s as a Western implant that failed to take root. “I describe it as a kind of Potemkin village, because it was largely supported by Western grants and funding,” he said. “It lasted while the money lasted.”

Baer attributes the failure of Russian activism to develop to the different priorities held by queer people across the country. LGBT Russians “were really focused on getting protections on their private life and the private sphere, which had been so invaded by the regime,” he said. “And so this idea of out-there activism and coming out didn’t make a lot of sense to people.” And even though Putin’s arrival on the scene might have pushed some people to demonstrate out on the streets, he added, hopelessness and cynicism are driving many activists out of the country. Transgender activists across the country prefer providing support to transgender people to staging protests in the hope of instigating social change.

The lack of integration of transgender voices within the Russian LGBT community also risks limiting the success of any campaigning efforts on their behalf. Elena Flegontova, a spokesperson for the activist group LGBT Set’, said that despite their efforts to include transgender people in their activities, that group remain underrepresented. This might in part be a defense mechanism. Baer observed that the ability to remain out of the public sphere is much valued among transgender people, which is why many look at activist efforts with suspicion. “There is safety in the general ignorance,” he said.

Even though there are a few transgender activists across the country, they often prefer providing direct support to transgender people to staging protests in the hope of instigating social change. FtM Phoenix, a Russian-American group devoted to improving life for Russia’s transgender people, focuses on counseling transgender clients and educating medical professionals. “Our main task and our main job is working with doctors,” said Kirill Sabir, who leads the group.

Under those circumstances, it is difficult to imagine institutional change without the help of the ruling elite. “We have no way to influence the legal processes within the Duma. Unfortunately,” Vinnichenko said. Isaev is of the same mind. “It’s a paradox,” he said, “Here you can’t do anything without the government.”

Glushkova deals with the contradictions of the system almost every day. As the coordinator of the Moscow-based legal-aid project Transgender Legal Defense Project, she assists transgender clients who are trying to change the gender marker on their documents. “We got a law that provides a possibility for transgender people to change their documents, if they provide ‘a medical document of a specific type’ stating that their sex has been changed,” she explained. The problem is, the Ministry of Health never developed standards for such a document—something they were supposed to do in 1998. They just don’t care, Glushkova said.

Getting the accurate gender marker on your official documents is essential in the transgender fight for a normal life. Across the country, ubiquitous security guards conduct diligent passport checks in business centers and libraries alike. And if the stated sex on your documents doesn’t match your physical appearance, how can you hope to find a good job? The contradiction could leave a transgender person unable to prove their identity and gain access to services, employment and even buildings.

“Without medical certificate you have no documents, without documents you have no job, without job you have nothing to eat,” said Sabir. In fact, unemployment and poverty are among the most debilitating issues affecting the transgender community, Vinnichenko said. She explained that many people face discrimination as they attempt to complete their studies and get jobs. Often they turn to prostitution and alcoholism as their main sources of, respectively, income and comfort. “They come from the regions to the capital, and they end up with no job, no education,” Vinnichenko said.

In their mission to improve life for transgender people, the Transgender Legal Defense Project team takes a case-by-case approach. In some regions far from Moscow, Glushkova explained, the local civil-registry office might accept a simple medical declaration diagnosing a person with transsexualism in order to change the gender marker on their birth certificate. In Moscow, the registrar refuses to. When this happens, the lawyers at the Project go to court and appeal to the judge. “Usually we win these cases,” Glushkova said.

Transgender people in Russia often focus on the small victories. Sabir takes pride in the work of the group’s peer-counseling program. Kazhdan started understanding her identity much better the moment she decided to start using the female pronoun. And Shmik, who provides psychological support to transgender people in his spare time, lightened up talking about the e-mail requests he receives from mothers of transgender children. Maybe, he said, the fact that these women are trying to understand is a sign that not everything is lost.