Psychiatrists are ready to treat sexual identity disorders

The Russian Society of Psychiatrists has prepared a version of clinical recommendations for the treatment of gender identity disorder. Let us remind you that in July 2023, a law prohibiting gender change without medical indications came into force, so the recommendations do not mention either surgery or hormonal therapy as treatment methods. At the same time, the authors propose to provide psychotherapeutic support to patients at all stages, among the goals of which is reconciliation with their innate gender. A representative of the trans community declares the unacceptability of both a number of diagnostic practices and the very attempts to return patients to heterosexuality through so-called “conversion therapy.” Psychiatrists interviewed by Kommersant believe that the recommendations will help specialists better understand each specific case.

The website of the Russian Society of Psychiatrists (RSP) has published a version of clinical recommendations for providing medical care to adult Russians diagnosed with “gender identity disorders.” Recommendations are necessary to support physicians’ decision-making regarding diagnosis, treatment, prevention and rehabilitation of diseases. The document is prepared by the professional community and approved by the Ministry of Health of the Russian Federation.

The first guidelines on transsexualism were issued in 1991; in 2012, the corresponding order was canceled. Since then, there have been no clinical guidelines for gender identity disorders in Russia. But on July 24, 2023, an amendment to the law “On the fundamentals of protecting the health of citizens in the Russian Federation” came into force: now Art. 45.1 prohibits gender reassignment – ​​that is, medical interventions, including the use of medications, that are aimed at “sex reassignment,” including “the formation of sexual characteristics of the other sex.” An exception is the treatment of congenital anomalies, as well as genetic and endocrine diseases associated with impaired formation of the genital organs in children. Doctors are now unable to prescribe medications for transgender transition, although the use of specific medications is not prohibited.

Accordingly, the proposed version of the ROP does not contain a description of the principles of hormone therapy and gender reassignment surgery, although it is noted that patients who underwent surgery before the law came into force have the right to hormone replacement therapy. In the “Psychotherapy” section, the authors propose providing psychotherapeutic support to patients at all stages. Among the goals are to achieve realistic ideas about one’s condition and develop an adaptive model of behavior, deactualize gender-role conflict, attempt to reconcile with one’s innate gender, and correct disorders of psychosexual development. Social adaptation of patients is also expected, including expanding the range of choice of behavior and improving the quality of life.

Representatives of the trans community regard this approach as “conversion therapy” (changing a person’s sexual orientation from homosexual or bisexual to heterosexual through psychological, physical or spiritual interventions). “If the Ministry of Health accepts this version of the clinical recommendations, this will mean that conversion therapy will be officially recognized as one of the methods of treating gender dysphoria,” comments transgender researcher Yana Kirei-Sitnikova (formerly a member of the Yabloko party, Gleb Sitnikov.— “Kommersant”) — The effectiveness of conversion therapy has not been scientifically proven, therefore, from a technical point of view, it cannot be included in clinical recommendations. However, ideological considerations may outweigh evidence-based medicine.” The drafters of the recommendations include in the diagnosis practices that transgender patients consider unacceptable, adds Yana Kirei-Sitnikova – for example, examination of the external and internal genitalia and questions about sexual practices.

According to Ruslan Isaev, a psychiatrist and head of a drug treatment and psychiatric clinic, clinical recommendations are not at all aimed at “banning something or tightening the screws.” According to him, the recommendations will provide an opportunity to better understand each specific case, both for people who want to make the transition and for specialists: “This is exactly what we work on in psychotherapy: achieving realistic ideas about our own internal reasons, goals, expectations from this step. This includes an attempt to reconcile with innate gender. This is absolutely normal. A competent specialist – a psychiatrist, a psychologist – helps a person consider all existing options.” Mr. Isaev says that in practice he encounters a “quite large” number of requests from relatives who complain that sex change stories are “replete with a lot of violations,” in particular, when they “draw” a gender change certificate for money. In addition, Mr. Isaev notes the increasing incidence of psychosis due to the use of psychoactive substances with the overvalued delusional idea of ​​changing the gender marker. After treatment, these highly valuable false conclusions disappear: “Perhaps the choice is really connected with the use of psychoactive substances, with “tunnel thinking”, with a severe traumatic situation, including in childhood. Psychotherapy allows you to see what can be done in a reality that seems dangerous, frightening, unbearable.”

Another psychiatrist, on condition of anonymity, noted that there is not a single theory that would reliably indicate the causes and mechanism of gender identity disorder, just as there is not a single reliable clinical study that would show in which direction the patient’s condition changes after one or another type of corrections. “Psychiatry works, but assessing its effectiveness and efficiency at the moment, using certain techniques, is an unsolved scientific problem,” says Kommersant’s interlocutor. “With such recommendations and a ban on surgery, we get a situation where people who would benefit from surgery could help, they will be left without help, and nothing will help people who would not have been helped anyway.” The specialist considers the reaction of the trans community to be too acute: “We receive two reactions with excesses: from the community, whose representatives see even a routine medical examination as a threat, and from official medicine, which has begun to be guided by the principle of obligation, rather than scientific evidence.”

The Russian Society of Psychiatrists did not respond to Kommersant’s request; The Ministry of Health of the Russian Federation has also not yet commented on the proposed version of the recommendations.

Natalia Kostarnova