India's transgender amendment leaves many in limbo

When transgender woman Kali Sidharth Medepalli began hormone replacement therapy in India, she expected to complete her medical transition and undergo surgery within a year.

But just months after she began treatment earlier this year, India's parliament amended the country's transgender law, and the clinic where she was receiving care stopped her medicines.

"Everything shut down," the 23-year-old communications specialist and LGBTQ rights activist told AFP in the southern city of Hyderabad.

Kali said she went 10 days without a testosterone blocker, experiencing hot flushes and body aches.

The amendment introduced penalties for forcing someone to assume a transgender identity through surgical, chemical or hormonal procedures.

Authorities say the changes are meant to better protect vulnerable groups by strengthening penalties for exploitation, forced identity and trafficking.

The government said it does not criminalise consensual, medically supervised care, but activists and doctors say the amendment created uncertainty for thousands of people.

"The healthcare system is very fearful right now," said transgender rights activist Vyjayanti Vasanta Mogli, a member of a Supreme Court advisory committee on transgender welfare.

The lack of clarity, she said, could "scare away even the ones who have the best interests for the trans people".

Kali later managed to obtain her medicine using her existing prescription but was forced to self-medicate.

The case illustrates the dilemma facing transgender people seeking safe medical care, said Sanjay Sharma, head of the Association for Transgender Health in India.

Doctors face a choice. Continuing treatment could expose them to legal risk, but refusing care could conflict with their medical responsibilities.

"How can I refuse care? I took an oath that above all do no harm," said Sharma, a doctor and retired airforce commodore.

Some private clinics have continued treatment but are taking extra precautions, including additional paperwork, consent forms and charging patients more.