“You’re Not Like That.” How Transgender People Survive as Immigrants, Facing Long Waits for Hormones and Discrimination from Doctors

Transgender people who are forced to flee Russia and Belarus, where they face persecution, find themselves in an extremely vulnerable situation. The combination of being queer and being an immigrant leads to systemic discrimination, critical delays in accessing vital hormone therapy, and a complete loss of trust in the healthcare system. For many, the wait can stretch on for years.

Why are transgender people migrating in large numbers right now?

The flow of migrants abroad has increased. In particular, transgender people are actively leaving Russia, where, in recent times, Transgender transition is prohibited. In Belarus, transgender activists and transgender people themselves are also forced to flee due to persecution.

Transgender people are already a vulnerable group and face discrimination far more frequently than other queer people. Migration only exacerbates the situation: there is a combination of migration-related stress and so-called systemic discrimination. A person does not lose their queer status, but acquires a new, equally vulnerable status— migrant or refugee status.

The main problem: prescriptions and years-long waitlists

When abroad, transgender people need, first and foremost, to continue hormone therapy (GT), if they use it. GT is a medication that is dispensed strictly by prescription written by a doctor. And this is where many barriers arise:

1. The issue of insurance and money. Access to doctors requires health insurance, which not everyone can afford due to a lack of disposable income. To receive government-provided health insurance, you must have legal status, or you must wait in line, or you must not have asylum-seeker status (depending on the country).

2. A Bureaucratic Marathon. The wait for insurance or legal status can be lengthy. But even after obtaining insurance, a person faces after many years of waiting an appointment with the right specialist: the wait to see a doctor can take two or even three years.

3. The Need for Re-evaluation. Even if a transgender person has been using gender-affirming treatments in their home country for a long time and has even had their legal documents updated, they often have to prove their transgender status all over again when abroad. This may require registering with a doctor or undergoing an evaluation by a medical board. This chain of evidence ...and sometimes it seems endless.

4. Health Effects. Because they cannot obtain a legal prescription, transgender people are forced to seek out hormone medications on on the black market, import them illegally from other countries, or take breaks from treatment. This seriously affects their physical and mental health and overall well-being. At the same time, they need to undergo regular checkups, get tested, and follow their doctor’s recommendations to monitor the hormones’ effects and ensure there are no side effects.

"The Photo on the ID Doesn't Match Her Appearance": Valentina's Case

A situation in which a person goes without treatment can last for months or even years. Here’s what that looks like, using the example of Valentina, a 26-year-old transgender woman who emigrated from Russia to Lithuania because of her anti-war stance (name and details have been changed):

• The beginning of the journey. Valentina entered Lithuania using male identification documents, even though she had been undergoing hormone therapy—which she had started in Russia—for about a year. At the border, the officers had questions because her appearance did not match her documents.

• Isolation and Searches. She hardly knew anyone in Lithuania, so she had to look for information on how to access gender-affirming care. She found a guide published by a local trans organization (TraM).

• Life Without Hormones. While Valentina was waiting to receive a humanitarian visa and then a residence permit—a process that took about half a year—she had no access to regular hormone therapy. She relied on acquaintances who brought her medication on an irregular basis. Because of these interruptions, she began to experience mood swings, depression, drowsiness.

• Bureaucratic hell. After obtaining her residence permit and health insurance, Valentina was able to schedule an appointment with the commission to apply for a driver’s license. However, she had to either wait in line for three months or pay for the doctor's services...to speed up the process. She chose to pay.

• The wait continues. It took even longer for the commission itself—which was supposed to confirm that she was a transgender woman—to reach a decision 3–4 months.

• The home stretch. In the end, it wasn’t until about a year after her arrival that Valentina was able to obtain a permanent residence permit, following a lengthy back-and-forth between her endocrinologist (whom she also paid to see) and her family doctor. By that point, she had already developed depression and hormonal changes that required treatment.

Discrimination in the Doctor's Office

One of the major problems is the doctors themselves. Not in every country are they willing to treat transgender people. Doctors may be transphobic, indifferent, or supportive (“friendly”). Finding a supportive specialist abroad is much more difficult than in one’s home country.

Even if a transgender person finds a supportive doctor, they face identification issues and stigmatization by other staff members:

• Incorrect usage. A person may be misidentified based on their appearance, addressed by their passport name (deadname), or referred to with the wrong pronoun.

• Humiliation. Every time a doctor or member of the staff says: "You're not like that"...this causes emotional pain, undermines a person’s sense of self-worth, and forces them into a state of vulnerability. Transgender people are increasingly reluctant to seek help, losing faith in their ability to find a specialist who can support them.

Valentina also experienced this kind of discomfort when she faced stigmatization from her family doctor, who persistently called her by her legal name and demanded an explanation as to why she needed gender-affirming treatment.

The Passport Trap

Another issue that seriously affects the lives of transgender migrants is— inability to change documents. Transgender people who cannot return to their home countries due to the threat of detention or torture are forced to remain in exile with the status specified in their passports.

It is impossible to change one’s documents before obtaining citizenship in another country—and the wait for citizenship can take years. Even if a person outwardly aligns completely with their gender identity and has been using gender-affirming treatment for a long time, they remain “trapped” in their old documents.

What should I do, and how can I find help?

Social pressure, bureaucratic barriers, and constant anxiety lead to the fact that transgender people lose trust and stop seeking medical care. This is a global problem, as health conditions among migrants can only get worse. Everyone has the right to good health.

Experts offer several recommendations on what to do in this difficult situation:

1. Search for a community. Communities offer support, recommend doctors who are friendly to people with HIV, explain how to navigate the bureaucratic process more easily, and help people find medications.

2. Find a specialist. It is very important to find a psychologist and a doctor who will accept you and be committed to helping you, prescribing medications, providing treatment, and promoting prevention—rather than discriminating against you or marginalizing you.

3. Use online support. Therapy and support from psychologists are often available for free through online services, trans-friendly clinics, or queer organizations.

Health begins with the right to be seen and heard. We urge doctors and psychologists to remember that migrants are in an extremely vulnerable situation and to show them compassion and solidarity.