India's amendment to its transgender protection law has left thousands of trans people without safe access to gender-affirming care. Clinics stopped prescribing hormones, the government identity card portal went offline, and doctors face legal uncertainty. The people paying the highest price are those without money, supportive families, or established medical relationships.

Kali's story

Kali Sidharth Medepalli had a plan. The 23-year-old communications specialist and LGBTQ rights activist from Hyderabad had begun hormone replacement therapy earlier this year, with a clear path in mind: continue treatment, complete her medical transition, undergo surgery. A year, she thought. A reasonable horizon.

Then India's parliament amended the country's transgender protection law, and the clinic where she was receiving care stopped her medicines. Just like that.

"Everything shut down," she told AFP.

She went ten days without a testosterone blocker. Ten days of hot flushes and body aches, of a body doing things she had been working hard to prevent, because a piece of legislation created enough uncertainty that the people caring for her stopped caring for her. She eventually managed to obtain her prescription medicines another way, but found herself self-medicating, without medical supervision. "Ideally, you should have a doctor doing this for you," she said. Yes, and that is exactly the point.

For Kali, a carefully planned transition has become something she can no longer see clearly. "I don't know the future," she said. "I can't plan it anymore."

What the amendment actually says, and what it does

The amendment introduced penalties for forcing someone to assume a transgender identity through surgical, chemical, or hormonal procedures. On the face of it, that sounds like protection. No one should be forced into a gender identity. No one should be subjected to non-consensual medical procedures. That is not a controversial position.

But the word "forcing" did a great deal of work in the drafting room, and not enough work in the clinic. The government has said the amendment does not criminalise consensual, medically supervised gender-affirming care. The problem is that "the government said" is not the same as the law being clear. Doctors read ambiguous legislation through the lens of personal risk. Clinics read it the same way. When the legal exposure is uncertain, the safest move for the institution is to stop. The person who pays for that caution is the patient.

Sanjay Sharma, head of the Association for Transgender Health in India and a retired airforce commodore, put the dilemma plainly: "How can I refuse care? I took an oath that above all do no harm." But refusing care and providing care both carry risk now, and that is an impossible place to ask a doctor to stand.

Some private clinics have kept going, with extra paperwork, extra consent forms, and higher fees. "Private clinics will now give care, but they lawyer up," Sharma said. Which means that access to care has become a function of how much money you have. Again.

The people left behind

Bhukya Ahalya is 21. She transitioned in 2025 and wants regular employment. But her identity documents still identify her as a man, and the government website for applying for a transgender identity card, the first step towards changing those documents, has not functioned since the amendment came into force.

She 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 card."

The amendment has added a medical board recommendation and a magistrate's approval to the certification process. At the same time, the portal people use to start that process does not work. The Ministry of Social Justice and Empowerment did not respond to AFP's request for clarification.

Meghna Kulkarni, a Mumbai parent supporting her child's transition, said the amendment "immediately rang danger bells." But Kulkarni's family had something most people do not: a network already in place. "We already knew the doctors, the surgeon, the psychiatrist." That network is what insulated them from the worst of the disruption. Most people do not have it.

The pattern underneath the story

What I keep seeing, in country after country, is this: a law is passed that acknowledges trans people exist. Progress is declared. Then an amendment arrives, framed as protection, and the practical routes to care, documentation, and legal recognition close down. The gap between what a law says and what it does to real lives is where trans people end up living.

Vyjayanti Vasanta Mogli, a transgender rights activist and member of a Supreme Court advisory committee on transgender welfare, said the lack of clarity could "scare away even the ones who have the best interests for the trans people." The healthcare system, she said, is "very fearful right now." Fear in a healthcare system does not stay in boardrooms and legal departments. It travels directly to the person sitting in a consulting room, or the person who cannot get an appointment at all.

India's official 2011 Census recorded around 488,000 transgender individuals. Human rights groups and experts estimate the actual population is somewhere between five and six million. There are no current official figures for how many trans people receive gender-affirming healthcare, which means there are no official figures for how many have been affected by this. The disruption is real, and its scale is genuinely unknown.

The amendment is being challenged in the Supreme Court, with petitioners citing constitutional protections including dignity, autonomy, privacy, and the right to self-identification. That challenge matters. Court processes take time, and Kali's body does not pause while the case is heard.

This is what legislative ambiguity costs. Not an abstraction. Not a policy outcome. Ten days without a testosterone blocker. A portal that does not work. A 21-year-old begging at traffic signals because she cannot get a document that would let her do anything else. A carefully planned future that has become unplannable.

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Dr Helen Webberley is a Gender Specialist and advocate, and the founder of GenderGP. She writes about gender diversity, trans healthcare, and the lives of trans people and their families.