Prejudice and Healthcare Access for Trans Men in India

Healthcare Biases Against India’s Trans Men: A Crisis Hidden in Plain Sight

On January 2, 2025, Mitr Clinic—India's first transgender-led healthcare center—reopened under the revamped name of Sabrang Clinic after funding cuts had forced it to shutter operations earlier that year. Located in Hyderabad, it promises inclusive healthcare for the transgender community, including critical services for trans men such as Hormone Replacement Therapy (HRT) and STI-related treatment. However, its revival underscores an uncomfortable truth: despite landmark rulings like the 2014 NALSA judgment and the Transgender Persons (Protection of Rights) Act, 2019, healthcare access for trans men remains fraught with systemic exclusion, unethical practices, and administrative barriers.

Misgendering and Administrative Gatekeeping: How This Breaks the Pattern

In theory, India's legal framework has made significant strides, with provisions recognizing the right to self-perceived gender identity and mandating access to healthcare for transgender persons under Section 15 of the Transgender Persons (Protection of Rights) Act, 2019. In practice, however, systemic misgendering continues to undermine these rights. Data from advocacy groups indicates over 60% of trans men in India encounter misgendering during their interactions with healthcare institutions. Such experiences discourage medical visits, resulting in risky self-medication trends, particularly for testosterone therapy.

Moreover, the requirement to link healthcare access with gender recognition certificates—issued under the Act—creates avoidable administrative hurdles. Only 74,000 transgender identity cards were issued via the National Portal for Transgender Persons as of October 2023, a fraction compared to the estimated 2 million transgender persons in India. For trans men, who often face societal invisibility, navigating this bureaucratic labyrinth proves disproportionately harder.

Structural Weaknesses and Knowledge Deficits

The institutional machinery behind healthcare provision appears ill-equipped to address the needs of trans men. Medical curricula remain rooted in binary notions of gender, often conceptualizing transgender healthcare through the lens of trans women’s experiences alone. The absence of Indian Council of Medical Research (ICMR)-approved protocols for Gender Identity, Expression, and Sex Characteristics (GIESC) further exacerbates disparities. Critics have questioned why, despite the advancement in other domains of medical research, gender-affirming care for transmasculine individuals remains an unchartered area in India.

Unethical practices in healthcare extend this critique further. Reports have surfaced of invasive pelvic examinations during consultations for hysterectomies, often conducted without consent. Additionally, medical rejection on prejudiced grounds—especially for procedures perceived to challenge patriarchal norms, such as hysterectomies among individuals with female reproductive systems—remains widespread.

The Gap Between Official Claims and Reality

The government has frequently touted initiatives like the National Council for Transgender Persons, launched in 2020 to formulate welfare policies for transgender communities. Yet, its impact on healthcare for trans men has been tepid at best. A parliamentary report in August 2023 noted that less than ₹50 crore out of the ₹200 crore budget proposed for transgender welfare had been utilized, with no earmarked funding for research or capacity-building toward trans-affirmative healthcare.

Hormone Replacement Therapy is a telling case study. Trans men often self-medicate due to a lack of standardized dosing guidelines tailored to body weight and health conditions. A survey of 306 trans men in metropolitan cities revealed that over 56% regularly consult non-endocrinologists for testosterone therapy, while 29% rely on informal community prescriptions. Long-term health risks such as cardiovascular issues are escalating in absence of proper dose-monitoring protocols.

Unasked Questions: Implementation, Regulation, and Equity

The bold promises of the Transgender Persons Act have been undermined by weak implementation. How effectively can healthcare be "inclusive" in systems where judgmental attitudes persist, training in gender-affirmative care is non-mandatory, and regulation of cross-sex hormone therapy remains absent? A glaring omission is the lack of community health workers with lived experiences integrated into delivery mechanisms—a model proven effective abroad but neglected domestically.

State-level capacity gaps remain equally troubling. Although healthcare is a state subject under India's federal structure, commitment levels vary widely. Tamil Nadu stands out for establishing designated transgender clinics, yet states like Uttar Pradesh report almost no targeted outreach mechanisms. This inequity poses an uncomfortable question: Isn’t healthcare for trans men becoming another marker of regional disparities in governance?

Comparative Insights from Argentina's Gender Health Movement

Argentina offers a compelling counterpoint. Its Gender Identity Law, 2012, ensured universal access to gender-affirmative care, including free HRT and surgeries, without bureaucratic coercion. The law mandates "informed consent" protocols that prioritize individual autonomy over medical paternalism—a glaring omission in India's Transgender Persons Act. Between 2012-2020, over 90% of gender-affirming surgeries were state-funded. India’s reliance on individual insurance schemes, by comparison, relegates transgender persons, particularly economically marginalized trans men, to neglect.

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