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Slovakia: Surgery once again a condition for gender change

January 12, 2024

Slovak Health Minister Zuzana Dolinkova in November revoked guidelines on the gender transition process. This is causing concern within Slovakia's LGBTQ+ community.

Rainbow and transgender flags on sale at the Rainbow Pride Bratislava Parade, Bratislava, Slovakia, July 22, 2023
There is widespread consternation in the LGBTQ+ community about the government's change of courseImage: Branislav Racko/IMAGO

Amy Zoyomi is a 29-year-old transgender woman from Lucenec, a town of 30,000 inhabitants in southern Slovakia. As an adult, Amy decided to move to the capital, Bratislava. Her gender identity was one of the main reasons for leaving her hometown.

For Amy, life in Lucenec and life in Bratislava are poles apart.

"When I walk down the street in my home town, people often stare at me," she told DW. "Sometimes they stop, and the stares change to verbal abuse. That doesn't happen in the capital. I feel safe here, people are much more relaxed and don't pay so much attention to others," she explained.

Despite finding solace in her circle of close friends and acquaintances in Bratislava, Amy's path to finding her true identity has been a rocky one — just as it is for many other members of the LGBTQ+ community in Slovakia, one of the last EU countries not to legally recognize same-sex marriage and civil unions and a country where gender transition has always been extremely difficult for transgender people.

Amy Zoyomi, wearing sunglasses and a large headscarf, walks along a catwalk; two other models can be seen in the background
Amy Zoyomi (pictured here in sunglasses and headscarf) says that while gender affirmation surgery helped her, it is not for everyone, and no one should be obliged to undergo itImage: Magdaléna Záňová

Amy first came out as gay when she was still a teenager. Her family dealt with the news quite well, she says, as they had already suspected what her sexual orientation was. Coming out as a trans woman, however, was not easy.

Gender affirmation surgery

After initial doubts, Amy decided to undergo gender affirmation surgery in Thailand in 2022. "It has helped me a lot. I can finally accept myself as I am and I feel much more self-confident and whole," she said.

According to Alexandra Demetrianova from the LGBTQI+ organisation Saplinq, only a few doctors in Slovakia provide health care for transgender people. "We are familiar with the practices of some of these professionals, some are affirmative and respectful, while others might use harmful methods such as conversion therapy," she told DW.

According to the tranzicia.org website, only four doctors in Slovakia currently specialize in the transition process. While there are some surgeons in Slovakia who perform surgeries such as mastectomy or breast enlargement, there are no professionals who perform vaginoplasty or vulvoplasty. Transgender people who decide to have these surgeries done have to travel to other countries, the nearest being the Czech Republic.

"This can really complicate the whole process," said Amy. "I was lucky enough to find good doctors, one was very reassuring, and that helped me, but some people have to wait a long time before they can start their transition, and that can be very frustrating."

Slovak lawmaker Zuzana Dolinkova takes the oath during the constituent session of the new Slovak parliament, Bratislava, Slovakia, October 25, 2023
Health Minister Zuzana Dolinkova said that the guidelines would be revoked 'in the interest of the stability of the government coalition'Image: Vaclav Salek/CTK/picture alliance

Amy was lucky: She was able to make her own decisions about her body without any undue pressure. Now, however, transgender people in Slovakia are not so lucky.

New minister revokes guidelines

In late November, Health Minister Zuzana Dolinkova of the center-left Hlas, or Voice, party revoked guidelines on gender transition that allowed transgender people to change their gender in legal documents without undergoing the surgery now required by the government, which would affect an individual's reproduction, and the certification by a medical professional that this transition has been completed.

The guidelines, which made access to health care easier for transgender people in Slovakia, had been introduced eight months previously by former Health Minister Vladimir Lengvarsky just before he left office, only to be revoked by the new government a month after it came to power.

Gender affirmation surgery not for everyone

"The fact that this operation helped me doesn't mean that it can help others. Some transgender people don't want to change their bodies and that's totally okay. It is inhuman to force someone into surgery like this," said Amy.

The minister's decision was a purely political one: She explained in a media statement on November 21 that the guideline would be revoked "in the interest of the stability of the government coalition."

A large crowd of people holding up rainbow flags and placards hold a huge banner that reads 'Rainbow Pride Bratislava  - for all families' at the Rainbow Pride Bratislava Parade, Bratislava, Slovakia, July 22, 2023
The LGBTQ+ community in Slovakia has been calling for more rights and greater safety for its members for a long timeImage: Branislav Racko/IMAGO

Ever since the brutal murder of two young members of the LGBTQ+ community in a gay bar in downtown Bratislava in October 2022, the community has been calling for guidelines that would make life easier for transgender people and for more rights and greater safety for members of the LGBTQ+ community as a whole.

Pressure from the nationalist right wing

The pressure to revoke the guidelines obviously came from the nationalist right-wing Slovak National Party (SNS), which is a member of the ruling three-party coalition alongside Smer and Hlas. In a recent interview, Environment Minister Tomas Taraba (SNS) expressed concern about the country, criticizing that "today's status quo in Slovakia is very progressive-liberal."

"We have to erase these things, and we [the parties in the coalition – ed.] had discussed it even before we started talking about ministries. It's no surprise to anyone," he said in an exclusive interview with the conservative news outlet Postoj.

Blow to the trans community

The revocation of the guidelines was a huge blow to the trans community, which saw it as another attack on it and the rights of LGBTQ+ people and noted that the new rules will only bring more pressure and suffering into their lives.

It also saw Health Minister Dolinkova's move as a violation of their rights: Gender affirmation surgery is not only a life- and body-changing intervention, it can in some cases lead to permanent sterility.

Trans woman fights for identity recognition in Bulgaria

The change in guidelines comes at a time when European Courts are passing rulings that support LGBTQ+ rights in EU countries. One example of this is a recent ruling by the European Court of Human Rights that said that by failing to legalize same-sex unions, Poland had violated the right to respect for private and family life.

Political discussions instead of informed decisions

"Politicians really abuse transgender people; they make hateful comments. It often makes me feel really bad, and it also hurts my family and friends," Amy told DW when asked about her feelings on Slovak politics.

Iniciativa Inakost (Initiative Otherness), a Slovak group that brings together LGBTQ+ individuals and organizations, is adamant that political stability cannot trump human rights. In its media statement, the initiative explained that the regulation passed by Lengvarsky before he left office had been based on "expert consensus" and follows the standard transition procedure.

After last year's double murder in Bratislava, a variety of human rights organizations came together and formed the initiative Ide nam o zivot (Our lives are at Stake).

Despite the revocation of the guidelines, the LGBTQ+ community and its allies are determined to fight on.

"Ensuring a dignified transition for transgender people is one of the demands of the Our lives are at Stake initiative, which was supported by over 100 organizations and almost 33,000 people," the members said in a recent statement. "We won't let it go."

Edited by: Aingeal Flanagan

Correction: This article was updated on February 14 to provide more details on the health care available to trans people in Slovakia and the process required for gender transition in that country.

A red-haired woman (Sona Otajovicova) stands beside a large shrub and smiles into the camera
Sona Otajovicova Bratislava-based Slovakia correspondent