Anastasia-Eva Domani was assigned male at birth but always enjoyed donning women’s stockings, high heels and makeup — secretive acts that were considered more or less a fetish when growing up in Ukraine under the Soviet Union. While living as a man, Domani, now 38, married and had a child. But last October, she decided to begin hormone treatment and her transition.

“I still have a passport and all the other documents for Oleksandr’s name,” she told NBC News, using her former name. “I will change it. But this is a complex process.”

Changing gender on legal documentation in Ukraine — such as a passport — has long been considered one of the most repressive policies found in any European country, due to its required procedures involving psychiatric diagnosis and forced sterilization.

When Domani, for example, wants to change her passport from male to female, she must first be labeled with a mental disorder and then undergo gender reassignment surgery, leaving her with effectively no control over how she identifies, but putting this decision to a number of doctors and politicians who have a binary definition of gender.

“When a transgender woman enters the hospital, she is identified in the ward according to her ‘male’ passport,” Domani said. “This causes a sense of gender dysphoria and shyness. It is very difficult to explain to the head physician your gender identity, especially if the doctor received medical education in Soviet times.”

Stereotypical gender roles engrained within society mean that a transgender person must embody the behavioral traits of the gender they wish to transition to — a transgender man should be perceived as what is understood as masculine and a transgender woman as feminine, essentially.

People like Domani are often refused legal gender recognition if they do not adhere to these principles, which is inclusive of a change of physical body parts and an implied heterosexual orientation. Read more via NBC