So interesting that this is like a global conversation. Trans people have existed, gender affirming care has been possible for 100+ years, but even the pretty right wing authoritarian Russia only banned it after it became an issue in the US, which only really happened after Obergefell in 2015 ended the gay marriage debate in the US.
I'm open to other ideas for why this became an issue. Not sure the 2018 changes to the ISD would be classified as cause or effect of the US debate.