‘Everything shut down’: India’s transgender law leaves patients in limbo over hormone therapy

New Delhi: When transgender woman Kali Sidharth Medepalli began hormone replacement therapy in India, she expected to complete her medical transition and undergo surgery within a year.

But only months after starting treatment earlier this year, India's Parliament amended the country's transgender law, prompting the clinic where she was receiving care to stop her medication.

“Everything shut down,” the 23-year-old communications specialist and LGBTQ rights activist told AFP in Hyderabad.

Kali said she went without a testosterone blocker for 10 days, during which she experienced hot flushes and body aches.

The amendment introduced penalties for forcing a person to assume a transgender identity through surgical, chemical or hormonal procedures. The government has said the changes are intended to protect vulnerable groups by strengthening penalties for exploitation, forced identity and trafficking.

Officials have maintained that the amendment does not criminalise consensual, medically supervised gender-affirming care. However, activists and doctors say the changes have created uncertainty among healthcare providers and transgender people seeking treatment.

“The healthcare system is very fearful right now,” said transgender rights activist Vyjayanti Vasanta Mogli, who is a member of a Supreme Court advisory committee on transgender welfare.

The lack of clarity could “scare away even the ones who have the best interests for the trans people”, she said.

Kali eventually obtained her medication using her existing prescription but was forced to self-medicate.

“Ideally, you should have a doctor doing this for you,” she said.

Doctors face legal uncertainty

The situation highlights the dilemma faced by doctors providing gender-affirming healthcare, said Sanjay Sharma, head of the Association for Transgender Health in India.

Doctors could face legal risks if they continue treatment, while refusing care could conflict with their professional responsibilities.

“How can I refuse care? I took an oath that above all do no harm,” said Sharma, a doctor and retired Air Force commodore.

Some private clinics have continued providing treatment but are taking additional precautions, including obtaining extra paperwork and consent forms and charging patients more.

“Private clinics will now give care, but they lawyer up,” Sharma said.

Access is particularly difficult for people who do not have supportive families, established doctors or the financial means to seek private healthcare.

Mumbai-based Meghna Kulkarni, who supports her child's transition, said the amendment had “immediately rang danger bells”. However, she said her family had a support network in place.

“We already knew the doctors, the surgeon, the psychiatrist,” Kulkarni said.

There are no official figures on the number of transgender people receiving gender-affirming healthcare in India, making it difficult to assess the scale of the disruption.

India also does not have a current official estimate of its transgender population. The 2011 Census recorded around 488,000 transgender people, while human rights groups and experts estimate the actual population could be between five million and six million.

Identity certification also affected

The uncertainty extends beyond medical care to transgender identity certification.

Bhukya Ahalya, 21, who transitioned in 2025, wants to find regular employment but has struggled to update her identity documents, which still identify her as a man.

She now survives by begging at traffic signals.

“Everyone wants me to move on from this life,” she said. “But when I want to move on, when I want to earn a respectful life, I don't get a TG (transgender) card.”

The government website used to apply for a transgender identity card, the first step towards changing several other official documents  has not functioned since the amendment came into force, according to AFP.

The amended process also involves additional scrutiny. A designated medical board must now recommend certification, after which a magistrate can issue the identity certificate.

The amendment has been challenged in the Supreme Court. Petitioners have cited constitutional protections including dignity, autonomy and privacy, as well as the right to self-identification.

AFP contacted the Ministry of Social Justice and Empowerment seeking clarification on the amendment, its rules and the identity-card portal, but received no response.

For Kali, a medical transition she had carefully planned has now become uncertain.

“I don't know the future,” she said. “I can't plan it anymore.”

(AFP)