San Francisco Frontiers - India's transgender amendment leaves many in limbo

But just months after she began treatment earlier this year, India's parliament amended the country's transgender law, and the clinic where she was receiving care stopped her medicines.

"Everything shut down," the 23-year-old communications specialist and LGBTQ rights activist told AFP in the southern city of Hyderabad.

Kali said she went 10 days without a testosterone blocker, experiencing hot flushes and body aches.

The amendment introduced penalties for forcing someone to assume a transgender identity through surgical, chemical or hormonal procedures.

Authorities say the changes are meant to better protect vulnerable groups by strengthening penalties for exploitation, forced identity and trafficking.

The government said it does not criminalise consensual, medically supervised care, but activists and doctors say the amendment created uncertainty for thousands of people.

"The healthcare system is very fearful right now," said transgender rights activist Vyjayanti Vasanta Mogli, a member of a Supreme Court advisory committee on transgender welfare.

The lack of clarity, she said, could "scare away even the ones who have the best interests for the trans people".

Kali later managed to obtain her medicine using her existing prescription but was forced to self-medicate.

"Ideally, you should have a doctor doing this for you," she said.

- Doctor's dilemma -

The case illustrates the dilemma facing transgender people seeking safe medical care, said Sanjay Sharma, head of the Association for Transgender Health in India.

Doctors face a choice. Continuing treatment could expose them to legal risk, but refusing care could conflict with their medical responsibilities.

"How can I refuse care? I took an oath that above all do no harm," said Sharma, a doctor and retired airforce commodore.

Some private clinics have continued treatment but are taking extra precautions, including additional paperwork, consent forms and charging patients more.

"Private clinics will now give care, but they lawyer up," Sharma said.

It is particularly difficult for people without supportive families, established doctors or money for private care.

Mumbai-based Meghna Kulkarni, who supports her child's transition, said the amendment "immediately rang danger bells", but unlike others, they had a support network.

"We already knew the doctors, the surgeon, the psychiatrist," Kulkarni said.

There are no official figures for how many transgender people receive gender-affirming healthcare in India, making the scale of the disruption difficult to assess.

India does not have a current estimate of its transgender population.

While India's official 2011 Census recorded roughly 488,000 transgender individuals, human rights groups and experts estimate that the actual population is between five and six million people.

- Uneven access -

The uncertainty over the amendment also affects transgender identity certification.

Bhukya Ahalya, 21, who transitioned in 2025, wants regular employment but has struggled to update her identity documents, which still identify her as a man.

She now survives by begging at traffic signals.

"Everyone wants me to move on from this life," she said. "But when I want to move on, when I want to earn a respectful life, I don't get a TG (transgender) card."

The government website for applying for a transgender identity card -- the first step towards changing other key documents -- has not functioned since the amendment came into force.

The amendment has added an extra layer of scrutiny to the process. Now a designated medical board must recommend certification, after which a magistrate can issue the identity certificate.

The amendment is being challenged in the Supreme Court. Petitioners cite constitutional protections including dignity, autonomy and privacy, as well as the right to self-identification.

AFP contacted the Ministry of Social Justice and Empowerment for clarification on the amendment, its rules and the identity-card portal, but received no response.

For Kali, her carefully planned medical transition has become uncertain.

"I don't know the future," she said. "I can't plan it anymore".

Z.Phillips--SFF