Access to gender-affirming hormonal therapy in Russia: perspectives of trans people and endocrinologists.

Purpose: Worldwide, trans people are known to take hormones without prescription or take higher or lower doses than prescribed. The study's goal was examination of the social context behind provision and receiving of gender-affirming hormonal therapy (GAHT) in Russia, as well as collection of opinions on the organization of healthcare. Methods: Semi-structured interviews with 20 trans individuals and 6 endocrinologists. Results: Trans respondents started GAHT between 2004 and 2022. Over that period, the number of trans-competent endocrinologists increased and it became easier to receive the diagnosis F64.0 "transsexualism" (ICD-10), which qualifies one to obtain GAHT. However, the majority still took hormones without supervision. The reasons for self-medication included: the lack of the diagnosis, high cost of appointments and tests, age under 18, and self-perceived understanding of principles of GAHT. Most endocrinologists learnt about GAHT after being approached by a trans patient. They received information from advanced training courses and academic literature. The specialists had diverse opinions on the ideal policy of providing GAHT to trans people, but all claimed that in Russian political realities they found the diagnosis "transsexualism" a necessary prerequisite for initiating GAHT to safeguard both doctors and patients. Conclusions: The lack of strict law enforcement in the pharmacological sphere in Russia enabled many trans people to initiate GAHT without supervision. Trans-competent endocrinologists were available for those who needed them. Under current political circumstances it is unlikely that the informed consent model (prescription without a psychiatric diagnosis) can be implemented in Russia.