The Ministry of Social Affairs wants to start an open discussion on how to change the rules around gender reassignment in the future. The new plans would make it easier than before but the ministry has said nothing definite has been agreed yet.
The state has been regulating gender reassignment since 1999 and the current process has two stages. Firstly, the person who wishes to change their gender must obtain the consent of an expert committee and then can they start hormone therapy or undergo surgery.
The second stage takes place two years after the initial decision. The person must apply to the commission again and asks for consent to change their legal status. After consent has been given, only then will their gender be changed in the population register.
A new draft regulation was made public in June. Liis Kesa, adviser of the public health department of the Ministry of Social Affairs, explained to ERR the need for the new regulation is largely technical.
"If we have a new public health law, the old law with this regulation will simply be repealed. In considering this bill, we have come to the conclusion that the right place for this issue is actually the Health Services Organization Act. We have not yet been able to open a very wide-ranging debate on this issue." said Kesa.
She confirmed discussions will begin when a new and comprehensive draft regulation has been finalized. The preliminary draft shows regulation is needed, she added, and there are plans to keep the commission.
"The commission assesses gender and agrees to proceed with gender reassignment. We have discussed as much with the Ministry of the Interior, that these stages must remain in place to be able to make sure the condition is permanent, that the person does not have the condition due to a mental disorder. In this sense, this draft regulation shows that, in fact, we do not envisage any very big changes here," Kesa said.
However, there are some important changes in the draft regulation. Medical modification of gender would no longer be regulated by the regulation. Additionally, in order to legalize gender, the commission should meet once instead of twice.
The explanatory memorandum to the new draft Public Health Act states that medical procedures, such as hormone therapy or surgical procedures, are sufficiently regulated by the Law of Obligations Act. That chapter of the law lays down the rules for the provision of healthcare.
Imre Rammul, head of the expert committee convened at the Ministry of Social Affairs, said any situations where a person can start medical procedures during the first stage must be avoided.
"If it happens that a person makes such a decision during an illusion and operations have already started, the genitals have been removed and so on, then it is essentially a crippling operation. This person must then stay on hormone replacement therapy for a lifetime," Rammul said.
According to Rammul, a commission consisting of experts is not inexpressible either. Of the people who have been given the green light to change their gender, three people have later changed their minds.
"But certainly that number would be many times higher if there were no pre-checks and human investigation in the process now," he said.
The draft of the new regulation retains the obligation to investigate whether the intention to change gender is caused by a psychiatric problem. The commission would also make sure that gender disparities persist. But, as has been said, the commission's opinion would only be needed to legalize gender.
Rammul noted that this may make people want to change their gender for purely practical reasons.
"Even if we talk about marriage, a person wants to marry someone of the same sex, they put in an application and does it with relatively little effort; a person wants to refrain from military service - there is another option; a man has been sentenced to prison and wishes to avoid prison violence or to spend his sentence having fun in a women's prison - why not?; an exhibitionist wants to visit the women's sauna... In other words, a number of such questions and adjacent problems may arise," he said.
Liis Kesa confirmed this is only the start of the process and that the new regulation will be more specific and less general. When the new regulation will be drafted largely depends on how work on the Public Health Act continues.
"Once we have received approval from the government for this bill, the regulations will definitely go ahead," Kesa said.
Population minister wants two-year waiting period
Minister of Population Riina Solman (Isamaa) finds that the choice of changing gender should not be made too simple because there have been cases where people want to go back to their original gender.
Solman noted that the existing expert committee bases its decision on if the applicant has had a transgender identity in the patient portal at least two years prior to the process and if there is an existing psychiatric evaluation, ruling out a possible mental disorder. A genetic test is also conducted to confirm chromosomal and gonadal sex coincidence.
The population minister said: "Therefore, the gender change applicant is given a decision to change their gender at least two years after the start of the process. So the whole process before the expert committee decision, based on changing the person's gender in the population registry, lasts at least two years."
The social minister's new draft regulation has stated that the committee will make a decision based on a psychiatric evaluation, which rules out a possible mental condition, basically erasing the two-year process.
Solman said changing gender should not be made a simple choice because there have been cases where people have wanted their natural gender back after operation.
She noted: "The current so-called two-year waiting period will help with the person remaining sure in themself after a long time. Having discussed it with experts, I ask for the two-year waiting period to be implemented going forward."
Solman also wants the opinion of the Estonian Council of Churches and the Estonian Bioethics Council to be taken into account.
The Ministry of Social Affairs previously proposed a simplification of gender reassignment earlier in 2015, when the Ministry of the Interior revised the Civil Status Act.
The document, signed by Yevgeny Ossinovsky (SDE) and Margus Tsahkna (Isamaa), proposed the complete abolition of the current regulation. According to the idea of the ministry at that time, the gender reassignment committee would have been disbanded and both legal and medical gender reassignment would have been left to the individual to decide.
"In this context, it means a person's right to decide for himself or herself. Including deciding whether or not he or she wishes to have his or her body medically corrected," the ministry said at the time. Making a legal change would have only required writing to an authority which issues identity documents.
In order to avoid reckless decisions or submission of false information, the ministry also proposed a waiting period of six months.
Editor: Helen Wright