For Mark, a 23-year-old non-binary transmasculine college student currently based in Guwahati, accessing mental health care had been a harrowing experience. In 2017, when they were 15, they started struggling with suicidal ideation, triggered by the dysphoria they experienced because of the conflict between the gender they had been assigned at birth and their identity. This was compounded by the academic pressures they faced from their school and parents to perform well, especially because they had been a high-performing student for the longest time. Mark went to school in a small town, Dhubri, in India’s north-eastern state, Assam.
Struggling with suicidal thoughts, Mark would sometimes resort to self-harm. That brought temporary relief but, they said, they soon realised the need for medical help. They told their family members, who were supportive, and sought out a psychiatrist.
Mark recalled that they shared their gender identity and pronouns with the psychiatrist early on, but the psychiatrist consistently misgendered them during their sessions, which worsened their distress. Mark said that the doctor addressed them by wrong pronouns at the start of every visit: “In one session, he would address me with ‘she’ and in another session he’d use ‘he’. I didn’t feel comfortable correcting him every time.”
After multiple instances of misgendering, across sessions that lasted from 2017 to 2019, Mark recalled that the last nail in the coffin was when the psychiatrist referred to their gender identity as something that “many young people have developed this disorder these days.”
Such queerphobic attitudes are rooted in medical history. Major medical manuals used by doctors worldwide, such as WHO’s International Classification of Diseases (ICD), and Diagnostic and Statistical Manual of Mental Disorders (DSM), termed transgender identity as a mental disorder. The DSM course corrected in 2012 and ICD fixed the error in 2019, to reflect the fact that gender is a spectrum, and that genders beyond the binary of male and female are also valid and normal.
Mark said that they were on antidepressants and sleeping pills, doses of which were fixed by their psychiatrist, the same doctor who had misgendered them. They were also undergoing talk therapy with another female psychologist affiliated with the same institution where the psychiatrist worked. “But her constant invalidation, too, made me too anxious. I just didn’t want to go to her and left treatment midway, both the medicines and the therapy,” Mark said. “In hindsight, I realised that it was very reckless of me to abruptly stop the medications midway because I read online that doing so can sometimes result in the symptoms returning in full force.” Although Mark stopped formal treatment, their need for support remained. With little queer-affirmative cultural and structural systems in Dhubri, they turned to the internet for help in 2019. They would only move to the urban centre of Guwahati much later in 2023 for graduation.
Mark spent hours online trying to understand even the fundamental explainers on gender identities, for example, what it meant to be a trans man. And then they found many Instagram pages dedicated to documenting queer experiences, both in India and outside. In these pages, Mark shared their experiences and questions. For instance, they once posted a query about feeling like a man but wanting to wear dresses. Mark said they would receive comforting answers from moderators of the pages or other commentators.
Over time, Mark made friends online, some in India, others outside it. This informal network gave Mark what the health system had not: language that helped them articulate their struggles with their identity.
“It is from these interactions that I eventually came to the conclusion that my gender identity does not need to make sense to anyone but me. That gave me the tools to accept that part of myself,” Mark told me. Although they are not in regular contact with some of those people online, those friendships provided crucial support during a time of crisis. Some of those friends are still in touch and check in on them occasionally.
A non-inclusive health system
Mark’s story reflects a wider reality: Many queer and trans individuals across India are forced to abandon formal medical care because of the queerphobic attitudes of its practitioners and the inherent bias of the system. As a medical professional, I have personally encountered the limitations of this system.
In 2014, when I was in my second year of the MBBS program at Christian Medical College, Vellore, I had just begun to navigate my sexuality as a pansexual woman. I undertook a forensic medicine class where the curriculum included sections mentioning that being gay and lesbian was a crime and an anomaly. The teachers never challenged it. In a 2021 case in the Madras High Court, the petitioners had mentioned that for undergraduate students studying Forensic Medicine in their MBBS, the medical curriculum described “sodomy,” “lesbianism” and oral sex as sexual offences, and “transvestism” (cross-dressing) as a “sexual perversion.” In 2022, the curriculum was revised after the Madras High Court directive to make textbooks more inclusive and affirmative of gender and sexual identities in Tamil Nadu. However, this change lasted only two years.
In 2024, the National Medical Commission (NMC), a statutory body in India that regulates medical education, medical professionals, institutes, and research, once again introduced terms such as ‘sodomy’ and ‘lesbianism’ as unnatural sexual offenses in its forensic medicine textbooks. However, later in the year, after widespread protests by queer activists, the NMC guidelines were put on hold.
The systemic lack of empathy among medical practitioners puts queer people at serious risk. In 2021, for instance, a 19-year-old student alleged in a petition he filed in the Delhi High Court that a psychiatrist he was consulting with had disclosed his sexual orientation to his mother without consent, a breach of confidentiality that left him vulnerable at home.
Such experiences foster fear and mistrust, causing many queer people to delay or avoid seeking medical help altogether. As a doctor with over a decade of experience, I have had only two openly queer patients.
The first was a 60-year-old transgender woman who had suffered a stroke in 2022. As I guided her through care, a nurse muttered: “Why don’t these people die off instead of coming here and burdening us?” The statement was so shocking that I couldn’t even confront the nurse. It was my first time witnessing a trans person in the healthcare space and the full force of transphobia was on display at a place that should have affirmed their identity.
The second was an intersex individual undergoing treatment for chest pain. When they disclosed their sexual identity to the medical team responsible for their care, a senior doctor remarked, in their presence, “Make sure to test him for sexually transmitted infections.” Couched within the clinical precaution was their bias about queer people being sexually promiscuous.
Such prejudices force some queer folks to turn to online communities and internet resources to seek medical support.
In 2020, Debbie, a 31-year-old transfemme person in Hyderabad, visited a local hospital seeking treatment for an infection in her ear. While filling out an outpatient registration form, she noticed that it only had male, female, and ‘others’ as options for gender identity. Transgender was not an option. “I marked ‘Others,’” she told me, “only for the receptionist to strike it out and tick ‘male’ before handing the form back to me.”
And the physician treating her for the infection, in the same hospital, asked her invasive questions about her transfeminine identity. “But I answered them anyway,” she recalled. “It made me feel like I was being forced to educate them about my body and gender identity when it should have been the other way around.”
Debbie said that she felt terrible and was angry for the longest time: “I’ve hated doctors and hospitals ever since, and this keeps happening.”
In September 2025, when Debbie booked a routine at-home blood test with a lab through their online platform, the resulting report listed her gender as “Male” and her name with the prefix “Mr,” even though she had selected “Others” at the time of registration.
“I don’t know how this happened,” Debbie said. She thinks that the blood sample collector must have marked her gender differently before submitting her samples.
For Debbie, the lack of medical knowledge about queer bodies among healthcare providers has resulted in situations where she has had to correct them herself. After facing several such instances of misgendering and mistreatment, Debbie decided to opt out of the modern medical system altogether. “I will only go to a hospital if I am dying,” she told me.
Mark echoed Debbie’s observation. For them, the fact that their former psychiatrist viewed being queer as a disease was a marker of structural ignorance. “But the gap, which formal [health] providers left, was filled by online queer communities,” they said.
Mark has turned to the internet for support in other medical situations as well. In 2019, when they were dealing with mental health challenges, they struggled with painful periods, acne, and hair fall—leading to a diagnosis of Polycystic Ovary Syndrome (PCOS). Mark said that the gynecologists they consulted were rude and dismissed their gender identity. So, they had to constantly pretend to be a cis woman to access care, from ultrasounds to medication. They eventually gave up on the medical system.
Mark said they were forced to rely on Western literature and internet articles to find ways to manage their symptoms, such as diet management and exercise. But they couldn’t take any medicines or treatment because they were scared to make any decisions about their body without expert guidance.
For someone like Mark, who already experiences their body as being at odds with how they identify, the situation is compounded by the fact that a diagnosis of PCOS is rarely discussed in gender-affirming terms by healthcare providers and the medical system at large.
Knowledge networks
In the absence of an affirming healthcare system, most queer individuals have developed strong knowledge-sharing networks, which they turn to for their medical queries, Gargi Dhananjayan, a non-binary, transfeminine doctor from Tamil Nadu, told me.
“There is a concentration of good knowledge among elite doctors and endocrinologists who are not accessible to the average queer person,” Gargi said. “These doctors also tend to be concentrated in bigger cities. So, eventually, the knowledge gained by queer people visiting those doctors trickles down to other queer people via WhatsApp, Instagram, or Telegram groups.”
Gargi is a part of many of those groups, especially for non-binary and trans feminine folks in Tamil Nadu and across the country. There are about 300-500 people in a group, they said. While many such groups cater to all LGBTQIA+ identities, some may intentionally centre their support around a particular identity. They function as hubs for sharing health-related news, research, lived experiences, and advice. Members often exchange practical advice on accessing queer-friendly healthcare.
“In these groups, individuals come together to discuss the medicines they are on for gender affirming care, HIV prevention medication, and other general conditions. There is knowledge sharing on what effects they are seeing in their bodies and if there are any side effects,” Gargi said.
Queer people could be on hormone therapy, or other forms of gender-affirming medical care, which could affect the way their bodies respond to certain illnesses or medications, details that mainstream medical system tends to miss, said Kay, a 27-year-old non-binary doctor from Karnataka.
In 2020, Kay was diagnosed with Idiopathic Intracranial Hypertension, a rare chronic condition marked by increased pressure around a person’s entire brain. Kay suspected that the medication their neurologist and neuro-ophthalmologist had put them on was resulting in their weight gain. When they brought this up to their doctor, Kay said, he dismissed their concern and asked them to exercise more. “I also spiralled into a major depressive episode immediately after beginning the drug acetazolamide, which is generally prescribed for my condition, but that was not acknowledged by the neurologist as well,” Kay said. According to a textbook published by the United States of America’s National Library of Medicine, depression is an adverse side effect of acetazolamide.
Desperate for answers, Kay turned to Reddit: dozens of people online were reporting the same issues, such as depression, arising from the same medication, acetazolamide, on the thread r/iih. Kay realised that in almost all the medical issues they faced, the doctors were approaching everything with a casual, generic lens. “When there is no framework to account for queer-specific health concerns, our lived realities are easily dismissed as exaggeration or non-compliance. Doctors should consider queer individuals’ experiences with medications and health conditions as starting points for research in queer health in India,” Kay said. For them, this gap makes online platforms not just supportive spaces, but essential ones—where queer people can share, compare, and build the knowledge that the medical system has yet to recognise.
In the online groups Gargi participates in, members respond to questions about specific medications or treatments by sharing their firsthand experiences or by providing links to relevant subreddits, studies, and research papers. Gargi cited the case of a transfeminine person who had to choose between Spironolactone (an anti-androgen, a drug or compound that blocks or suppresses the effects of androgens, which are male sex hormones like testosterone) and estrogen therapy as she medically transitioned. Through group discussions online, she learned that Spironolactone often causes excessive urination—sometimes requiring diapers—an outcome she wanted to avoid, especially post her bottom surgery. She did not receive these insights from her formal medical consultations, said Gargi. But the experiences of her peers online helped her decide to opt for estrogen, a decision that suited her.
Some of the WhatsApp groups that Gargi participates in comprise only trans doctors. “If we do not understand something in research, we reach out to an expert in the field to clear our doubts,” they said. “This way, there is a lot of useful and rich community knowledge generated every day.”
Gargi shared that about a month ago, someone posted in one of the WhatsApp groups about acquiring Post-exposure Prophylaxis (PEP), a drug that protects people from contracting HIV after they have had unprotected sex.
The person lived in an area where the drugs were unavailable. In India, a minimum 28-day PEP course typically costs ₹3,000–₹6,000, depending on the brand. PEP also needs to be started immediately, within three days of possible exposure, otherwise its effectiveness reduces. So, it was crucial that the drug reached this person on time. A few queer people from the same group pooled in money, procured the medications and shipped it to the person.
Gargi said that many queer individuals even “keep a track of which pharmacies in their cities stock drugs such as PEP and hormone supplements for gender affirming care and are willing to share such knowledge on these groups to other queer individuals.”
Gargi once helped send PEP to a person in rural Perambalur in Tamil Nadu, who had had a risky sexual encounter, and realised that their own medication had expired. Someone sourced it from Chennai and sent it to Perambalur by bus. Gargi who is based in Perambalur dispatched it to the village.
These online groups value community knowledge and individual lived experiences. “In medical school, we’re taught that first-person narratives are the lowest form of evidence, but this excludes truths that don’t fit the majority. Research should consider qualitative experiences, so that important knowledge isn’t lost in the cracks,” Kay said.
The acts of solidarity online bridge urgent gaps but online health support has its limits. Much of the discussions or the resources that get shared in these groups are in English, excluding queer people without devices or English proficiency. Gargi suggested that building open-access community knowledge banks, translated into local languages, is a better idea to make healthcare information widely accessible.
Such knowledge banks can reduce risks by appointing peer moderators to verify advice, adding disclaimers, and involving queer health professionals to guide without dominating discussions. A similar model exists at the Kamineni Institute of Medical Sciences (KIMS), Telangana. Started in 2013 on WhatsApp, this group serves anyone who has regular medical conditions such as diabetes and hypertension. Patients log daily details—such as their blood and sugar readings, any side effects related to medicines, any other struggles they might have—in WhatsApp groups, while volunteers and healthcare professionals monitor updates, offer guidance, and share tips.
The flip side
Kanchan Pawar, a queer affirmative primary care physician currently based in Pune, told me that “the knowledge acquired via these networks must only allow queer individuals to make collaborative medical decisions with appropriate expert supervision, but not replace expert supervision completely.”
She shared that some of her transgender patients were doing “DIY therapy” based on the information they received on online groups, and cautioned that this can be risky. For example, she has seen transwomen who take extremely high doses of hormones without checking their hormone levels periodically. This is associated with a host of side effects, including blood clots in various veins in the body, said Kanchan. “Similarly, I have seen transmen take the same dose of testosterone as their friends without considering the fact that appropriate dosing is dependent on their height and weight,” she said. “They also do not get the knowledge that, on testosterone, they need to check their blood thickness levels and cholesterol levels periodically.”
Whenever Kanchan meets patients who are following unverified medical advice from online groups, she encourages them to seek support from their communities while also reminding them that medically supervised therapy will help them in reaching their goals in a risk-free manner.
Today, Mark is no longer suicidal and has embraced their gender identity. But they still fear doctors and have not sought formal mental health support. Debbie continues to avoid medical care due to anxiety. For queer individuals like Mark and Debbie, the internet has become both a sanctuary and a symptom—a refuge born out of a healthcare system that was never built for them. As Gargi told me: “Healthcare is a human right, but the way India treats queer health shows how certain groups of people are selectively humanised and dehumanised.”
The resilience of queer communities in creating their own care networks is remarkable, but it should not have to exist in place of institutional accountability. Until queer people can walk into a hospital without fear of erasure, the promise of universal healthcare in India will remain incomplete.
This story is supported by the Mariwala Health Initiative.