NEW DELHI: The midday sun beats down on Dr. Ram Manohar Lohia (RML) Hospital in Delhi, where a small group gathers outside Room No. 7. Among them is Mohini, a young transgender woman, her face etched with a mix of anticipation and anxiety. She’s here for the transgender clinic, a government initiative launched in September 2023 to provide free healthcare services to individuals like her. But as she waits, her mind races with questions: Will the doctors understand her unique needs? Will she finally receive the gender-affirming care she so desperately desires? And, perhaps most pressingly, how long will this journey take?

Mohini’s story is one of countless others within Delhi’s transgender community, a community that often finds itself marginalized and underserved. The high cost of gender-affirming surgery in private hospitals, ranging from ₹5 to ₹7 lakh, is a daunting obstacle for many, especially those struggling with poverty and discrimination. Despite its limitations, the RML clinic offers a glimmer of hope for transgender individuals navigating a complex and often inaccessible healthcare system.

The outpatient registration slip directs a trans patient, after their initial consultation with doctors, to various departments for further investigations. Photo Credit: Kh. Manglembi Devi/HoA

 “I am jobless these days and desperately looking for a job,” Mohini confides, her voice filled with frustration. “I can’t afford SRS (Sex reassignment surgery) in private hospitals, which is why I chose to come here to RML Hospital for it. But it’s taking a lot of time and energy.”

Her words resonate with the experiences of many transgender individuals in Delhi, who often face financial constraints and a lack of awareness about available resources. While the clinic offers a comprehensive range of services, including medical evaluations, psychological assessments, hormonal therapy, and referral for surgery, its limited operating hours and the complex process involved in accessing care pose significant challenges. Since the unit’s opening, 234 individuals have registered for gender-affirming care, yet the clinic has not completed a single transition surgery. 

“It’s a very slow process,” says Vaishnavi Nand Giri, a transgender activist and patient at the clinic. “Today is my third visit. After many struggles, I finally reached the endocrinology department, where I was instructed to take some tests at the main block, room no. 322. When I got there, there was no doctor and it was closed. I have to come back next Friday, between 2 pm and 4 pm. We need at least an everyday OPD like other general patients have, or we are requesting the Government of India to provide a hospital exclusively dedicated to transgenders.”

Dr. Ajay Shukla, Director of RML Hospital, acknowledges the challenges but emphasizes the clinic’s commitment to providing quality care. In an interview, he explains, “Transgender Clinic facilitates evaluation by a physician with relevant investigations (Fasting blood glucose, Renal function test, Liver function test, Thyroid-stimulating hormone levels, Total testosterone levels in trans-men/ estradiol and prolactin levels in trans-women and Screening for sexually transmitted diseases).”

He further outlines the process for accessing surgery, which involves a multidisciplinary board assessment, hormonal therapy, and ongoing psychological evaluation. However, he reveals a crucial detail: “No gender affirming surgeries have been conducted after starting of Transgender Clinic in the Departments of Urology, Plastic Surgery, Gynaecology and Paediatric Surgery.”

While the clinic provides essential pre-operative care, the absence of surgeries performed thus far raises questions about the timeline and feasibility of accessing comprehensive gender-affirming care through this government initiative.

Many pointed out the concerns regarding the adequacy and effectiveness of offering these services only once a week, on Fridays from 2 pm to 4 pm. Photo Credit: Kh Manglembi Devi/HoA

Anju, another patient at the clinic, shares her experience: “I found out about this special facility from a friend who had already undergone gender change surgery here. I have been visiting this clinic for the last three months, and my medications are ongoing. I am happy that the clinic provides all the medicines for free, it’s helping me financially.”

Despite the financial relief, Anju, like many others, faces the challenge of balancing healthcare appointments with work and other responsibilities. The clinic’s limited hours and the lengthy process involved in accessing care can disrupt their lives and livelihoods.

For Deb, a young transgender man from Arunachal Pradesh, the journey to RML Hospital was filled with self-doubt and societal stigma. “Being from a small village in Arunachal Pradesh, I was having self-doubt about myself as I was born as a girl but my behaviour and but did things differently than a girl,” he explains. “With the rise of smartphones and the internet, YouTube and Google search, I found out that I was in the wrong body and it took me around 19 years to tell my parents about my orientation.”

Watch our report: What does the transgender community think about RML Hospital’s TG clinic?

Rudrani Chhetri, the founder of Mitr Trust, a Delhi-based Community-Based Organization (CBO), argues that a weekly clinic is insufficient as an intervention. Additionally, Chhetri critiques the delayed implementation of insurance coverage promised under PMJAY, noting that despite assurances, tangible progress remains elusive. In 2022, the Ministry of Social Justice and Empowerment signed a Memorandum of Understanding (MoU) with the National Health Authority (NHA) to provide a Comprehensive Medical Package to Transgender Persons under Ayushman Bharat-PMJAY. However, Chhetri laments, “All of this exists only on paper; there has been no implementation.”

As India marks  Pride Month, the stories of individuals like Mohini, Vaishnavi, Anju, and Deb remind us that the journey towards true inclusivity and acceptance is ongoing. Their experiences highlight the urgent need for accessible, affordable, and comprehensive transgender healthcare that respects and supports the diverse needs of the community. While the RML clinic offers a glimmer of hope, it is merely a first step. Let this Pride Month be a call to action for policymakers, healthcare providers, and society as a whole to work together to create a more equitable and inclusive healthcare system for all transgender individuals in Delhi and beyond.

Delhi’s Pride Parade: Embracing Inclusivity and Equality for Every Individual. Photo Credit: Kh Manglembi Devi/HoA

READ MORE: In Photos: Pain in Pride – The agony and resilience of transgender communities.

Who is a trans person? 

A transgender person is someone whose gender identity differs from the sex they were assigned at birth. Here’s a breakdown:

Gender identity: This is a person’s internal sense of being male, female, or something else. It’s different from sex, which is typically assigned at birth based on physical characteristics.

Assigned sex at birth: This is usually male or female, based on what doctors see when a baby is born.
So, someone who was assigned female at birth but identifies as male would be a transgender man. A person assigned male at birth but identifies as female would be a transgender woman.

Here are some additional things to know:

Transgender is an umbrella term. It can also encompass people who identify as neither male nor female, or as a combination of both.
Not all transgender people medically transition (like with hormones or surgery) to align their body with their gender identity. Transition is a personal journey, and what works for one person may not be what works for another.

Here are some resources if you’d like to learn more:

National Center for Transgender Equality: National Center for Transgender Equality
Understanding Transgender People:  transequality.org

What is Gender Dysphoria? 

Gender Dysphoria is the feeling of discomfort or distress that might occur in people whose gender identity differs from their sex assigned at birth or sex-related physical characteristics.

Key points to know about GD: 

• Not a mental illness: Gender dysphoria is a natural variation of human experience
• Common feelings: Those experiencing gender dysphoria may feel
• Their body doesn’t match their true gender
• Uncomfortable with societal expectations for their assigned gender
• Desire to change their body to align with their gender identity
• Treatment options: Many people find relief through
• Social transition (changing name, pronouns, clothing)
• Hormone therapy
• Gender-affirming surgery
• Therapy or counseling
• Support is crucial: Understanding, acceptance, and access to appropriate healthcare are essential for those experiencing gender dysphoria
• Remember: Everyone’s experience with gender dysphoria is unique. There is no one-size-fits-all approach to support or treatment