The hugely unpopular Transgender Persons (Protection of Rights) Amendment Bill 2026 has secured presidential assent and is now the law of the land.
Criticisms of the Bill have largely focused on the provisions that scrapped the right to self-determination of gender, replacing it with scrutiny and certification by a medical board. However, Section 18 of the amended Trans Act, which now includes punishments ranging from 5 years to life for compelling, coercing, alluring, or unduly influencing a person to adopt a transgender identity, can have far-reaching and dangerous consequences. Legal experts have warned that these provisions could be wrongfully used to criminalise anyone who offers support or shelter to a trans person in the process of transitioning. Crucially, this can include medical professionals who offer gender-affirming care.
The impact of these provisions is already being felt on the ground. Sanjay Sharma, CEO and Managing Director of the Association for Transgender Health in India (ATHI), told queerbeat that in some hospitals and clinics across the country, gender-affirming care has slowed or stopped as providers grapple with legal ambiguity and fear of criminal liability.
Sanjay, a retired Air Commodore, spent decades running hospitals for the Indian Air Force. In 2018, he founded ATHI, after his child came out as transgender. The Delhi-based NGO operates as a national umbrella organization for transgender healthcare by integrating advocacy, professional training, and policy advice. The Indian Professional Association for Transgender Health—which consists of 106 surgeons, endocrinologists, and mental health experts across the country who offer healthcare support to trans people—works under its ambit.
Describing the situation as “a public health emergency” that is entirely “man-made,” Sanjay warned that in the absence of an immediate response from the government, there would be dire implications for transgender healthcare in India.
How does the Trans Bill 2026 impact healthcare for transgender and gender-diverse people?
The intent of the bill was only to define the beneficiaries of government schemes like SMILE Yojana (Support for Marginalized Individuals for Livelihood and Enterprise—a central government scheme that offers education, livelihood, and medical support to trans persons) and Ayushman Bharat (another centrally-funded scheme that offers health insurance for marginalised and economically vulnerable populations, including transgender persons).
[The Bill] does not explicitly say “do not give care” [to trans persons]. So, as far as medical providers are concerned, we are still supposed to continue giving care to people who seek it. From a medical standpoint, we treat gender incongruence as defined by WHO under ICD-11 [International Classification of Diseases, 11th edition], and that has not changed.
If the law does not explicitly block gender-affirming care, why is there so much fear?
The fear is coming from how certain clauses—especially Section 18—are being interpreted. It talks about coercion into transgender identities, including through hormonal or surgical interventions, and attaches severe penalties. This has caused panic among care providers. There has been no clarification from the government stating that ethical care will continue. That absence of clarity is what is driving fear.
The Ministry of Social Justice and Empowerment has stated in response to a query in Parliament by DMK MP Tiruchi Siva that the recent amendments “are not intended to restrict legitimate gender affirming care.” What is your opinion on that?
This is just one question answer session in the Parliament. It is not enough to dispel the atmosphere of fear that is there among professionals that they will be penalised and prosecuted. We want the Ministry of Health to take ownership and issue a statement.
How are healthcare providers responding to the new law?
The support system has already begun to crumble. People involved in crisis intervention are scared. Endocrinologists, mental health professionals, surgeons—everyone [in our network of medical professionals] is asking what to do. Some are considering notarized affidavits and legal waivers on stamp paper to shield themselves from severe penalties. Others are considering recording consultations. These practices which are being discussed out of fear of prosecution will not only create barriers of care but will also increase cost of care.
Surgeons are reluctant to operate. Hormone providers are hesitant to prescribe. In practical terms, care has already slowed, and in many places, it has stopped.
What does this mean for transgender and gender diverse persons seeking gender-affirming care?
The cost of transgender healthcare is expected to rise sharply as the ambiguity of the new legislation causes the public health system to come to a grinding halt, forcing patients toward private providers where care is approximately ten times more expensive due to the lack of free consultations and subsidized medications. It creates barriers at multiple levels.
The move away from centralized, regulated centers means a loss of volume-based pharmaceutical discounts and the potential disappearance of sliding scale pricing that ethical providers previously used to subsidise care for needy patients
Hospitalisation costs are also predicted to climb because community support networks—which previously allowed for early discharge and home recovery—are now under threat of prosecution, forcing longer and more expensive hospital stays. Finally, the new bill’s restrictive definitions have rendered many individuals ineligible for government insurance schemes like SMILE Yojana and Ayushman Bharat, leaving them to pay for complex, multi-stage transitions entirely out of pocket.
Why should this be regarded as a public health emergency?
A public health emergency is any sudden event that affects the health of a large number of people. Here, we are dealing with more than one crore individuals. The numbers quoted of transgender population in the parliamentary debates are untrue.
We are already seeing mental health breakdowns, increased risk of self-harm, and at least one reported suicide following the bill’s proposal. This is not an isolated issue, it is widespread, and it is immediate.
What kind of mental health impact are you observing?
This follows a known trauma trajectory: initial shock, then meltdown, followed by fear, hopelessness, and increased self-harm and substance abuse. It is not just individuals, entire families are affected. Parents are now doing suicide watches for their children. This is a systemic mental health crisis.
What are the risks if formal healthcare systems withdraw care fearing criminalisation?
Unregulated providers will fill the gap. These are individuals operating without training, often in unsafe conditions. We have seen such cases before—procedures being carried out in hotel rooms, by untrained individuals. If formal care collapses, those practices will return and expand.
How does this affect India’s global standing in healthcare?
India had aligned itself with WHO and UN standards, recognizing gender-affirming care as part of human-centric healthcare. Now, we risk being seen as a country that does not follow international medical guidelines. That affects credibility, research, and global standing.
What must be done to address this crisis?
The Ministry of Health has remained silent. There are no helplines, no crisis response mechanisms, no clear directives. There needs to be an immediate instruction to continue ethical care in line with international standards. Without that, the system will continue to deteriorate.
Beyond that, there are three immediate requirements: A national program for transgender healthcare, Indian standards of care based on evidence, alignment with international standards until national protocols are developed. Without these, care will remain fragmented and inaccessible.
Your final assessment of the current situation?
We are in a public health emergency. Care systems are slowing down, providers are withdrawing, patients are in distress, and there is no institutional response. This is not something that can be ignored or delayed. Immediate intervention is necessary.