Recently, the US House of Representatives passed a bill proposing a federal ban on gender-affirming care (GAC) such as hormones and puberty blockers for minors. Paediatric GAC is also increasingly restricted in the UK, Sweden, Finland, and other European countries, and in several states in Australia, Canada, and the US amid an intense medical debate.
India, however, is moving in the opposite direction, and expanding access to gender-affirming care. In the private sector, market reports suggest that the GAC industry in India is growing at 8-16% annually. In the public sector, specialised GAC services are expanding via prestigious centres such as AIIMS Bhopal’s Transgender Health Clinic, along with other govt hospitals.
Gender-affirming care is a medical approach intended to address gender dysphoria arising from a perceived mismatch between one’s experienced gender and one’s biological sex. The core intervention is to modify the body to more closely resemble a self-identified gender, primarily through hormones and surgeries.
For example, a male who identifies as a trans woman may seek to surgically remove his genitals. He may suppress testosterone or take oestrogen to increase breast size. A female who identifies as a trans man may choose a double mastectomy along with the removal of her uterus and ovaries. She may use testosterone to grow a beard and get a deep voice.
In children and adolescents, puberty blockers are often introduced as an early intervention, sometimes to children as young as eight or nine. This is paired with social transition, and later, cross-sex hormones. Surgeries are usually postponed to after age 18.
Patient data and systematic evidence reviews from around the world show that the risk-benefit profile of these interventions in minors is deeply unfavourable.
There is no strong evidence that puberty suppression or cross-sex hormones improve long-term psychological health, reduce depression, or lower suicide risk in adolescents. By contrast, the evidence of harm is substantial. Medicalised transition in childhood can permanently compromise fertility, sexual function, and long-term physiological development. Documented risks include impaired bone density and cardiovascular effects, with ongoing concern about impacts on brain development.
For most children suffering from gender distress, loving support and non-intervention is all that is required. In long-term follow-up studies of children diagnosed with gender dysphoria before the era of medical transition, roughly 80% reconciled with their sexed bodies as puberty progressed. Puberty itself resolves distress.
Tragically, once children are on puberty blockers, almost all of them progress to cross-sex hormones and further medicalisation. Along with preventing physical changes, puberty blockers appear to hinder the developmental process through which gender dysphoria often resolves. Rather than affirming the child’s belief that they were ‘born in the wrong body’, and providing puberty blockers and body modifications, India should follow the UK and ban paediatric GAC.
Children presenting with gender-related distress frequently have co-existing conditions such as autism, anxiety, depression, and anorexia. Distress about sexed bodies is sometimes linked to trauma, such as sexual abuse. Internalised homophobia often plays a significant role — a teenage boy experiencing same-sex attraction may identify as a ‘straight girl’ rather than a ‘gay boy’.
Ethical, evidence-based medicine requires careful exploration of these underlying factors. Instead, under gender-affirming protocols, distress is often immediately interpreted through the lens of gender identity, while other psychological or psychiatric conditions go insufficiently examined or untreated. This type of ‘diagnostic overshadowing’ leaves underlying issues unresolved. Exploratory psychotherapy that is open-ended and non-judgemental should therefore be the first-line response. It allows clinicians to understand the source of distress without prematurely committing a child to irreversible medical pathways.
In India, debates about paediatric gender medicine are frequently framed as identity or cultural issues. In 2021, a teacher-training manual developed by the National Council for Educational Research and Training proposed that teachers discuss puberty blockers with adolescents. The manual was withdrawn after objections from the National Commission for Protection of Child Rights, which had received multiple complaints. The controversy included debates on ‘American propaganda’, ‘the welfare of the LGBTQIA+ community’, ‘wokeness’, ‘social inclusion’, etc.
This framing misses the point entirely.
Should children and young adults experiencing distress about their sexed bodies be able to access powerful drugs and surgeries with irreversible and life-altering consequences, substantial evidence of harm, and no credible evidence of benefit?
That is not a cultural question. It is a matter of healthcare regulation. India should insist on the same standards of evidence, caution, and child protection in GAC that it demands in every other area of medicine. The current push towards expansion, while international consensus is moving towards restriction, is a mistake.
Disclaimer
Views expressed above are the author’s own.
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