When India changed its transgender law in March, the arguments were about identity: who gets to say who is trans. Six months on, a quieter problem is showing up in clinics. Doctors are stepping back.

“Very quiet but very certain withdrawal,” is how Delhi psychiatrist Dr Kavita Arora describes it in an interview with Queerbeat published on October 5. Doctors, she says, are asking themselves: “Should I put my neck on the line or not.”

A quick recap of the law

India’s President Droupadi Murmu signed the Transgender Persons (Protection of Rights) Amendment Bill, 2026, into law on March 30, days after it rushed through both houses of parliament, as we reported at the time.

It rewrote the 2019 Transgender Persons Act in a few big ways:

  • No more self-identification. A designated medical board now recommends whether someone is recognised as transgender, and a district magistrate issues the certificate.
  • New criminal penalties for forcing someone to take on a transgender identity, including through surgical, chemical or hormonal procedures. Authorities say the aim is to protect vulnerable people from exploitation and trafficking (AFP via Malay Mail).
  • Reporting. According to Dr Arora, surgeries must be reported to the district magistrate whether or not the patient consents.

It reversed the spirit of the Supreme Court’s 2014 NALSA judgment, which recognised self-identified gender as a right.

What doctors are telling researchers

Dr Arora is a founding member of the Indian Mental Health Alliance (IMHA), a not-for-profit. In July, IMHA launched a survey for health workers in English, Hindi, Marathi, Bangla and Kannada, open to all healthcare providers, not just mental health professionals.

About 150 to 160 people responded, mostly from Delhi, Karnataka and Maharashtra, Queerbeat reports. It’s a small, self-selected sample, so treat it as a signal rather than a census. But the signal is strong:

  • About 76% said the Act significantly reduces access to care.
  • Roughly 10% said there may be no impact.
  • The biggest worries were medical ethics and patient confidentiality, especially the proof requirements and mandatory reporting.

One finding stands out. Many respondents wrongly believed the Act also changes the definition of sexual orientation or LGBTQIA identities in general. Confusion like that is exactly how care dries up: a doctor who isn’t sure what’s legal often just stops.

“If we go by the Act, then the role of the doctor has changed. You cannot be a doctor first,” Arora said, as quoted by LGBTQ Nation.

What it looks like for patients

An AFP report from Hyderabad last month put faces to the numbers.

Kali Sidharth Medepalli, a 23-year-old communications specialist and LGBTQ rights activist, had started hormone therapy earlier this year. After the amendment, her clinic stopped her medicines. She went 10 days without a testosterone blocker and had hot flushes and body aches before she could get medicine again on her existing prescription. “I don’t know the future,” she told AFP. “I can’t plan it anymore.”

Sanjay Sharma, a doctor who heads the Association for Transgender Health in India, put the dilemma simply: “How can I refuse care? I took an oath that above all do no harm.” Some private clinics are carrying on, he said, but with extra paperwork, consent forms and higher charges. “Private clinics will now give care, but they lawyer up.”

Vyjayanti Vasanta Mogli, a trans rights activist who sits on a Supreme Court advisory committee on transgender welfare, told AFP that “the healthcare system is very fearful right now.”

The people hit hardest, AFP notes, are those without supportive families, established doctors or money for private care. And the government’s transgender identity-card website, it reports, hasn’t worked since the amendment took effect.

What the government says

The government says the amendment does not criminalise consensual, medically supervised care. But the Ministry of Social Justice and Empowerment didn’t respond to AFP’s questions about the law, its rules or the identity-card portal, and according to Queerbeat, the rules to implement the Act still hadn’t been notified.

That gap is the problem. A law that says “consensual care is fine” while surrounding it with boards, reports and prison terms leaves doctors guessing. Many are choosing the safest option for themselves, not for their patients.

What happens next

The amendment is being challenged in India’s Supreme Court, where petitioners argue it violates constitutional rights to dignity, autonomy, privacy and self-identification (AFP). No hearing date has been reported.

Nobody knows how many trans people in India rely on gender-affirming care: there are no official figures. The 2011 census counted about 488,000 transgender people; rights groups estimate the real number at five to six million.

Until the court rules or the government publishes clear rules, trans Indians are relying on something the law can’t legislate: individual doctors deciding to keep showing up.