India transgender law change disrupts healthcare

India's amendment to its transgender law has disrupted access to gender-affirming healthcare for some people, according to doctors, activists and patients, after clinics interpreted the changes as creating legal risk.

The amendment introduced penalties for forcing someone to assume a transgender identity through surgical, chemical or hormonal procedures. Authorities say it is intended to protect vulnerable groups from exploitation, forced identity and trafficking, and the government says consensual, medically supervised care is not criminalised.

Activists and doctors say the wording has created uncertainty. Kali Sidharth Medepalli, a 23-year-old transgender woman in Hyderabad, told AFP that the clinic treating her stopped her medicines after the amendment. She said she went 10 days without a testosterone blocker, suffered hot flushes and body aches, and later obtained medicine on an existing prescription but had to self-medicate.

Vyjayanti Vasanta Mogli, a transgender rights activist and member of a Supreme Court advisory committee on transgender welfare, said the healthcare system was fearful. Sanjay Sharma, head of the Association for Transgender Health in India, said doctors must weigh possible legal risk against their medical responsibilities.

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

The uncertainty also affects gender identity certification. The government website for applying for a transgender identity card has not functioned since the amendment came into force. A designated medical board must now recommend certification before a magistrate can issue an identity certificate.

The amendment is being challenged in the Supreme Court. Petitioners cite constitutional protections including dignity, autonomy and privacy, as well as the right to self-identification.

There are no official figures for how many people receive gender-affirming healthcare in India, and India does not have a current estimate of its transgender population. The 2011 Census recorded about 488,000 transgender individuals, while human rights groups and experts estimate the actual population at between five million and six million people.