ransgender healthcare in India has made strides in recent years, with legal recognitions and government initiatives marking significant progress. The Supreme Court’s 2014 recognition of transgender individuals as the “third gender” and the Transgender Persons (Protection of Rights) Act, 2019, aimed to ensure equal treatment in healthcare. However, significant gaps persist, leaving many transgender individuals without access to comprehensive, inclusive, and dignified healthcare. This blog explores the current state of transgender healthcare in India, highlights recent developments, and identifies critical areas where improvements are needed to ensure equitable healthcare for the transgender community.
Current Challenges in Trans Healthcare
Transgender individuals in India face multifaceted barriers when accessing healthcare, as outlined in various studies and reports:
- Discrimination and Stigma: A 2014 Al Jazeera report highlighted that discrimination by medical professionals, who often lack knowledge about gender identity, prevents many transgender individuals from seeking care. For instance, a case study from Kolkata described a transgender woman denied treatment after a sexual assault due to embarrassing questioning by hospital staff.
- Health System Barriers: A 2024 study from BMC Health Services Research in western Rajasthan noted long waiting times, distant facilities (sometimes 500 km for post-surgical care), and a lack of trained providers for gender-affirming care like hormone replacement therapy (HRT) or sex reassignment surgery (SRS). The absence of transgender-specific care at primary healthcare levels further limits access.
- Higher Health Burden: The National AIDS Control Organisation (NACO) white paper reports a high HIV prevalence among transgender individuals (7.5% overall, 11.2% among those with low literacy). Additionally, transgender individuals face increased risks of mental health issues, sexually transmitted infections (STIs), and non-communicable diseases like diabetes and hypertension, particularly after age 45.
- Social and Economic Exclusion: Many transgender individuals engage in sex work due to limited job opportunities, increasing health risks. The lack of legal documentation, such as identity cards, hinders access to healthcare services, as noted by India’s National Human Rights Commission.
- Personal Barriers: Limited awareness of rights, such as transgender ID cards, and reliance on traditional methods (e.g., seeking care from community “gurus”) further complicate access to modern healthcare.
Recent Developments in Trans Healthcare - Recent initiatives indicate progress in addressing transgender healthcare needs:
- Ayushman Bharat TG Plus Scheme: Launched by the Indian government, this scheme provides transgender individuals with health insurance coverage of INR 5 lakh per year, including gender-affirming surgeries, hormone therapy, and post-operative care. This addresses a critical gap in access to transition-related healthcare.
- Sabrang Clinic Reopening: India’s first transgender healthcare clinic, previously closed due to funding cuts, reopened in 2025 as Sabrang Clinic with support from Indian organizations. It offers tailored services, including HIV/AIDS care and mental health support.
- Community-Led Efforts: Organizations like the Sahodari Foundation, founded by transgender activist Kalki Subramaniam, empower transgender individuals through education, art, and advocacy. While not directly focused on healthcare, Sahodari’s initiatives, such as scholarships and the Thoorikai Project, address social and economic barriers that indirectly improve healthcare access by fostering empowerment and reducing stigma.
Critical Gaps in Trans Healthcare
Despite these advancements, several critical gaps remain: - Limited Focus on Comprehensive Care: Much of the healthcare focus for transgender individuals has been on HIV/AIDS and gender-affirming services. A 2024 PLOS Global Public Health study emphasizes the need for routine healthcare services, including management of non-communicable diseases, nutritional programs, and mental health support, given the higher health burden in the transgender community.
- Insufficient Mental Health Support: Transgender individuals face heightened risks of mental health issues due to transphobia, discrimination, and violence. However, mental health services tailored to their needs are scarce, and stigma around seeking such care persists.
- Economic Barriers: The high cost of private gender-affirming care, such as SRS and HRT, remains a significant hurdle. Many transgender individuals resort to self-medication or unqualified practitioners, leading to health risks like urinary tract infections post-surgery due to poor hygiene or surgical complications.
- Lack of Trained Providers: Healthcare providers often lack training in culturally sensitive care, including the use of correct pronouns and understanding transgender health needs. This leads to miscommunication and inadequate treatment.
- Inaccessible Infrastructure: Many healthcare facilities lack trans-friendly registration and admittance procedures, causing confusion or discrimination. For example, transgender individuals may be unsure whether to be admitted to male or female wards, as highlighted in a case study by the Civilian Welfare Foundation.
The Role of Sahodari Foundation - The Sahodari Foundation, established in 2008 by Kalki Subramaniam, has been a pioneer in transgender empowerment in India. Through initiatives like the Transgender Education Project and the Thoorikai Project, Sahodari supports underprivileged transgender individuals by providing educational resources and using art to address trauma. These efforts indirectly support healthcare access by breaking the cycle of school dropouts and improving job opportunities, which can enhance economic stability and access to healthcare. Sahodari’s advocacy for transgender rights, including its contribution to the 2014 Supreme Court verdict, has also helped create a more inclusive environment, though direct healthcare initiatives could further amplify its impact.
Moving Forward
To bridge the gaps in transgender healthcare, India needs a multi-faceted approach: - Policy Implementation: Strengthen the enforcement of the Transgender Persons (Protection of Rights) Act, 2019, to ensure nondiscriminatory healthcare access.
- Training Programs: Implement widespread training for healthcare providers on transgender health needs and cultural sensitivity.
- Comprehensive Care Models: Expand healthcare services to include routine care, mental health support, and affordable gender-affirming care, moving beyond the current focus on HIV.
- Community Engagement: Support community-led initiatives like Sahodari Foundation to address social and economic barriers that impact healthcare access.
- Infrastructure Improvements: Develop trans-friendly healthcare facilities with inclusive registration processes and accessible locations.
Conclusion - Transgender healthcare in India has seen progress with initiatives like the Ayushman Bharat TG Plus scheme and the reopening of Sabrang Clinic. However, significant gaps remain in providing comprehensive, accessible, and stigma-free healthcare. Join us and share some stories with us.