The global healthcare system has experienced considerable development in recent decades, and in recent years there has been constant talk of healthcare reforms in Armenia. The topic of daily discussion in the political, media and social spheres is the quality of healthcare, funding, availability and accessibility of targeted services to different vulnerable groups. In this article, we have tried with the president of “Right Side” HRD organisation – Lilit Martirosyan to briefly review the obstacles in the healthcare of transgender people, to understand the possible solutions to overcome them.

• Mrs. Martirosyan, please, mention what kind of medical interventions are required to protect the health of transgender people?

• • First of all, let me say that not all transgender people need medical interventions. Those who want to harmonise their body with their identity through medical interventions are called transsexuals. For transsexuals, hormone replacement therapy and (or) gender reassignment surgery may be especially important.

• Taking care of the health of transsexuals is difficult, is it possible in Armenia?

• • In developed and developing countries, often a primary care physician and (or) an endocrinologist coordinates their care. But our research shows that the vast majority of trans people are afraid to seek primary care because of discrimination or disclosure of medical privacy. Endocrinologists do not have professional skills to care for transgender people’s health, and there are no gender reassignment surgeons in Armenia. Our community is in self-treatment by seeking consultations from one another, or on the Internet, etc. Only our organization knows about a hundred of such trans people. In addition the available medications on the market are not intended for hormone replacement therapies for transsexuals. 

• Then how are the surgeries and hormone therapy performed, and how much do they cost?

• • Transsexuals have to undergo hormone replacement therapy for a year or two, often psychological counselings, after which gender reassignment can be performed. A foreigner doctor is invited to Armenia, who performs gender reassignment surgery. In general, the cost of surgeries alone can be up to 10 million drams. Recently, it became possible to alleviate the costs of healthcare care for trans people, by establishing contacts with a Ukrainian endocrinologist, who coordinated the hormone replacement therapy for 18 people. Hormone therapy is carried out according to the international standards and medical protocols, which are absent in Armenia. For three months, the cost of treatment with all examinations and medical checkups was about 350,000 drams per person. Trans people in Armenia can earn this amount only through sex work, as these expenses are not included in private insurances, are not covered by state programs, and in general, there are no relevant specialists.

• Mrs. Martirosyan, how is legal gender recognition being implemented?

• • There is a problem with the current legislation. According to the current law, the Ministry of Justice of the Republic of Armenia requires the submission of a gender reassignment certificate, the form of which must be approved by the Ministry of Health of the Republic of Armenia. Of course, it does not exist, and our efforts with the Ministry of Health have not brought results. On the other hand, doctors are afraid to perform such interventions in Armenia, so in case of surgeries performed here, they mention “sex correction”, which is not accepted by the Civil Acts Registration Office. We have to ask for the certificate from the foreign clinic, from the doctor who did the surgery.

• How do you plan to solve the issues raised?

• A comprehensive solution to the above-mentioned problems is needed. As a new strategic priority for the next five years, we are advocating for the adoption of medical protocols in line with international standards, improve the medication market, and ensure availability of specialists. On the other hand, legal gender recognition should be carried out based on self-determination, without mandatory sterilization. On this topic, we have a strategic litigation case against the RA Ministry of Justice, based on the similar case of ECHR in 2019. We do not spare any effort to ensure that future universal public health insurance covers the costs of hormone replacement therapy and gender reassignment surgery. In many EU countries such costs are already included in public insurance, and from the CIS member states, for example, in Belarus, gender reassignment surgeries are also free. Our ultimate goal is to ensure the availability and accessibility of targeted, inclusive and quality health services for vulnerable groups of the population.

     Mar 2, 2021 Armenia Yerevan