Can T.N.’s reforms change transgender healthcare?

Transgender healthcareincludes a range of services for physical and mental health, with a major component beinggender-affirming care, which may include hormone therapy and surgery to align a person's body with their gender identity.

Tamil Nadhas been reforming transgender healthcare byexpanding access to gender-affirming care through state-run gender clinics, implementing ethical and sensitive care guidelines, and supporting gender self-identification

“Leave no one behind,” a core principle of the United Nations Sustainable Development Goals and Universal Health Coverage, urges governments to prioritise healthcare for the most marginalised. Yet, transgender persons continue to face significant barriers to affordable, quality healthcare. Tamil Nadhas emerged as a pioneer in addressing these inequities through inclusive public health policies and welfare schemes that recognise the intersection of health, dignity, and social rights.

Tamil Nadhas implemented extensive reforms for transgender healthcare through its newState Policy for Transgender Persons, 2025, whichexpands access to gender-affirming care, mandates sensitisation training for medical professionals, and provides free surgeries and hormone therapy in government hospitals

Key Healthcare Reforms

The State Policy for Transgender Persons, 2025, and related directives from the Tamil NadMedical Council (TNMC) include several key reforms:

Gender-Affirming Healthcare:The policy expands access to gender-affirming care, including free gender affirmation surgeries and hormone therapy at select government hospitals. Tamil Nadwas one of the first states in India to establish dedicated gender clinics in government hospitals, with facilities in Chennai (RGGGH) and Madurai (Government Rajaji Hospital).

Mandatory Medical Sensitisation:The TNMC has made it mandatory for all doctors, medical faculty, and students across the state to undergo sensitisation and training on LGBTQIA+ health and transgender-specific needs. This is the first initiative of its kind in India and aims to combat stigma and discrimination within the medical community.

Inclusive Health Insurance:The policy aims to include transgender and intersex persons in the Chief Minister's health insurance scheme, expanding coverage for essential medical services.

Infrastructure:Provisions include the creation of separate hospital wards and gender-neutral restrooms/facilities in healthcare institutions to ensure dignity and privacy.

Ethical Standards:The TNMC directive mandates disciplinary action for violations of ethical standards, including coercive treatment or misgendering practices

Broader Policy and Legal Context

These healthcare reforms are part of a broader, more comprehensive approach to transgender rights in Tamil Nadu, which is considered the most progressive state in India for LGBTQ+ rights

Self-Identification:The policy affirms the right to gender self-identification without requiring medical procedures or certificates.

Anti-Discrimination:The state has strong anti-discrimination protections in place, including a ban on forced sex-selective surgeries on intersex infants and prohibitions against familial harassment and conversion therapy.

Welfare Board:The Tamil NadTransgender Welfare Board, established in 2008, serves as a nodal body to address the social protection needs of the community and monitor the policy's implementation.

Ongoing Discussions:While the current policy has been criticized by some activists for lacking clarity on horizontal reservations in education and employment, the Madras High Court has directed the government to take a clear stand on the matter, indicating further reforms may be forthcoming