Doctors are scared
Dr Gargi, a transgender person from the Kothi community, says that doctors fear giving care to the trans community because of the amended Act. “The Act mentions that you cannot forcibly transition anyone. But when we approach doctors voluntarily, they are scared of giving us hormone replacement therapy (HRT) or gender affirmation services, as they believe families of trans folks could use the Act to incriminate those who assist in transitioning, even if it was to declare anyone as trans. The amendment is unscientific as no doctor can declare someone as trans. In addition to making life difficult for trans persons, it also punishes those who assist us even if they have a medical license,” she laments.
For those who already have TG cards, there is some clarity. During a hearing on August 17, the Union government told the Supreme Court that TG cards issued before the 2026 amendment would continue to remain operational, subject to the outcome of the petitions challenging the law. But for those seeking an ID card under the new system, the process could carry a significant medical and financial burden.
Doctors across the country have also started demanding parental video consent, or consent from attendees from the community seeking surgery.
Lakshya Mannar, a trans woman, says that recently, she was asked to give video consent for one of her friends she was accompanying for a breast implant surgery in Pune. Trans women often seek medical care outside of Tamil Nadu because the treatment there is better.
“So, we go to Pune because the surgery and after-care is much better there. I’ve taken three of my friends there, but nobody had asked for a video recording of our consent till now. While one could imagine that the consent video of the care-seeker is needed, why mine? I am just an attendee,” she says.
While Lakshya was attempting to seek gender-affirming care, she has put her plans on hold following this amendment. “I’ve been planning to do my surgery in Thailand, as I’ve heard of many instances of medical complications during and after the surgery. This has deeply scarred me. But now it’s even worse, as the amendment has put so many obstacles before me,” she says. “As per this Act, I need a doctor and then a magistrate to approve my TG card. And that card can get me a passport but only a surgery will give me legal acceptance as a trans person. I do not look like a trans woman, so people suspect me. And, this Act further prevents care to those who do not fit into the norms. It has created undue pressure and mental stress for us. I do not have parents to give me consent.”
The first step in seeking gender affirming care is a TG card, which in itself is discriminatory, claim activists, as self-identification should be enough. Following that, gender incongruence is recorded and a psychiatrist would attest to it in a letter. With that letter, you can seek gender affirming hormone therapy or surgery. For surgery, assessments are made by two mental health professionals (psychiatry and clinical psychology).
It’s noteworthy to point out that for any kind of gender affirming care, the World Professional Association for Transgender Health recommends only informed consent.
Fred says after the amendment, multiple psychiatrists doubt as to how their referral letters would help in seeking gender affirming care. And many endocrinologists fear that they could be booked as criminals, as the phrasing of the amendment criminalises anyone helping someone transition.
“The amendment has undone years of activists, NGOs, and seniors from the community. This could be detrimental to our health, because we’re scared to approach a primary/secondary/tertiary care unit or even disclose to our families that we’re trans,” he adds. “We already face so much stigma and discrimination; now, it will increase as the amendment excludes us from protections, as it makes us vulnerable to sexual violence.”
Swetha Shri from SAATHI, an NGO, says that there were a handful of doctors who were providing gender-affirming care. “They were startled by this, and reached out to elders in the community for clarity on the amendment. This resulted in a private clinic in Chennai asking for video consent of parents of trans people even if they are adults,” she says.
Swetha adds that this was an added burden on people who are kicked out of their homes and have to support themselves. “There are literally very few who offer surgery with minimal complaints, and now this amendment has made it more difficult,” she says.
While a letter was sought before, awareness campaigns by such NGOs sensitised hospitals and doctors towards gender affirming care, and negated that.
Jaya says the amendment was brought in so that the schemes for the community are not misused. But the schemes themselves are so few. “How much exploitation could happen by the community? From a free house to people over the age of 40 to shelters and free admissions, there are some things in place. But if someone is taking advantage of these schemes unfairly, we’ll be the first ones to flag it,” she explains.
Their demand to have more gender clinics in TN, other than in Chennai, has also not been fulfilled. Chennai has a gender clinic only in RGGGH. Further, she adds, “The amendment does not add any safeguards to the schemes, or the aid we could access. While if someone violates us, the punishment is 2 years; for supporting someone, we could face rigorous punishment. How is this fair?” she fumes.
Source: https://www.dtnext.in/news/chennai/how-transgender-amendment-act-hinders-medical-care