As Russia’s invasion shuttered pharmacies across Ukraine last February, Kira Gordon knew she was running out of the hormone pills she needs to take each day as a transgender woman.
The stress was so overwhelming that Gordon struggled to get through the first month of the invasion.
“I couldn’t eat or drink,” said Gordon, 23, who lives in the capital Kyiv.
“It was a terrifying experience, and after that I started stocking up on tablets and medicines.”
Stopping hormone treatment can bring serious physical and mental health impacts, from depression and anxiety to increased cancer risks, said a briefing about the war’s impact on trans people released last year by LGBTQ+ rights group ILGA-Europe.
Transitioning has always been tough in Ukraine. Trans people often encounter discrimination from doctors and struggle to access gender affirming health care such as hormones and surgery. Updating legal documents can also be a long process.
As Ukraine marks a year since Russia invaded on Feb. 24, LGBTQ+ activists say the conflict has worsened the challenges.
Cross-sex hormones ran short when the war began as many pharmacies shut, and those that remained open often had long queues and limited stocks.
Fighting left drug stockpiles inaccessible and disrupted supply chains as medics grappled with an influx of wounded patients.
Though supply issues have eased in some areas since the early months of the war, trans people still face shortages of many drugs across the country, said Olha Poliakova, head of national LGBTQ+ organisation Gender Stream.
The situation remains dire in areas seeing fighting and territories occupied by Russia, where transporting in hormones and other medicine is nearly impossible, activists said.
Even when hormones are in stock, Poliakova said prices have spiked, putting them out of reach for many.
Cross-sex hormones should only be sold with a prescription in Ukraine, according to LGBTQ+ organisation Insight.
But a reporter from Openly was able to buy them over the counter in Kyiv, which LGBTQ+ activists say is a common experience.
Transportation challenges, the destruction of warehouses holding drug stockpiles, and Ukraine’s weakened currency have all pushed up the price of medications, researchers said in Frontiers in Pharmacology journal in November.
Some hormone drugs have doubled or tripled in price as a result, said Anastasiia Yeva Domani, director of Cohort, an organisation that supports trans people in Ukraine.
Many trans people have lost their jobs because of the war, making it even more difficult for them to afford medicine, said Poliakova.
For example, one testosterone drug brand has roughly doubled in price to up to 1,150 hryvnia ($30), she said.
Some have turned to risky methods, including cooking up their own hormones using cheaper drugs available in pharmacies, said Poliakova, a practice she said had long been used by vulnerable trans people but one which is extremely dangerous.
“It’s not good quality, it’s not hygienic and it has a very low effectiveness,” she said.
Gender Stream is supplying trans people with hormones with the help of international partners and volunteers, who transport medication across the borders.Poliakova said her group had a waiting list of 70 people in need of refills once they get a delivery.
“They’re gone before they even reach us,” she said.
Help from LGBTQ+ organisations has been critical for trans people like Morgana Liulka, who lost her translation job shortly after the war began and has been struggling to afford hormones.
“There’s no work and prices are rising, it’s very hard for trans people,” Liulka said, who got hormones for free from Insight.
REFORMS PUSH ON HOLD
For many trans and non-binary people, accessing gender-affirming healthcare has also become harder because many LGBTQ+ friendly practitioners fled abroad or became unreachable. Non-binary people identify as neither fully male nor female.
Edward Reese, who is non-binary, was preparing for gender-affirming surgery when the war started.
Having lost contact with his doctor and facing indefinite delays, Reese travelled to Sweden to have the operation in a private clinic last year.
“I was lucky that I had this opportunity and money,” said Reese.
With the government focused on the conflict, trans people said it has become harder to update their paperwork to match their gender identity, while initiatives to improve conditions for those seeking transition are facing delays.
Inna Iryskina, a trans rights campaigner at Insight, said shortly before the war she had been lobbying the health ministry to stop classifying trans people as having a “disorder”.
“It’s a step that … specialists have been moving towards for a long time,” she said, adding that progress on the issue had now slowed.
Ukraine’s Ministry of Health did not immediately respond to a request for comment.
“Before this, trans people didn’t have the best social and financial lives through transphobia inside the country,” said Poliakova.
“But with the full-scale war, it got worse.”
Reporting by Natalie Vikhrov.
GAY TIMES and Openly/Thomson Reuters Foundation are working together to deliver leading LGBTQ+ news to a global audience.