People who want to change their sex in Estonia must first ask permission from the health care minister. No one can start hormone treatment and undergo sex reassignment surgery without Jevgeni Ossinovski's signature today.
The Ministry of Social Affairs believes it is high time to change this. „Sex reassignment is a medical, not a political procedure, which is why corresponding decisions should be made by a medical committee, not the minister,“ Ossinovski believes. The minister's position is echoed by officials.
„We believe it is not right when a minister needs to give his permission for medical procedures,“ said adviser of the ministry's health system development department Ingrid Ots-Vaik.
The latter requirement is stipulated in the „Common requirements of medical operations for gender reassignment“ regulation from 1999. People are expected to prove they are transgender to a ministry expert committee comprised of psychiatrists, a gynecologist, and a urologist before the minister can approve the procedure.
Eleven applicants last year
A person has to be diagnosed with transgender identity and have lived with it for two years before they can turn to the minister. People wishing to change their gender must also have a certificate from a psychiatrist stating that the said desire is not caused by a mental disorder. The third requirement is a genetic study.
„The minister and the committee cannot deny a person's right provided all three conditions have been met,“ Ots-Vaik said. She added that neither the minister's signature nor the committee have any additional value. „It is all a formality.“
Head of LGBT society OMA Keskus Kristel Rannaäär says it is degrading. „I personally cannot imagine having to prove to a committee that I'm a woman,“ she said.
The ministry is preparing to send out draft legislation to amend the public health act that would consign the 1999 regulation to history.
„Why should the state intervene with people's bodies?“ Ots-Vaik asked. „The right to bodily self-determination is a fundamental right.“
The ministry's expert committee has been headed by psychiatrist-sexologist Imre Rammul since its founding, who does not believe his work to be just a formality.
„We ask a number of questions – more from some people, less from others. We try to establish a person's mental condition. We ask about future plans. Whether people are informed when it comes to risks involved. About what would happen were they to change their mind or want to have children some day,“ he said.
Rammul said that he cannot imagine gender reassignment without the committee. „We should definitely not have a free-for-all,“ he added.
The social ministry believes gender reassignment does not need separate regulation.
„Gender reassignment is a complex health care service offered by different medical professionals in their corresponding capacity,“ Ots-Vaik said. „Health care services depend on individual patients' medical condition. That is why it is impossible for the committee to determine a finite list of services needed.“
Applicants are few, even though their number has risen slightly in recent years. Last year saw 11 applications for gender reassignment. „Society is becoming more open and knowledgeable,“ Ots-Vaik suggested in terms of why. Officials say no one has been turned down.
Rammul said that the committee has seen one person who wanted to reverse their sex change. He also said that some candidates have been turned down over the years. In most cases the committee has held people's mental condition to be the obstacle. „It does not happen often,“ Rammul said.
However, abolishing the regulation will create a number of new problems. A ministerial directive currently serves as basis for both medical and legal gender reassignment. After a year of hormone treatment a person gets the right to adjust their gender legally and apply for new identification documents.
Abolition of the 1999 regulation would take with it grounds for legal gender reassignment. „The problem will concern the interior ministry,“ Ots-Vaik said.
The social ministry believes medical and legal gender reassignment should be separated. Officials believe that one should not depend on the other, and that a person should be able to change their gender without undergoing medical procedures. This position is also supported by the Estonian Bioethics Council.
Freedom to change sex in the eyes of the law
Social protection minister at the time Margus Tsahkna (IRL) and Minister of Health Care and Labor Jevgeni Ossinovski (SDE) made a proposal to the interior ministry to amend the vital statistics registration act and the population register act to allow people to determine their gender without having to apply for a permit from anyone the year before last.
„We propose a switch to a new gender approval system to better protect the rights of transgender people – people who feel their gender identity does not coincide with their biological gender can file an application with a capable state agency to change their gender and personal identification number,“ the ministers wrote.
Tsahkna and Ossinovski proposed that even though it would not be necessary to involve experts, people should meet a set of minimum requirements. A person would have to be of legal age and have active legal capacity. The entire process could take six months, following the example of Denmark, instead of the current four-five years.
No one would be able to change their gender twice a year, however, as the ministry believes the opportunity should be given once in a lifetime.
„Draft legislation to amend the vital statistics registration act, population register act, and the state fees act will be sent out for coordination to the justice ministry,“ said adviser at the Ministry of Internal Affairs Kristin Rammus. She added, however, that the principles of gender reassignment have not been changed.
The ministry cannot say why it finds Tsahkna and Ossinovski's proposal to be unsuitable. „Because the bill has not been submitted for approval yet, we cannot comment in more detail at the moment,“ Rammus said.