A disturbing step for rights, dignity and mental health

The Transgender Persons (Protection of Rights) Amendment Bill, 2026 has caused deep confusion, perplexity, and, over the past two weeks since its introduction, apprehension and fear. In trying to make sense of both the intent and the possible implications of the amendment, these days have raised more questions than they have provided satisfactory answers. At the core is the question, “Who owns my gender and therefore my gender identity?”

For the majority of men and women who happen to be cisgender, life hardly ever brings us to a point where we are faced with this as a question. There is no ‘evaluation’ that we need to undergo. Whether it is a form at a hospital, clinic, bank, or workplace, we claim our gender ourselves by ticking a box. We simply state our gender, not expecting anyone to question the obvious. However, for gender diverse and transgender individuals, this is what is proposed henceforth. This violates the foundational principles of dignity, autonomy and mental well-being.

From progression to regression

In 2014, the Supreme Court of India delivered a historic judgment in NALSA vs Union of India, recognising transgender persons as a legitimate gender identity. It was a watershed moment for jurisprudence, public policy and governance because it rested on a simple and powerful principle: gender identity is self-identified. Just as any individual declares themselves a man or a woman without external verification, transgender persons, too, were reaffirmed as the final and only authority on their gender identity. This principle is rooted not only in human dignity and autonomy but also in constitutional morality under Articles 14 (Equality before Law), 15 (non-discrimination), 19 (Freedom of Expression) and 21 (Right to Life and Personal Liberty).

In 2019, Parliament passed the Transgender Persons (Protection of Rights) Act. While parts of it were criticised by the community, it remained aligned with NALSA on the cornerstone issue of self-identification. Indeed, it acknowledged the community’s long history of discrimination and exclusion, and sought to prohibit discrimination, ensure access to education and health care, extend welfare measures such as housing, skill development and employment support. These welfare schemes, in our minds, as allies and health-care practitioners, represented an attempt to build an enabling framework rather than a restrictive one.

Much of the work being done at both the health-care training and education levels, as a result of the 2019 Act, requires sensitisation drives to ensure that curricula and training for health care and allied professions are sensitive to gender-affirming practices, and to make welfare schemes more widely known and implementable. In these six years, all stakeholders had just about started to align themselves with the global standards that the 2014 judgement and the 2019 Act both validated.

The amendment to the 2019 Act — which was notified in the Gazette on March 30, 2026 — fundamentally reverses the NALSA judgment. It replaces self-identification with medical and bureaucratic gatekeeping, redefining who is ‘allowed’ to call themselves transgender. Under this amendment, a transgender person must appear before a medical board; undergo an assessment to ‘prove’ their gender identity; wait while the board forwards its recommendation to the District Magistrate, and obtain a certificate declaring them transgender.

There is no medical or evaluative biomarker for gender identity. No external knowledge or proof of any sort can determine the deeply held and personally felt experience of one’s gender identity. There would have been no need for trans individuals to “come out “at all if that had been the case.

This is the accepted truth in medicine and health care across the globe. Therefore, it is perplexing that the Amendment talks about determining and validating someone’s gender through a process in which the answer to the question “what is my gender?” has to be given by complete strangers.

This raises many issues that seem to present challenges at many levels.

Medical boards — many of which do not exist at the district level — are already overburdened even for urgent health-care needs. In the absence of criteria, as well as time and process, it is likely that boards may fall back on arbitrary, invasive or abusive examinations, including the possibility of genital inspection. This stems arguably from the traditional way of “assigning “gender at birth by looking at the genitals of a newborn child by a doctor or another adult. This is far from what we know to be the understanding of gender identity for gender diverse and trans individuals. Extrapolating this method to an adult and making it mandatory is in direct and complete violation of dignity, privacy and bodily autonomy. I cannot imagine any circumstance that would make me wish to approach this premise for myself as an adult cisgender woman. The very thought of such a scrutiny by a board of strangers, would probably create anticipatory mental distress and make me actively avoid approaching such a premise.

Instead of improving welfare access, the amendment will likely shrink it, deter individuals from approaching the state, and reintroduce fear and humiliation into an already vulnerable population.

Mental health fallout, crisis in the making

The transgender community already faces extreme vulnerability. Data show that 99% of transgender persons have faced social rejection; 52% have faced harassment or violence in educational spaces; 57% of trans women report experiencing physical or sexual violence at least once, and transgender adolescents have suicide attempt rates estimated between 13% and 50%, far above the national average.

Against this backdrop, introducing additional layers of suspicion, verification and scrutiny is not just insensitive. It is unsafe. As a mental-health practitioner and an ally for the trans community, I am deeply concerned.

Not just prospective; what is concerning is the uncertainty for thousands of transgender individuals currently enrolled in health-care services, whose access may now be questioned or invalidated in the face of the ambiguity about supporting the gender exploration and gender journey of an individual. This is not merely a procedural shift; it has the potential of developing rapidly into a public mental-health emergency.

The amendment introduces a clause that criminalises ‘undue influence’ in helping someone identify as transgender, with penalties up to 15 years of imprisonment. For mental-health practitioners, psychologists, lawyers and educators, this creates an unprecedented ethical and legal risk. In many families, gender-identity journeys create tension or disagreement. Community-based organisations, trans-affirmative mental health practitioners and services are frequently accused of ‘encouraging’ adolescents simply for acknowledging their lived reality. Under this amendment, such allegations could become criminal charges.

This will discourage health-care practitioners from providing essential, evidence-based care; challenge community-based organisations to remain as allies, and push transgender persons away from formal health care and heighten mental distress that will likely remain unsupported.

Additionally, the amendment collapses distinctions between transgender, intersex and hijra identities, erasing cultural, social and biological differences. Trans men remain nearly invisible in the framework, further marginalising them.

An appeal for reflection and action

The current amendment risks undoing a decade of progress across law, governance, health systems and institutional practice. If misuse has occurred — even if limited to the 0.01% that the government suggests — the solution lies in audits, verification protocols and administrative strengthening — not in policing gender identity or forcing medicalisation.

To uphold constitutional values, protect mental health, and ensure administrative feasibility, this amendment must be reconsidered. We owe each individual in India the assurance that governance frameworks do not deepen fear, stigma, or exclusion for any community.

Dr. Kavita Arora is a senior psychiatrist with over 25 years of clinical practice and lived-experience expertise, a Founding Cohort member of India Mental Health Alliance (IMHA), Co-Founder of Children First, and an adviser and trainer in gender-affirming mental health practices across several Indian institutions