India's Trans Amendment Act, 2026 does not explicitly ban gender-affirming care, but its vague language has frightened doctors across the country into slowing or stopping it. Daniella Mendonca, an intersex woman in Mumbai, had her surgery delayed twice, was required to file a court affidavit, and faced weeks of uncertainty after a decade of living as herself. Her story shows exactly what protective legislation costs the people it claims to protect.

Who is Daniella Mendonca?

Daniella Mendonca is a Mumbai-based real estate professional, an intersex woman, and a trans and intersex rights activist. She had been on hormone replacement therapy for four years and had lived as a woman for over a decade. She was, by any measure, at the end of a long road when she booked her gender-affirming surgery for mid-April this year. Not the beginning of something uncertain: the end of something she had already done.

A few weeks before the date, her surgeon told her it would have to be postponed. Then he told her why. The Transgender Persons (Protection of Rights) Amendment Act had just come into force, and it had introduced enough legal ambiguity around surgical procedures that he needed time to work out what it meant for him. For Daniella, it meant her surgery was pushed to 10 May, and then again to 25 May, when it finally went ahead.

"You don't wake up one morning and decide you want to get the surgery done," she told Queerbeat. "It takes planning over many years. You finally decide to go for the surgery and the dates are finalised, but now you have to fight the universe to make the surgery happen."

That line stays with me. Fighting the universe. That is what it felt like to Daniella, and reading her account, I think she is right to name it that way. Because the obstacles were not clinical. They were not about her health or her readiness or her surgeon's skill. They were bureaucratic, legislative, and entirely avoidable.

What the Trans Amendment Act actually did

The Act amended India's 2019 legislation, which was already imperfect but at least existed as a framework of rights for trans people. The amendment introduced clauses criminalising anyone who "compels" another person to assume a trans identity, with language vague enough that healthcare professionals across India began asking whether performing gender-affirming surgery, even on a consenting adult who had pursued it for years, might expose them to prosecution.

The Act also declares that causing "grievous hurt" through surgical, chemical, or hormonal procedures can be punished by fines and imprisonment of ten years to life. Read alongside the compulsion clauses, you can see exactly why a surgeon might pause. This is not a theoretical chilling effect. It is a real one. Dr Sanjay Sharma, head of the Association for Transgender Health in India, told Queerbeat in April that care had already slowed and in many places stopped. A survey launched in July by the India Mental Health Alliance found that over three-quarters of the 150 healthcare professionals who had responded believed the Act reduces access to healthcare for trans people.

The hospital where Daniella was due to have her surgery responded to this uncertainty by asking her to file an affidavit before a local district court, confirming she was acting voluntarily and had consulted psychiatrists, surgeons, and other professionals. The affidavit also required her to declare she would not sue her treating doctors for the consequences of surgery, unless negligence was involved. Daniella described filing it as "such mental trauma." Her lawyer was kind and efficient, and got it done in about ten days. But Daniella knew of other trans people who had faced humiliation and intrusive questioning in the same process, and she carried that knowledge with her.

Why intersex people are not a footnote here

Public debate about gender-affirming care almost always imagines a trans person and leaves everyone else out of the frame. Daniella's story is a reminder that legislation aimed at trans healthcare reaches intersex people too, and not as a technicality. Daniella is an intersex woman who is also a trans activist. The law did not distinguish between these things. It did not need to. Its vagueness is part of the point: vague law frightens broadly.

This matters because one of the rhetorical moves made by those who support restrictions on gender-affirming care is the suggestion that they are protecting people from decisions they will regret, or from pressure they cannot resist. Daniella had been on hormone therapy for four years. She had lived as herself for over a decade. She had consulted psychiatrists and surgeons and made an informed choice over years. The law still placed an additional legal barrier between her and her own body. That is not protection but an obstacle presented as concern.

What the double standard looks like

Queerbeat's reporting makes a point worth amplifying. Cisgender people in India undergo aesthetic and surgical procedures without affidavits, without criminal clauses hovering over their surgeons, without courts being involved in their bodily decisions. The scrutiny applied to Daniella's surgery is not applied to rhinoplasty or breast augmentation or any number of interventions that reshape bodies in ways their owners want. The difference is not clinical complexity or patient safety. The difference is whose bodily autonomy is considered self-evident and whose requires legal justification.

More than 120 public health practitioners published a statement in the Indian Journal of Medical Ethics in May calling for the Act's repeal, arguing that its narrowed definition of trans is inconsistent with established scientific evidence. The Endocrine Society of India followed with a position statement emphasising patient-centred care regardless of the legal framework, and providing guidance to support clinicians in continuing to deliver gender-affirming care. Daniella read these as a shift: doctors beginning to remember that their oath requires them to care for patients who come to them with a need.

What made the difference for Daniella

Daniella's surgery happened because her surgeon stayed supportive. He explained everything. He listened. He did not misgender her. He told her, despite all of this, that if anything went wrong from his end, he would take full responsibility. "My doctor is very, very inclusive and friendly," she said, and that plainness carries more weight than any formal praise would. She also recognised what it cost him: that anaesthesiologists, nurses, and theatre assistants were all present, and any one of them could, under the new law's framing, become a source of risk for him.

She got her surgery. That is real, and it matters. But she got it because she had a sympathetic doctor, a reassuring lawyer, the resources and knowledge to navigate a legal system that should never have been involved, and the resilience to keep going when dates shifted and obstacles multiplied. Not everyone has all of those things. Many people in India, and elsewhere, do not have any of them. That is what the impact of legislation like this actually is: not a clean prohibition that people can argue against in court, but a fog of risk that some people have the resources to push through and many do not.

Daniella fought the universe, as she put it, and the universe gave way. I am glad about that, and I also want to be very clear about what it took.

If there is a news story you would like me to cover then just let Sammy know.

Dr Helen Webberley is a Gender Specialist, Medical Educator, writer, and advocate, and the founder of GenderGP.