When Mehr Khan, a 26-year-old event planner and transgender woman from India, arrived at her clinic for a standard hormone therapy appointment, she found the treatment had been put on hold. The reason: a recent legal change had narrowed who qualifies for such services.
“The doctor was really just hiding his face. He didn’t know what to say,” Khan recalled, describing what she witnessed at the clinic in the southern city of Hyderabad. She said she could see “fear on the staff’s faces” as well.
Khan is among a growing number of transgender Indians who have been denied care following a March change in the law that eliminated the option to self-identify gender. Under the revised rules, legal gender recognition now requires certification from a panel of medical professionals rather than a letter from a gender-affirming care provider such as a surgeon or psychiatrist.
However, the government has not yet clarified what types of specialists must serve on these panels, nor whether those panels answer to state or national authorities — leaving providers in a state of legal limbo.
India’s government says the change is intended to prevent misuse of welfare benefits and strengthen protections. But medical professionals and activists warn the vague language is creating confusion and cutting patients off from essential medications.
Neither the government nor Tata Trusts, which funds the Sabrang Clinic where Khan was receiving treatment, responded to requests for comment.
Reuters spoke with at least a dozen transgender individuals who said the law change had disrupted their medical care, with clinics pausing services and postponing surgeries. Five physicians said they are proceeding with extra caution, with some now requiring patients to sign declarations confirming they are seeking treatment voluntarily.
“Doctors are very concerned and confused as to what kind of care they are now allowed to give,” said Arundhati Katju, a senior attorney with a Supreme Court practice.
The shift in India comes amid a broader global pattern of restricting transgender healthcare. The United States has recently moved to limit access to gender-affirming care, while countries in Asia such as Thailand offer wider access to treatment but less legal recognition.
In the southern city of Bengaluru, 24-year-old business development manager Ananya Balamurali said a gender-affirming surgery she had scheduled for July at a private clinic in New Delhi has been placed on indefinite hold because of the legal change.
In the port city of Kozhikode in the southern state of Kerala, 30-year-old makeup artist Ichu said a government hospital refused to approve her hormone replacement therapy even after months of consultations. She said doctors had initially been “ready to give the letter” but pulled back after an internal board meeting.
The Association of Transgender Health in India puts the country’s transgender population at approximately 20 million out of a total population of 1.4 billion — far higher than the roughly 500,000 counted in the country’s most recent census from 2011.
Association founder Dr. Sanjay Sharma said the amended law undermines a landmark 2014 Supreme Court ruling that recognized transgender people as a third gender. “This is a public health emergency,” said Sharma, a former air force official and the father of a transgender child.
Sharma warned that the legal provisions could be interpreted as penalizing hormonal and surgical treatments, potentially exposing doctors to criminal prosecution. He also raised concerns that medical board evaluations could become physically and mentally invasive.
The 2026 law recognizes only certain groups as having “legitimate” transgender status: members of traditional communities who are culturally invited to bless weddings and births, intersex individuals, and people described as having been “coerced” into being transgender. It explicitly rules out self-identification and bars gender changes on official documents for those outside this narrow definition.
Gender-affirming hormone replacement therapy, or HRT, uses hormones such as estrogen or testosterone to align a person’s physical characteristics with their gender identity. Surgeries are typically preceded by up to a year of such treatment. Doctors warn that abruptly stopping HRT can disrupt the body’s hormonal system, leading to bone density loss and symptoms resembling menopause.
Activists fear that restricted access to regulated care will drive transgender people toward unqualified providers. “We’re worried that the new law might push the transgender community into a shell,” said Hyderabad-based activist Rachana Mudraboyina, warning that many may turn to unlicensed practitioners to avoid documentation requirements.
In Bengaluru, Debbie Das, who owns a design business, said the uncertainty caused her to postpone starting HRT. She is chronically ill and has lost income after the legal change led to the cancellation of some work projects. “I didn’t want to start HRT and then have to panic about whether I should stop,” she said.
Fred Rogers, a counselor based in the southern city of Chennai, noted that transgender men may be particularly at risk since the law does not clearly include them, and public awareness of transgender issues tends to center on women.
The government maintains the law is designed to combat exploitation and trafficking and to expand access to welfare services. Activists, however, say some provisions may produce the opposite effect.
Ichu, who uses only one name, now travels 50 kilometers — about 31 miles — to reach a clinic outside her hometown, while Khan has been relying on an older prescription after missing a planned dosage adjustment. “People at the clinic said, ‘Give us a week or two, we’ll figure this out,’” Khan said. “It’s been months now and we’re still entirely clueless about where to go, what to do.”
