In recent years, India has taken significant steps towards recognizing the rights of transgender and gender diverse people, from the landmark 2014 NALSA judgment to the Transgender Rights Protection Act 2019. But behind these legal victories lies a harsher reality. Transgender people in India continue to live with disproportionate levels of social exclusion, unemployment, violence and poor health. Mental health is perhaps the most neglected area, with rates of depression, anxiety and suicidality far higher than in the general population. This suffering is not inevitable. It is the result of systemic barriers that deprive transgender people of the opportunity to live as their authentic selves and access the care they need. The scale of the crisis can hardly be overestimated: this is evident from recent studies 31% of Indian transgender people have attempted suicide, almost half of them before the age of 20; depression, anxiety and self-harm are widespread, leaving trans communities among the most vulnerable in the country.
Understanding GAC
Gender Affirming Care, or GACis the umbrella term for a range of interventions that support people in aligning their identity, body and social recognition. This includes something as basic as using the correct name and pronouns, access to peer support and advice, as well as medical interventions such as gender-affirming hormone therapy (GAHT) and surgery when desired. For too long, GAC has been misunderstood as cosmetic or optional. The truth is that for many transgender people it is medically necessary, not only to align their physical characteristics with their gender identity, but also to protect their mental health. Numerous studies have shown that access to gender-affirming care, including counseling, hormone therapy, and surgery, significantly reduces gender dysphoria, depression, and suicidal ideation, while improving overall psychological well-being. Recent studies in JAMA network opened And Andrology confirm that those who have access to hormones or surgery demonstrate significantly improved psychological well-being, are less dependent on mental health services and have a better overall quality of life.
Barriers to GAC
Yet in India, even the most basic forms of gender-affirming care remain out of reach for most. There are few endocrinologists trained in transgender health, there are no national treatment protocols, and the costs are prohibitive. Although Ayushman Bharat TG Plus has promised to provide support, implementation is incomplete with most transgender people still forced to pay out of pocket or go without. The average cost for gender confirmation surgeries in urban hospitals can range from ₹2 to ₹8 lakh, while annual hormone therapy costs ₹48,000 to 72,000 – enough to push many families into debt. The danger of neglect is underscored by stories of desperate self-medication with hormones bought without a prescription, leading to kidney damage, cardiovascular crises and lifelong health complications.
GAHT often plays a crucial role in these interventions. Using hormones such as estrogen or testosterone under supervision can alleviate the distress caused by gender dysphoria and help individuals live more comfortably in their bodies. GAHT is one of the most accessible forms of medical transition globally, but remains largely out of reach in India. Many people have no choice but to self-medicate with hormones purchased without medical supervision or supervision, exposing themselves to serious health risks. This dangerous situation is not a product of personal choice, but a consequence of systemic neglect.
Mental health implications
The mental health consequences of this neglect are serious. Community-based research in India shows that transgender people face increased psychological distress, not only from stigma and discrimination, but also from not being able to access gender-affirming services. The cycle is vicious: rejection from families, harassment at school and the workplace, and humiliation in health care all worsen mental health outcomes. National surveys– including the NFHS and the NSSO – largely ignore transgender experiences, erasing their needs from policy and budget conversations and allowing their realities to remain invisible. As a result, crucial decisions are made every day in Indian hospitals and government offices without even the most basic data on who is affected. Without access to safe and supportive care, transgender people remain vulnerable, often isolated and forced to navigate life-threatening situations alone.
Necessary solutions
However, the solutions are within reach. Mainstream healthcare systems must integrate gender-affirming care into routine services, and ensure that doctors, nurses and mental health professionals are trained and equipped to provide competent, respectful support. Public hospitals should make GAHT and other services affordable and accessible, ideally covered by insurance or government healthcare programs. Partnerships with transgender-led organizations are also critical, as community groups have long provided safe spaces, peer guidance, and informal referrals in the absence of state support. These groups must be supported and resourced, not left behind. Equally important are investments in research. India has very limited data on the impact of GAC and GAHT on mental health, and evidence is essential for designing policies and services that respond to the lived realities of transgender people living here.
Consistent evidence
Opponents often argue that the science around gender-affirming care is inconclusive or that it represents a “Western” idea. Yet the evidence is consistent: GAC, including GAHT, improves mental health, reduces suffering and saves lives. Omitting it does the opposite. More importantly, framing gender-affirming care as an alien concept ignores the constitutional principles of equality and dignity that India has already committed to. Although the right to health is not explicitly recognized as a fundamental right in India, the Supreme Court has interpreted the right to life under Article 21 of the Constitution to include the right to a life of dignity and access to healthcare. Within this framework, access to gender-affirming care should be seen as an integral part of the right to life and dignity for transgender and gender-diverse people.
Political, ethical demand
Feminist scholarship has long challenged the rigid binaries and patriarchal structures that regulate bodies, identities, and expressions of gender and sexuality. The struggle for gender-affirming care is part of this broader feminist push for bodily autonomy and self-determination. By challenging heteronormative and cis-normative assumptions underlying health care and social policy, feminist and queer perspectives remind us that affirming care is not merely a medical issue—it is a political and ethical demand for recognition, equality, and freedom from patriarchal control.
True mental health equity will only be possible when everyone—regardless of gender identity—can access care that is safe, affirming, and rooted in dignity. India cannot wait: the evidence, the ethical imperative and the constitutional mandate all demand urgent action on gender-affirming care.
(Manmeet Kaur Bhatia is a research fellow at The George Institute for Global Health India mbhatia@georgeinstitute.org.in; Dr. YK Sandhya is Mental Health Program Leader syatirajula@georgeinstitute.org.in; Dr. Deepika Saluja is thought leadership advisor and program manager -Ubuntu Initiative at The George Institute for Global Health DSaluja@georgeinstitute.org)
Published – Oct 9, 2025 10:35 AM IST
#Gender #Affirming #Care #Mental #Health #India #Wait