When Mariana left the police station in a northern Kazakh city in 2017 with a new passport and an official ID card that listed her gender as a woman, she knew those two things would change her life.
Having lived for years with documents that described her as male -- even though she looked, behaved, and felt like a woman -- Mariana jumped from job to job, often having to leave when it was discovered her ID showed a different gender than her identity.
At one job, she decided to be brave and tell her co-workers that she was transgender, or a person whose gender identity differs from the sex they were assigned at birth.
“One of the employees nearly broke my ID card he was so furious,” says the 20-something Mariana. “I was bullied, they gossiped about me, I felt highly uncomfortable and insecure.”
But getting those documents identifying her as a female was a very long, costly, and even humiliating process.
Kazakhs seeking to change their gender on official documents must first go to a psychiatric institution's mental-disorders department, where they can be kept for 30 days.
There they are examined by a Commission for the Medical Certification of Persons with Sexual Identification Disorders that is composed of three psychiatrists and other medical specialists.
“I felt like an object for research,” says Mariana, of her meetings with doctors. “They can ask you a lot of inappropriate questions and if you’re not defensive about your boundaries they can easily violate them.”
Tests include genetic and hormonal tests and a head X-ray to identify any possible pathology in the brain -- a throwback to another era when being transgender was considered a psychological disorder.
One doctor even told Mariana that she must undress in front of the medical commission and would risk not being approved for surgery if she refused.
“The vast majority of transgender people have had negative experiences when visiting doctors,” a representative from Alma-TQ, Kazakhstan’s leading transgender rights group, told RFE/RL.
Patients endure “unethical treatment, verbal and emotional abuse, harm to their health due to inappropriate treatment or intentional refusal to provide medical care,” the representative added.
If the commission finally decides to diagnose the person with “transsexualism,” it will recommend hormone therapy and a surgical sex change.
But only after having the gender-confirming surgery -- which includes sterilization -- may the person apply for a change in their official documents.
The entire process usually takes years to complete and costs between 1-1.5 million tenges ($2,400-$3,650) for male to female surgery and up to 3 million tenges ($7,300) for the female to male operations.
“During those years [needed for the entire process], you’re outed to your whole network of everyone who has ever known you,” says Robyn Alice McCutcheon, a former U.S. diplomat who served in Kazakhstan and was among the first American foreign-service officers to undergo surgical gender transition while serving abroad.
“Any services, whether it’s education, medical -- anything that requires showing a document -- puts a person in danger” says McCutcheon.
Had Mariana sought to change her documents eight years earlier the process would have been comparatively easy. The more liberal law required only several medical tests and 30 days of psychiatric evaluation to legally change one’s gender.
But Kazakhstan adopted a health code in 2009 that allows sex-reassignment surgery for “persons with sexual identity disorders.”
It also stipulates that transgender persons who suffer from somatic or neurological diseases may not qualify for surgery, while those who are under 21 cannot apply to change their gender in official documents.
The same new law prohibits transgender people from adopting children.
And in 2011, the Kazakh Justice Ministry mandated “transsexual surgery” as a prerequisite to officially change one’s sex on their documents.
That caused problems for many transgender people who decide to forego surgery due to health issues, financial reasons, personal reasons, or to avoid sterilization, as is mandated under Kazakh law.
If they elect to not have the surgery, a person cedes their right to legal recognition under their identified gender.
According to TengriNews, just 10 people in Kazakhstan had sex reassignment surgery and changed their documents from 2017 to 2019.
Numerous human rights groups, including Human Rights Watch and Article 19, have called on Kazakhstan to change those laws that they deem discriminatory.
In a letter to RFE/RL, the director of the Kazakh Justice Ministry's International Law and Cooperation Department, Mahsat Bereketov, said “the rights of transgender people in Kazakhstan are protected by the constitution, ratified international treaties in the field of human rights, as well as other legislative acts.”
“Belonging to a certain biological sex entails legal consequences,” wrote Bereketov, citing military service for men, mandatory retirement ages, and certain punishment before the law. He added that “individuals who changed [their] personal data without surgical intervention could not confirm their identity and found themselves in difficult situations. For example, when staying in medical institutions [located in women’s or men’s wards].”
In several Western European countries, such as the Netherlands, one can change their legal gender after getting a letter from a psychologist.
And in Russia, by comparison, a person can obtain an official certificate to get their gender changed on official documents and be allowed to have gender-confirming surgery within days after having a meeting with a commission and paying a fee.
According to the Russian representative of the Trans*Coalition in the Post-Soviet Space, at least 1,000 people changed their legal gender in Russia in 2019 and about one-third of them underwent surgery.
In the United States, more than 9,500 people had surgical sex changes (two-thirds of them were female to male) in 2018, according to the American Society of Plastic Surgeons.
Unfortunately, medical problems for transgender people don’t end after undergoing surgery.
According to research produced by the Trans*Coalition in the post-Soviet Space, two-thirds of people who undergo such surgery in Eastern Europe and Central Asia are immunocompromised due to postsurgical health issues, chronic illnesses, or other ailments.
Studies have shown that transgender people often face discrimination in receiving health care, of which many cases have been reported in Kazakhstan.
Trans*Coalition and other local activists say they are delivering food and hormonal drugs to transgender people since many in Kazakhstan affected by COVID-19 may not receive adequate health care due to transphobia, incompatible documents, or financial strain.
Transgender Kazakhs also face a slew of problems that extend beyond the medical sphere.
They are barred from working in law enforcement or serving in the military, and without official documents they struggle to find work, open bank accounts, travel abroad, purchase real estate or cars, and even to rent apartments.
Without viable employment and sometimes on the verge of becoming homeless, some transgender people turn to working in the sex industry.
Conservative families -- of which there are many in predominantly Muslim Kazakhstan -- frequently disown their transgender members.
McCutcheon recalls the case of a transgender woman who “had been living under the radar, transitioned, for a number of years…[and] her family said ‘we want you home, we accept you.’ [But after moving in with them] they chained her to a radiator and forcibly shaved her head.”
In the worst of cases, living with incompatible documents can be life-threatening.
A 2020 report by ILGA-Europe (International Lesbian, Gay, Bisexual, Trans, and Intersex Association) details the story of a chronically ill transgender woman in Kazakhstan who was called a “faggot” and a “freak” by hostile paramedics who threatened to kill her. They were not detained.
Kazakhstan’s lack of antidiscrimination laws for the LGBT community also fosters a culture of hate and discrimination.
When a popular Kazakh news site published an article about police abuse of a transgender woman, comments included “it is right that [she was] beaten,” and references to her being an “it” and “a monstrous degradation.”
Local human rights groups documented more than 40 cases of hate speech and violence against members of the LGBT community from January-July 2019, with many cases likely not being reported.
As a result, transgender Kazakhs and rights activists quite often try to live their lives without being noticed.
“You’re always under pressure to speak quietly and be aware if someone is watching you and hearing things you’re saying” says Mariana, who has become a transgender rights activist.
In 2016, Kazakhstan’s state Islamic board issued a fatwa against gender confirming surgery, calling it a “great sin” that must be “punished.”
The religious ruling alienates the transgender community in a country that is some 70 percent Muslim, most specifically in Kazakhstan’s conservative provinces.
This odium is fueled by the Kazakh media, which sensationalizes transgender people and uses their stories for popular entertainment.
McCutcheon noted “a number of instances of the media in Kazakhstan bringing someone into a talk show...to be attacked…to elicit an emotional response from them.”
A recent Alma-TQ analysis of the media showed mocking and dismissive rhetoric being used in reference to transgender persons, while journalists refer to transgender males as “ex-men” and “ladies.”
When McCutcheon, 65, served in Kazakhstan from 2014-17, she worked with local NGOs to facilitate a roundtable discussion on transgender issues and organized events surrounding the annual International Day Against Homophobia, Transphobia, and Biphobia.
Though it’s difficult to give precise numbers on how prevalent the transgender community is in society, one study found that between 0.4 and 2.7 percent of the U.S. population is transgender and between 25-35 percent of them have sex-reassignment surgery.
When Kazakh officials proposed passing a Russia-style “gay propaganda law” prohibiting advocacy of the LGBT community in the alleged interest of “protecting children,” the U.S. Embassy and other diplomatic missions expressed their opposition to such legislation and the draft bill was eventually ruled unconstitutional.
The effort by the government coincided with Kazakhstan’s bid for the 2022 Winter Olympics and its preparation for the 2017 World Expo in Astana.
“The message from the diplomatic community to the [Kazakh] government was ‘You want to show Kazakhstan to the world as a showcase of this modern country. Why would you want to enact a law that’s going to bring the world human rights community down on you?’ And that worked,” says McCutcheon.
But foreign diplomats and activists can only intervene to a certain extent.
Similar “anti-propaganda” legislation was drafted in 2018 and, after local activist groups lobbied against it, the language was changed to be nondiscriminatory -- though without specific reference to the LGBT community -- and was made law.
But activists still fear the Kazakh government could enact by-laws that are as harmful as the draft law was.
Getting one’s official documents is still the crux of the matter, and though some advocacy groups are working to make the laws friendlier toward transgender people, they must do so discreetly.
Kazakh NGOs may be penalized and even disbanded for receiving aid and funding from foreign sources, which is why McCutcheon believes the most important efforts occur “within the country itself.”
Alma-TQ is considered a trailblazer in such efforts.
The group provides information on transgender health care, rights, and support groups while also training doctors on best practices for treating transgender patients.
Alma-TQ also documents hate crime and discrimination cases as well as the way transgender members are represented in the media.
“It’s about educating others,” says Mariana. “I think we’re already doing that, slowly but surely. It just takes a lot of time and patience.”
But in Kazakhstan, having official documents with the correct gender listed are “the linchpin to being able to change your entire life,” says McCutcheon.
“Remove the document, remove the person,” she adds, quoting Mikhail Bulgakov’s classic novel, The Master And Margarita.