Inclusive healthcare for the LGBTQIA+ community in India remains a challenge due to barriers like discrimination, fear of mistreatment, and a lack of culturally competent medical education. While the reality on the ground is still dismal, some recent initiatives and policies mandating LGBTQIA+-affirmative action offer opportunities for change.
Recently, Tamil Nadu became the first Indian state to mandate LGBTQIA+ sensitisation and transgender health training for all doctors, medical faculty members and students across the state. As per a circular issued by the Tamil Nadu Medical Council (TNMC) in September, all Continuing Medical Education (CME) programmes are now required to include dedicated sessions on inclusive healthcare, transgender rights, and the ethical responsibilities of healthcare professionals in treating sexual and gender minorities.
The directive follows the State Policy for Transgender Persons, unveiled by Chief Minister MK Stalin in July. The policy affirms gender self-identification rights, expands access to gender affirming healthcare and proposes state-funded scholarships, short-stay homes, and legal frameworks for the transgender and intersex persons. With a sizable queer population in south India, and prominent hijra communities across Kerala, Karnataka and Tamil Nadu as well, the policy and the directive offer hope to many.
Time for change
“It is not just a policy change, it is a cultural transformation in the way we practise care,” says Dr Sandeep Bafna, consultant, reconstructive urology, Apollo Hospital, Chennai, referring to the Tamil Nadu mandate. “Creating an inclusive healthcare environment requires continuous effort and visible support from senior professionals who can set an example for others to follow,” he adds.
Although Tamil Nadu has not had the best track record when it comes to gender sensitivity and open-mindedness, Dr Bafna says, “The state has often been a pioneer in progressive healthcare measures, from organ donation to strong public health programmes. This mandate reflects the same spirit of foresight.”
“It acknowledges that inclusion is not only a social responsibility but also an essential part of modern medicine. We cannot deliver holistic care without understanding the diversity of human experiences,” he adds.
Dr Dilip Bhanushali, president of the Indian Medical Association, too, applauds the directive. “This move can be scaled up for adoption by other states, if Tamil Nadu succeeds in making healthcare more inclusive through this directive. Starting out with workshops and lectures, the issue can get magnified into additions in the curriculum and language of treatment.”
“Sensitisation should begin early-integrated into undergraduate medical training and reinforced during postgraduate education and continuous medical learning,” says Dr Sandesh Parab, consultant urologist, andrologist and renal transplant surgeon, KIMS Hospitals, Thane. “Access to healthcare for the LGBTQIA+ community remains a challenge for many, especially in smaller towns or conservative setups where awareness is limited. Even in urban areas, some patients hesitate to disclose their orientation or gender identity for fear of bias,” he adds.
Medical maladies
Dr Neelam Suri, senior consultant, obstetrics and gynecology, robotic surgery, Indraprastha Apollo Hospitals, says that the biggest challenge in treating transgender and LGBTQIA+ individuals lies in the “lack of awareness and comfort on both sides.”
She explains, “In gynaecology, many outdated assumptions persist, such as equating all patients with cisgender women or assuming heterosexual relationships define reproductive health. These gendered beliefs alienate those who do not fit conventional norms,” she adds.
According to Dr Suri, transgender patients “may also experience body or genital dysmorphia, making routine gynaecological visits emotionally challenging.” She points out another failing in the medical documentation systems, which do not recognise all genders: “The lack of inclusive medical records and health forms that recognise different gender identities is another pertinent issue. This often results in awkward or insensitive interactions, even when the intent is positive,” she says, adding: “In such situations, even basic preventive health check-ups feel out of reach.”
Similar myths exist in the discipline of urology. “Urology, being closely associated with reproductive and sexual anatomy, often carries gendered assumptions-such as equating certain organs with one fixed identity,” says Dr Parab, explaining further, “Myths like ‘gender identity is determined purely by anatomy’ or ‘only cisgender men have urological problems’ still exist in certain circles.”
This observation is echoed by Dr Parab. “Many avoid hospitals altogether until their conditions worsen. The lack of open communication can affect the accuracy of history-taking, especially in cases involving sexual health, urinary issues, or hormonal therapy. Another challenge is the limited availability of standardised, gender-affirming medical protocols,” he adds.
Sensitisation, dialogue
True inclusion requires continuous training, curriculum integration, and institutional accountability, says Dr suri. “Doctors and medical students must be encouraged to unlearn biases and update their knowledge regularly,” she says, adding: “Hospitals should ensure inclusive infrastructure, gender neutral documentation, and safe spaces for all patients. Unless sensitisation is followed by practical implementation and policy enforcement, the change will remain superficial.”
Dr Parab adds: “Hospitals should adopt inclusive policies, ensure gender-neutral restrooms, create safe consultation spaces, and actively train staff on appropriate language and behaviour. Discrimination or insensitivity also must be addressed swiftly. Only when policy, practice, and empathy work together can inclusivity truly become part of everyday medical care.”
The issue also needs dialogue, open discussions, and exposure to real-world experiences, says Dr Bafna. “When medical students and doctors engage with authentic stories and perspectives, empathy becomes a natural part of their professional identity rather than something that is merely taught.”
“Every state should mandate gender and transgender sensitisation in medical education. This should be part of both undergraduate and postgraduate training, supported by workshops, seminars, and exposure to real life patient cases,” opines Dr Suri. “A structured, hands-on approach across all states can ensure that every doctor is prepared to provide care that is inclusive, respectful, and equitable – not just in gynaecology, but across all medical disciplines.”
According to Dr Suri, making medical care more inclusive allows transgender individuals to be part of mainstream health programmes while addressing their specific medical, surgical, and mental health needs. “Over time, such efforts can build trust and transform the healthcare experience for this community.”
Dr Parab says that while the Tamil Nadu mandate is an excellent first step, it must be reinforced by “practical, on-ground implementation. Sensitisation should go beyond a one-time lecture – it needs to be an ongoing effort embedded into institutional culture,” he says.
Hope floats
While no Indian state, except Tamil Nadu, has any directive to include gender sensitisation in medical training and education, some government hospitals are now running separate clinics and consultations for transgender and queer patients, either on the hospital’s revolving fund, or through private CSR funding. For instance, Hyderabad had a dedicated clinic for transgenders funded by Tata Trusts called the Mitr Clinic. Similarly, Humsafar Trust runs a permanent HIV testing clinic in Mumbai, and the King George’s Medical University (KGMU) in Lucknow, Uttar Pradesh, also runs a monthly clinic for consultations with transgender and other queer individuals.
At KGMU, what started as an odd CSR initiative, through which the hospital would run privately funded consultations for LGBTQIA+ patients in association with non-profit organisations like Maan Foundation and Humsafar Trust, is now completing a year of running a dedicated monthly OPD for trans and queer patients. These sessions are held on the last Thursday of every month. “The idea is to provide proper treatment and care for the LGBTQIA+ community without stigma and judgement, in an OPD system just like other patients,” says Prof D Himanshu, in charge of the clinic.
In just over a year, the number of OPD patients has grown from a couple of hesitant stragglers in a month to about a dozen or so every month, with former patients encouraging others from the community to seek medical care and treatment.
