Transgender law raises alarms over surgeries, therapies and rights: ‘Will we be erased?’

“Humara toh wajood hi nahi raha (We have no identity left),” says Sanjana Tiwari, a transwoman who works as an online peer counsellor for a non-profit and has already started seeing more instances of harassment among the transgendered sex workers she counsels. “They tell me that policemen, clients and others have already started saying things like ‘you do not exist, you are a man, you are fake.’ They ask me whether they should die by suicide because they are not being recognised by their gender after their long fight to feel like themselves,” she says.

She says while it does not affect her much, she dreads that the younger transgender people will have to jump many more hoops before they can get a TG card, take hormone therapy and sign up for a gender reassignment surgery. Subjecting themselves to a test by a medical board, feels Tiwari, may make them soft targets of societal ridicule and delay evaluations on which their surgery or therapies are dependent. “Besides, many do not undergo the surgery because of high costs or because they are just happy to present their chosen gender socially. Will they not be able to get a transgender ID at all now?” asks Tiwari, unsure of how the new law will affect her and the other transgendered sex workers she cares for.

The journey to nowhere

Nazz knew from a very young age that she was a girl. “I would play with dolls, I wanted to act like the mother of my cousins, I would wear my mother’s clothes whenever I was alone at home,” she says, recounting all the verbal and sexual abuse she endured. It was only after she came to Delhi and interacted with others from the community that she understood what was happening within her. It took years and almost Rs 11 lakh that she had saved up since her teenage years to get the care she wanted — counselling, hormone therapy, laser treatment for facial hair removal and a sex reassignment surgery.

Her transition was expedited by a forced marriage — she had to get a TG card to divorce the woman who she never wanted to marry and with whom she never could have physical relations. Had this happened today, the new Act would have halted her in her tracks.

The process then and now

The 2026 Act redefines what it means to be a transgender person while doing away with all provisions and agency for self-identification. It only recognises people belonging to the socio-cultural groups such as Hijras and Kinnars or intersex people with variations in external genitalia, chromosomal pattern or gonadal development among others.

It does not recognise persons who have gender incongruence or dysphoria — conditions where there is a mismatch between a person’s perceived gender and the sex assigned at birth along with significant distress that it causes. It completely erases the identity of transmen and transwomen who may not belong to any socio-cultural community.

The earlier Act of 2019 had a broader definition of transgender as “…a person whose gender does not match with the gender assigned to that person at birth and includes trans-man or trans-woman (whether or not such person has undergone sex reassignment surgery or hormone therapy or laser therapy or such other therapy), person with intersex variations, genderqueer and person having such socio-cultural identities as kinner, hijra, aravani and jogta.”

The most troublesome aspect of the new law is the mandate to the district magistrate to issue a certificate of identity only on recommendation of a medical board and in consultation with other medical experts. A very senior doctor, who was among those who framed the country’s guidelines for the treatment of transgendered persons, on condition of anonymity, said: “It is unclear how this will be implemented — the definition in the Act is definitely restrictive and does not recognise people with gender incongruence or dysphoria. We don’t yet know the role of the medical board and whether it will be able to recognise those outside a cultural identity.”

The challenge for therapies

The challenge, the doctor says, is that even the confusion can lead to immediate halt in the care for transgendered persons. “While the Act doesn’t say medical care cannot be provided, it does punish undue influence. While the provision is meant to prevent deras and akhadas from forcing people to get castration, family members, who are not okay with a person transitioning, can also file a case against a doctor. No one wants to take that risk.”

Dr Mohan Raj, consultant psychiatrist from Chennai who works with transgendered persons, says, “No one in India can get a sex reassignment surgery or hormone replacement therapy just like that — there are proper procedures in place. They need a letter or certificate from at least two psychiatrists stating that they have gender incongruence and do not suffer from psychosis or other conditions that would not allow them to make this decision. After this, they could do hormone therapy with mental health follow-ups. Now, with the new definition and the requirement for a medical board, my letter becomes redundant. They cannot go on to get further care that they would like.” He adds that this process of setting up a medical board, which would go through each and every case, is likely to lead to unnecessary delays in providing such care.

Dr Richie Gupta, one of the leading gender reassignment surgeons in India with an experience of over 5,000 cases, says that the new law will unnecessarily hamper the care of transgendered persons. “When I started performing sex reassignment surgeries 34 years ago, there were very few people who would undergo it. Now, my team does nearly 250 surgeries each year. People come with their families to get the surgeries, parents bring their children on their own. And I am not talking of just urban centres. Access to social media has created a lot of awareness. No one is doing this with their eyes shut anymore.”

Another surgeon from a renowned government hospital, on condition of anonymity, says that the number of institutions providing these surgeries has gone up sharply since the law was first formalised in 2019.

Dr Gupta feels the current Act criminalises a lot of things and has stringent penalties. “The National Medical Commission (the apex medical education regulator) should come out with a strong statement saying that people who provide gender-affirming care would not be punished under the provisions of the Act.”

Access to care hit

Access to care was already difficult without the added challenges of the new law. Dr Aqsa Shaikh, the first trans woman to head a Covid-19 vaccination centre, says, “I am from the medical fraternity, yet it took me several years to go through the process. There are huge social challenges — like how I had to address my transition at the beginning to take control of the narrative. And then there is the entire process of undergoing counselling and living socially as the chosen gender that people have to undergo before they can get the surgery.”

The cost of getting therapy and surgery is a huge hurdle. The new law just adds to the burden. Dr Raj anticipates many people will continue to unnecessarily live in distress with the self-identification clause off the table. “This will just complicate the journey,” says Tiwari.