Published Oct 23, 2026 | 10:12 PM ⚊ Updated Oct 23, 2026 | 10:12 PM
The government has said the changes would clarify the law, prevent the misuse of welfare benefits and protect people from coercion and trafficking.
Synopsis: The Endocrine Society of India, in a position statement, said the Transgender Persons (Protection of Rights) Amendment Act, 2026, does not prohibit gender-affirming medical care and urged doctors to continue treatment with stricter safeguards for consent, clinical decisions and documentation. The society, however, noted that the law narrows the definition of transgender persons and introduces stronger penalties, prompting some clinicians to restrict care and putting patients at risk of harm.
The Endocrine Society of India has said the Union government’s contentious Transgender Persons (Protection of Rights) Amendment Act, 2026, does not explicitly prohibit doctors from providing gender-affirming medical care or require them to stop ongoing treatment, and called for continuity of care under stricter clinical and ethical safeguards.
In a position statement published in the Indian Journal of Endocrinology and Metabolism, the society said the law retains provisions for healthcare, including gender-affirming surgery (GAS) and hormone therapy, while placing a greater responsibility on doctors to establish that interventions are voluntary, medically indicated and ethically conducted.
“Importantly, the statute does not explicitly prohibit the provision of gender-affirming medical care, nor does it mandate discontinuation of ongoing therapy under earlier regulatory frameworks. In fact, section 15 of the Act provides for health facilities, including GAS and hormonal therapy to be provided by the appropriate government,” the authors said.
The position statement was written by endocrinologists Anirban Majumder, Debmalya Sanyal, Pramila Kalra and Kaushik Pandit, along with legal expert Somabha Bandopadhay.
The authors said the Act’s penal provisions target non-consensual or exploitative practices rather than gender-affirming care itself. “The Act does not criminalise gender-affirming care per se. Rather, it targets non-consensual or exploitative practices,” they added.
However, they warned that the law’s broad framing raises the legal stakes for healthcare providers, who must be able to demonstrate that treatment decisions meet clinical and ethical requirements.
“This expansive framing places a heightened responsibility on healthcare providers to ensure that all gender-affirming interventions are demonstrably voluntary, clinically indicated, and ethically conducted. Failure to adequately establish these elements may expose professionals to legal scrutiny, particularly in ambiguous or contested situations,” they said.
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The amendment’s stronger criminal provisions, which cover hormonal interventions, have also unsettled clinicians providing gender-affirming care. Some doctors withdrew from providing such treatment or restricted access to it. Subsequent surveys of healthcare providers reported significant reductions in access.
The society warned against interruptions in treatment, citing the psychological harm and mental health risks that delays or denial of care can cause.
“Delay or denial of care may result in significant psychological harm. Disruption of gender-affirming care may also lead to increased mental health burden (dysphoria, anxiety, depression, suicide risk) and unsafe and unregulated interventions,” the authors wrote.
“Ensuring continuity of care is therefore a public health priority.”
The statement draws a distinction between legal recognition of a person’s identity and the provision of medical treatment, arguing that the two must not be treated as the same process.
“Legal certification of identity and provision of medical care are distinct processes. Hence, clinical care should be guided by medical necessity and patient well-being,” the authors said.
The society has advised doctors to follow established clinical standards, including Version 8 of the World Professional Association for Transgender Health’s Standards of Care and the society’s own clinical practice guideline.
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The Act amends the Transgender Persons (Protection of Rights) Act, 2019. Union Social Justice and Empowerment Minister Virendra Kumar Khatik introduced the amendment in the Lok Sabha on 13 March 2026. Both Houses of Parliament passed it by voice vote within days. It received presidential assent on 30 March and came into force in May.
The 2019 law followed the Supreme Court’s 2014 NALSA judgment, which recognised the right to self-identified gender. The 2026 amendment removed the right to self-perceived gender identity and narrowed the legal definition of a transgender person. It also introduced a medical board process and increased the penalties under Section 18.
The government has said the changes would clarify the law, prevent the misuse of welfare benefits and protect people from coercion and trafficking.
Opposition parties, transgender community members and activists criticised the amendment, arguing that it runs counter to the NALSA judgment and was passed without scrutiny by a parliamentary committee. Congress MP Shashi Tharoor called it a “deeply regressive proposal”.
Members of the National Council for Transgender Persons, including Kalki Subramaniam and Rituparna Neog, resigned or protested over the lack of consultation.
The Endocrine Society of India has also raised concerns about the narrower definition, warning that it excludes people whose gender identity rests primarily on their own sense of identity and personal experience.
“However, the amended definition appears to narrow the scope of inclusion, raising concerns regarding the status of individuals whose gender identity is primarily based on self-identity and personal gender experience,” the authors said.
They noted that non-binary, gender-fluid, genderqueer and agender people fall outside the amended legal definition.
The society distinguishes between patients already receiving gender-affirming care and those seeking to begin treatment. For existing patients, earlier certificates, mental health evaluations and records of past interventions can help support the continuation of therapy.
However, previous documentation alone does not protect clinicians from legal scrutiny under the amended law.
“However, the new amending act is prospective in its procedural orientation. Therefore, for clinicians, medico-legal safety rests not on prior documentation alone but on current, well-documented informed consent with clear evidence of voluntariness,” the authors said.
For new patients, particularly those relying solely on self-identification, those without family support and minors, the society recommends greater scrutiny of consent, including notarised consent.
Consent should be in writing and preferably witnessed. It should record the patient’s self-reported gender identity, diagnosis, the benefits and risks of treatment, available alternatives, implications for fertility and the reversibility of interventions. It should also establish that the decision is voluntary and free from coercion.
The authors recommend involving a registered psychiatrist when a patient’s decision-making capacity is uncertain or coercion is suspected. They caution, however, that psychiatric involvement should not become a routine barrier to treatment, stressing that it is required “when required and not as mandatory gatekeeping.”
The society makes clear that gender-affirming surgery is a personal choice, not a requirement for treatment or recognition of gender identity.
“Surgery is an individual’s choice and is not mandatory. Therefore, referral or surgical clearance from an endocrine perspective is not obligatory,” the authors said.
They advise caution about genital surgery before a patient has completed one year of hormone therapy.
The statement also stresses that doctors must protect patients’ privacy while complying with legal reporting requirements.
Healthcare professionals must “maintain confidentiality as a core legal obligation of a health care professional, disclose information only where legally mandated, and inform patients about potential reporting requirements in advance (during the consent process). The Digital Personal Data Protection Act 2023 (DPDP Act 2023) classifies health data as sensitive personal data.”
Reporting requirements also apply after surgery. The institution must submit the prescribed details to the District Magistrate and the designated authority.
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The amendment has been challenged in the Supreme Court on constitutional grounds. According to available reports, the Court issued notice on the challenge but did not stay the law’s operation. Certificates issued before the amendment were initially treated as valid pending the outcome of the proceedings.
The authors acknowledge that the legal position remains under review as implementation evolves. They argue that this uncertainty does not justify interrupting medically necessary treatment.
“Law exists, but implementation is evolving and the matter is under review. Continuation of gender-affirming care is both medically necessary and ethically justified,” they said.
They identify thorough documentation, demonstrable consent and adherence to established clinical protocols as central to protecting both patients and healthcare providers from legal complications.
“Meticulous documentation, clear demonstration of voluntariness, and adherence to evidence-based protocols constitute the cornerstone of medico-legal safety in gender-affirming care,” the authors said.
(Edited by Dese Gowda)
