You won’t find any mention of Dr. Dmitri Isaev’s clinic online. Patients can’t look up its number in a phone book. Both its address and name are kept secret and those who would like to see Isaev, Russia’s top sexology expert, find out about the location of his St. Petersburg clinic only by word of mouth.

For nine years, Isaev, a 60-year-old psychiatrist, led a five-member commission of doctors at St. Petersburg State Pediatric Medical University which issued official permission for gender-reassignment surgeries and for the necessary changes to identity documents.

It ranked as both the country’s largest such commission and among its most active, authorizing corrective procedures for up to half of the few hundred sex-change surgeries that occur in Russia each year, according to Isaev. Costs for the permits were kept at a relatively modest 10,000-15,000 rubles, or about $162-$243, based on current exchange rates.

But on July 20, 2015, Isaev, a well respected academic, was forced to resign and his commission was dissolved, pushing Russia’s trans community even further to the periphery of society.